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Caesarean delivery of a breech singleton with eight loops of nuchal cord
  1. Carissa Herkelman1,
  2. Daniel Nicoara1,
  3. Lisa Thiel2 and
  4. Judith Florido1
  1. 1Obstetrics and Gynecology, University of Michigan Health-West, Wyoming, Michigan, USA
  2. 2Maternal Fetal Medicine, Spectrum Health, Grand Rapids, Michigan, USA
  1. Correspondence to Dr Daniel Nicoara; daniel.nicoara{at}


Nuchal cord accidents comprise a third of stillbirths in the third trimester. These are often due to higher order nuchal cords, with more than three loops. In this report, we discuss a case of a gestation complicated by a nuchal cord with eight loops and severe fetal growth restriction, requiring expedited delivery due to non-reassuring fetal heart tones. Our case demonstrates the value of high-quality ultrasound in detecting complex nuchal cords, as well as highlighting the potentially dynamic and unstable fetal status in an affected gestation. Antenatal knowledge of nuchal cord in the setting of non-reassuring fetal status can help guide patient counselling and assist with identifying possible aetiologies. Finally, our case demonstrates that close monitoring and early intervention can prevent potentially catastrophic outcomes.

  • obstetrics and gynaecology
  • pregnancy
  • materno-fetal medicine
  • ultrasonography

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  • Contributors DN and CH contributed equally in the writing, proofreading and editing process. JF and LT provided guidance and assisted with review and editing. DN and JF were involved in the direct care of the patient that is the subject of this report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.