Triple loop nuchal cord

Case contributed by Dennis Odhiambo Agolah


One previous ectopic pregnancy, two previous cesarean section. For routine fetal surveillance.

Patient Data

Age: 35 years
Gender: Female

Indirect grey mapping sonographic evaluation of the fetal nape (on sagittal) demonstrates scalloping multiple layers of the fetal nuchal fold (divot sign) that on color and power Doppler imaging, shows tripled loop of the umbilical cord rounding the fetal neck.

Two of the loops completely encircle the fetal neck with an O-shaped appearance (type B) while the third loop is well applied but overlaps the postero-lateral aspects and crosses over from the placental to the umbilical surface with a resultant U-shaped appearance (type-A). The fetal myocardial movements and the great neck vasculature are unremarkable.

The Doppler tracings within each of the nuchal cord loops and the middle cerebral arterial Doppler velocimetry indices as well as the fetal ductus venosus pulsatility index and its associated systolic-diastolic-atrial (S-D-A) waveform, were uneventful.

Case Discussion

Multiple (triple) loops of the nuchal cord encircle the fetal neck as demonstrated on the grey and color/power Doppler evaluation. Sonographic identification and diagnosis of such loops (in time) help in clinical planning which subsequently may lessen any adverse perinatal outcomes related to umbilical cord entanglements in utero. 

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