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Clinical Images  |   May 2019
Fetal Nuchal Cord
Author Notes
  • From the Department of Obstetrics & Gynecology at the New York University Langone Hospital–Brooklyn. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Daniel Martingano, DO, New York University Langone Hospital–Brooklyn, 150 55th St, Brooklyn, NY 11220-2508. Email: daniel.martingano@nyumc.org
     
Article Information
Imaging / Obstetrics and Gynecology / Clinical Images
Clinical Images   |   May 2019
Fetal Nuchal Cord
The Journal of the American Osteopathic Association, May 2019, Vol. 119, 332. doi:https://doi.org/10.7556/jaoa.2019.057
The Journal of the American Osteopathic Association, May 2019, Vol. 119, 332. doi:https://doi.org/10.7556/jaoa.2019.057
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. 
References
Collins JH. Nuchal cord type A and type B. Am J Obstet Gynecol. 1997;177(1):94. [CrossRef] [PubMed]
Clapp JF III, Stepanchak W, Hashimoto K, Ehrenberg H, Lopez B. The natural history of antenatal nuchal cords. Am J Obstet Gynecol. 2003;189(2):488-493. [CrossRef] [PubMed]
Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2006;274(2):81-83. [CrossRef] [PubMed]
Henry E, Andres RL, Christensen RD. Neonatal outcomes following a tight nuchal cord. J Perinatol. 2013;33(3):231-234. doi: 10.1038/jp.2012.79 [CrossRef] [PubMed]