Sagittal imaging of the fetal neck. Fetal cranium is to the right of the image. Real-time sonography depicting a quadruple nuchal cord. Note the prominent “divot sign” representing marked subcutaneous indentation of the fetal skin overlying the posterior aspect of the fetal neck, exerted by pressure of the four loops of nuchal cord upon the fetal neck. Also note that each of the larger umbilical veins is accompanied by two (smaller caliber) umbilical arteries, respectively.