Sextuple Nuchal Cord Entanglement in a Preterm Neonate: A Case Report

Nuchal cord, or wrapping of the umbilical cord around the fetal neck, is a common obstetric finding; however, multiple loops are uncommon, and entanglement exceeding four loops is rare. High-order nuchal cords (≥ 5 loops) may predispose to cord compression, abnormal fetal heart rate tracings and intrauterine compromise. Advances in prenatal ultrasonography, particularly colour Doppler imaging, have improved detection, but the optimal management of these cases remains uncertain.

We present a case of a 42-year-old gravida 6, para 3124 woman (three term deliveries, one preterm delivery, two prior abortions and four living children) whose pregnancy was complicated by a sextuple (six-loop) nuchal cord, identified antenatally at 24 weeks 2 days. Despite initially preserved Doppler flow, the patient later developed decreased fetal movement and recurrent variable and late decelerations on fetal monitoring, consistent with non-reassuring fetal heart tracings. An emergent preterm caesarean delivery was performed, revealing six tight loops of umbilical cord around the fetal neck. A live preterm neonate was delivered and admitted to the NICU for ongoing care.

This case underscores the potential hemodynamic impact and perinatal risks associated with extreme nuchal cord entanglement. Antenatal detection using colour Doppler ultrasound, combined with vigilant fetal surveillance and timely intervention, is critical for optimising outcomes. Awareness of maternal symptom reporting and early response to non-reassuring fetal heart tracings can facilitate favourable results even in rare, high-order nuchal cord cases.