A 21-year-old woman, gravida 1, para 0, at 36.7 weeks’ gestation was evaluated for sudden-onset, acute abdominal pain. Physical examination findings were significant for positive Murphy sign and Chapman point on the right between the sixth and seventh rib. The patient was afebrile without leukocytosis. Magnetic resonance imaging of the abdomen and pelvis demonstrated cholelithiasis and an incidental finding of a single, type B nuchal cord (image A, asterisk and image B, arrows). A diagnosis of biliary colic secondary to cholelithiasis was made, and the patient was discharged home. At 39.6 weeks’ gestation, the patient had a labor course complicated by frequent variable decelerations, but she subsequently delivered a healthy male with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. 

A loop of umbilical cord around the fetal neck is a common finding at delivery,¹ and the incidence increases with advancing gestational age.² Although it can cause variable decelerations in antenatal fetal heart rate monitoring, type A, reducible,³ and B, tight,⁴ nuchal cords are not associated with adverse perinatal outcomes.