A nuchal cord is when the umbilical cord becomes wrapped around the fetus's neck. Symptoms present in the baby shortly after birth from a prior nuchal cord may include duskiness of face, facial petechia, and bleeding in the whites of the eye. Complications can include meconium, respiratory distress, anemia, and stillbirth. Multiple wraps are associated with greater risk. The diagnosis may be suspected if there is a decrease in the baby's heart rate during delivery. Nuchal cords are typically checked for by running the finger over the baby's neck once the head has delivered. Ultrasound may pick up the condition before labor. If detected during delivery, management includes trying to unwrap the cord or if this is not possible clamping and cutting the cord. Delivery can typically take place as normal and outcomes are generally good. Rarely long term brain damage or cerebral palsy may occur. Nuchal cords occur in about a quarter of deliveries. The condition has been described at least as early as 300 BC by Hippocrates. Signs and symptoms Symptoms of a prior nuchal cord shortly after birth in the baby may include duskiness of face, facial petechia, and bleeding in the whites of the eye. Complications can include meconium, respiratory disease, anemia, and still birth. Diagnosis In 1962, J. Selwyn Crawford MD from the British Research Council defined a nuchal cord as one that is wrapped 360 degrees around the fetal neck. Crawford commented "It is all the more remarkable, therefore, that little work has been done. to analyze its effects during labor and delivery". To date, there is no prospective case control double-blind study looking at nuchal cords and observational studies vary in opinion as to the degree of poor outcomes. Also not included in these studies is which umbilical cord form (of the 8 different possible structures) was considered a nuchal cord. Ultrasound diagnosis of a cord around the neck was first described in 1982. “Coils occur in about 25% of cases and ordinarily do no harm, but occasionally they may be so tight that constriction of the umbilical vessels and consequent hypoxia result.” Williams Obstetrics 16th Edition, has only one single sentence in the entire textbook regarding cords around the neck. By contrast, the First Edition of the Encyclopædia Britannica from 1770 had 20 pages of information about Umbilical Cord Pathology with drawings of Umbilical Cord Entanglement. The Royal College of Obstetricians and