A rare case report of septuple nuchal cord entanglement with favourable perinatal outcome

Abstract

A nuchal cord refers to the umbilical cord being looped one or more times around the fetal neck. While often a common finding during pregnancy and labor without adverse effects, it can sometimes lead to complications, including variable decelerations in fetal heart rate, reduced fetal movement, signs of fetal distress, and, rarely, intrauterine fetal demise (IUD). This case describes a rare instance of seven loops of the umbilical cord encircling the fetal neck, identified during a cesarean section in a woman who presented with labor pains at 37 weeks and 1 day of gestation. The pregnancy was complicated by gestational diabetes and polyhydramnios. Intrapartum fetal surveillance revealed recurrent variable decelerations on cardiotocography and the presence of grade 2 meconium-stained liquor. Intraoperatively, seven tight loops of the umbilical cord were observed wrapped around the fetal neck, with a cord length of 115 cm. The fetal and maternal outcomes in cases of nuchal cord entanglement depend on various factors, including the number of loops, cord length, coiling tightness, and amniotic fluid index. Careful intrapartum monitoring and prompt interventions can improve perinatal outcomes, even when nuchal cord entanglement is not diagnosed prenatally. Managing nuchal cord entanglement remains challenging. Although multiple loops (more than five) are rare, we report an uncommon instance of seven loops of nuchal cord entanglement, which resulted in favorable maternal and fetal outcomes.