cephalic presentation with cord around the neck

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The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

• Down, with the back facing the birth canal.
• Sideways, with one shoulder pointing toward the birth canal.
• Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

• An attempt to deliver the baby in the breech position is not successful.
• You do not want to try to have the baby delivered vaginally in the breech position.
• An attempt to move the baby into a head-down position is not successful.
• You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

• Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
• Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
• Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
• Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
• Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Your Pregnancy Matters

What happens if the umbilical cord is around my baby’s neck?

May 22, 2018

An umbilical cord is a lifeline for a baby in the womb. Running from the baby’s abdomen to the placenta, the umbilical cord usually contains three blood vessels and is about 21” long. It provides oxygen, blood, and nutrients to the developing fetus. However, later in pregnancy many women fear the thought of the umbilical cord wrapping around the baby’s neck and the possibility of problems during delivery or even a stillbirth.

Pregnant women: Breathe a sigh of relief. Nuchal cords are surprisingly common and unlikely to cause problems during pregnancy or at birth. Estimates suggest that 20 to 30 percent of all deliveries involve a nuchal cord. And a 2018 study in the American Journal of Obstetrics and Gynecology reports that, the majority of time, babies do just fine when one is present. 

What causes nuchal cords?

Random fetal movement is the primary cause of a nuchal cord. Other factors that might increase the risk of the umbilical cord wrapping around a baby’s neck include an extra-long umbilical cord or excess amniotic fluid that allows more fetal movement.

Nuchal cords typically are discovered at birth. Occasionally, patients ask if we can see them on ultrasound, which sometimes we can. There’s no way yet to prevent nuchal cords or unwind them from a baby’s neck in the womb. But when a baby is born with a nuchal cord, your doctor will know what to do because it happens so frequently.

When is a nuchal cord dangerous?

If the cord is looped around the neck or another body part, blood flow through the entangled cord may be decreased during contractions. This can cause the baby’s heart rate to fall during contractions. Prior to delivery, if blood flow is completely cut off, a stillbirth can occur.

In the 2018 study, 12 percent of deliveries had a nuchal cord. Most babies with a nuchal cord had just a single loop around the neck. Fortunately, there was no increased risk for growth problems, stillbirth, or lower Apgar scores in this group. 

What happens during delivery?

Since the vast majority of time we don’t know if a baby will have a nuchal cord, it is routine that the doctor will check the baby’s neck for a nuchal cord after the baby’s head is delivered. Usually the cord is loose and can be slipped over the baby’s head. At times it might be too tight to easily slip over the head, and the doctor or midwife will clamp and cut the cord before the baby’s shoulders are delivered. This keeps the cord from tearing away from the placenta when the rest of the baby’s body is delivered. 

Remember, a nuchal cord is common, and complications caused by the condition are rare. If you’ve been told your baby has a nuchal cord and you have questions, call us at 214-645-8300 or  request an appointment online .

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What Is Cephalic Position?

The ideal fetal position for labor and delivery

• Why It's Best

Risks of Other Positions

• Determining Position
• Turning a Fetus

The cephalic position is when a fetus is head down when it is ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery.

About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy . Your healthcare provider will monitor the fetus's position during the last weeks of gestation to ensure this has happened by week 36.

If the fetus is not in the cephalic position at that point, the provider may try to turn it. If this doesn't work, some—but not all—practitioners will attempt to deliver vaginally, while others will recommend a Cesarean (C-section).

Getty Images

Why Is the Cephalic Position Best?

During labor, contractions dilate the cervix so the fetus has adequate room to come through the birth canal. The cephalic position is the easiest and safest way for the baby to pass through the birth canal.

If the fetus is in a noncephalic position, delivery becomes more challenging. Different fetal positions have a range of difficulties and varying risks.

A small percentage of babies present in noncephalic positions. This can pose risks both to the fetus and the mother, and make labor and delivery more challenging. It can also influence the way in which someone can deliver.

A fetus may actually find itself in any of these positions throughout pregnancy, as the move about the uterus. But as they grow, there will be less room to tumble around and they will settle into a final position.

It is at this point that noncephalic positions can pose significant risks.

Cephalic Posterior

A fetus may also present in an occiput or cephalic posterior position. This means they are positioned head down, but they are facing the abdomen instead of the back.

This position is also nicknamed "sunny-side up."

Presenting this way increases the chance of a painful and prolonged delivery.

There are three different types of breech fetal positioning:

• Frank breech: The legs are up with the feet near the head.
• Footling breech: One or both legs is lowered over the cervix.
• Complete breech: The fetus is bottom-first with knees bent.

A vaginal delivery is most times a safe way to deliver. But with breech positions, a vaginal delivery can be complicated.

When a baby is born in the breech position, the largest part—its head—is delivered last. This can result in them getting stuck in the birth canal (entrapped). This can cause injury or death.

The umbilical cord may also be damaged or slide down into the mouth of the womb, which can reduce or cut off the baby's oxygen supply.

Some providers are still comfortable performing a vaginal birth as long as the fetus is doing well. But breech is always a riskier delivery position compared with the cephalic position, and most cases require a C-section.

Likelihood of a Breech Baby

You are more likely to have a breech baby if you:

• Go into early labor before you're full term
• Have an abnormally shaped uterus, fibroids , or too much amniotic fluid
• Are pregnant with multiples
• Have placenta previa (when the placenta covers the cervix)

Transverse Lie

In transverse lie position, the fetus is presenting sideways across the uterus rather than vertically. They may be:

• Down, with the back facing the birth canal
• With one shoulder pointing toward the birth canal
• Up, with the hands and feet facing the birth canal

If a transverse lie is not corrected before labor, a C-section will be required. This is typically the case.

Determining Fetal Position

Your healthcare provider can determine if your baby is in cephalic presentation by performing a physical exam and ultrasound.

In the final weeks of pregnancy, your healthcare provider will feel your lower abdomen with their hands to assess the positioning of the baby. This includes where the head, back, and buttocks lie

If your healthcare provider senses that the fetus is in a breech position, they can use ultrasound to confirm their suspicion.

Turning a Fetus So They Are in Cephalic Position

External cephalic version (ECV) is a common, noninvasive procedure to turn a breech baby into cephalic position while it's still in the uterus.

This is only considered if a healthcare provider monitors presentation progress in the last trimester and notices that a fetus is maintaining a noncephalic position as your delivery date approaches.

External Cephalic Version (ECV)

ECV involves the healthcare provider applying pressure to your stomach to turn the fetus from the outside. They will attempt to rotate the head forward or backward and lift the buttocks in an upward position. Sometimes, they use ultrasound to help guide the process.

The best time to perform ECV is about 37 weeks of pregnancy. Afterward, the fetal heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after having ECV done.

ECV has a 50% to 60% success rate. However, even if it does work, there is still a chance the fetus will return to the breech position before birth.

Natural Methods For Turning a Fetus

There are also natural methods that can help turn a fetus into cephalic position. There is no medical research that confirms their efficacy, however.

• Changing your position: Sometimes a fetus will move when you get into certain positions. Two specific movements that your provider may recommend include: Getting on your hands and knees and gently rocking back and forth. Another you could try is pushing your hips up in the air while laying on your back with your knees bent and feet flat on the floor (bridge pose).
• Playing stimulating sounds: Fetuses gravitate to sound. You may be successful at luring a fetus out of breech position by playing music or a recording of your voice near your lower abdomen.
• Chiropractic care: A chiropractor can try the Webster technique. This is a specific chiropractic analysis and adjustment which enables chiropractors to establish balance in the pregnant person's pelvis and reduce undue stress to the uterus and supporting ligaments.
• Acupuncture: This is a considerably safe way someone can try to turn a fetus. Some practitioners incorporate moxibustion—the burning of dried mugwort on certain areas of the body—because they believe it will enhance the chances of success.

A Word From Verywell

While most babies are born in cephalic position at delivery, this is not always the case. And while some fetuses can be turned, others may be more stubborn.

This may affect your labor and delivery wishes. Try to remember that having a healthy baby, and staying well yourself, are your ultimate priorities. That may mean diverting from your best laid plans.

Speaking to your healthcare provider about turning options and the safest route of delivery may help you adjust to this twist and feel better about how you will move ahead.

Glezerman M. Planned vaginal breech delivery: current status and the need to reconsider . Expert Rev Obstet Gynecol. 2012;7(2):159-166. doi:10.1586/eog.12.2

Cleveland Clinic. Fetal positions for birth .

MedlinePlus. Breech birth .

UT Southwestern Medical Center. Can you turn a breech baby around?

The American College of Obstetricians and Gynecologists. If your baby is breech .

Roecker CB. Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios .  Journal of Chiropractic Medicine . 2013;12(2):74-78. doi:10.1016/j.jcm.2013.06.003

By Cherie Berkley, MS Berkley is a journalist with a certification in global health from Johns Hopkins University and a master's degree in journalism.

• Learn   /  

Why Is Cephalic Presentation Ideal For Childbirth?

5   Dec   2017 | 8 min Read

During labour, contractions stretch your birth canal so that your baby has adequate room to come through during birth. The cephalic presentation is the safest and easiest way for your baby to pass through the birth canal.

If your baby is in a non-cephalic position, delivery can become more challenging. Different fetal positions pose a range of difficulties and varying risks and may not be considered ideal birthing positions.

Two Kinds of Cephalic Positions

There are two kinds of cephalic positions:

• Cephalic occiput anterior , where your baby’s head is down and is facing toward your back.
• Cephalic occiput posterior , where your baby is positioned head down, but they are facing your abdomen instead of your back. This position is also nicknamed ‘sunny-side-up’ and can increase the chances of prolonged and painful delivery. 

How to Know if Your Baby is In a Cephalic Position?

You can feel your baby’s position by rubbing your hand on your belly. If you feel your little one’s stomach in the upper stomach, then your baby is in a cephalic position. But if you feel their kicks in the lower stomach, then it could mean that your baby is in a breech position.

You can also determine whether your baby is in the anterior or posterior cephalic position. If your baby is in the anterior position, you may feel their movement underneath your ribs and your belly button could also pop out. If your baby is in the posterior position, then you may feel their kicks in their abdomen, and your stomach may appear rounded up instead of flat. 

You can also determine your baby’s position through an ultrasound scan or a physical examination at your healthcare provider’s office. 

Benefits of Cephalic Presentation in Pregnancy

Cephalic presentation is one of the most ideal birth positions, and has the following benefits:

• It is the safest way to give birth as your baby’s position is head-down and prevents the risk of any injuries.
• It can help your baby move through the delivery canal as safely and easily as possible.
• It increases the chances of smooth labour and delivery.

Are There Any Risks Involved in Cephalic Position?

Conditions like a cephalic posterior position in addition to a narrow pelvis of the mother can increase the risk of pregnancy complications during delivery. Some babies in the head-first cephalic presentation might have their heads tilted backward. This may, in some rare cases, cause preterm delivery.

What are the Risks Associated with Other Birth Positions?

A small percentage of babies may settle into a non-cephalic position before their birth. This can pose risks to both your and your baby’s health, and also influence the way in which you deliver. 

In the next section, we have discussed a few positions that your baby can settle in throughout pregnancy, as they move around the uterus. But as they grow old, there will be less space for them to tumble around, and they will settle into their final position. This is when non-cephalic positions can pose a risk.  

Breech Position

There are three types of breech fetal positioning:

• Frank breech : Your baby’s legs stick straight up along with their feet near their head.
• Footling breech: One or both of your baby’s legs are lowered over your cervix.
• Complete breech: Your baby is positioned bottom-first with their knees bent.

If your baby is in a breech position , vaginal delivery is considered complicated. When a baby is born in breech position, the largest part of their body, that is, their head is delivered last. This can lead to injury or even fetal distress. Moreover, the umbilical cord may also get damaged or get wrapped around your baby’s neck, cutting off their oxygen supply.  

If your baby is in a breech position, your healthcare provider may recommend a c-section, or they may try ways to flip your baby’s position in a cephalic presentation.

Transverse Lie

In this position, your baby settles in sideways across the uterus rather than being in a vertical position. They may be:

• Head-down, with their back facing the birth canal
• One shoulder pointing toward the birth canal
• Up with their hands and feet facing the birth canal

If your baby settles in this position, then your healthcare provider may suggest a c-section to reduce the risk of distress in your baby and other pregnancy complications.

Turning Your Baby Into A Cephalic Position

External cephalic version (ECV) is a common, and non-invasive procedure that helps turn your baby into a cephalic position while they are in the womb. However, your healthcare provider may only consider this procedure if they consider you have a stable health condition in the last trimester, and if your baby hasn’t changed their position by the 36th week.

You can also try some natural remedies to change your baby’s position, such as:

• Lying in a bridge position: Movements like bridge position can sometimes help move your baby into a more suitable position. Lie on your back with your feet flat on the ground and your legs bent. Raise your pelvis and hips into a bridge position and hold for 5-10 minutes. Repeat several times daily.
• Chiropractic care: A chiropractor can help with the adjustment of your baby’s position and also reduce stress in them.
• Acupuncture: After your doctor’s go-ahead, you can also consider acupuncture to get your baby to settle into an ideal birthing position.

While most babies settle in a cephalic presentation by the 36th week of pregnancy, some may lie in a breech or transverse position before birth. Since the cephalic position is considered the safest, your doctor may recommend certain procedures to flip your baby’s position to make your labour and delivery smooth. You may also try the natural methods that we discussed above to get your baby into a safe birthing position and prevent risks or other pregnancy complications. 

When Should A Baby Be In A Cephalic Position?

Your baby would likely naturally drop into a cephalic position between weeks 37 to 40 of your pregnancy .

Is Cephalic Position Safe?

Research shows that 95% of babies take the cephalic position a few weeks or days before their due date. It is considered to be the safest position. It ensures a smooth birthing process.

While most of the babies are in cephalic position at delivery, this is not always the case. If you have a breech baby, you can discuss the available options for delivery with your doctor.

Does cephalic presentation mean labour is near?

Head-down is the ideal position for your baby within your uterus during birth. This is known as the cephalic position. This posture allows your baby to pass through the delivery canal more easily and safely.

Can babies change from cephalic to breech?

The external cephalic version (ECV) is the most frequent procedure used for turning a breech infant.

How can I keep my baby in a cephalic position?

While your baby naturally gets into this position, you can try some exercises to ensure that they settle in cephalic presentation. Exercises such as breech tilt, forward-leaning position (spinning babies program), cat and camel pose can help.

Stitches after a normal delivery : How many stitches do you need after a vaginal delivery? Tap this post to know.

Vaginal birth after caesarean delivery : Learn all about the precautions to consider before having a vaginal delivery after a c-section procedure. 

How many c-sections can you have : Tap this post to know the total number of c-sections that you can safely have.

Cover Image Credit: Freepik.com

Related Topics for you

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Suggestions offered by doctors on BabyChakra are of advisory nature i.e., for educational and informational purposes only. Content posted on, created for, or compiled by BabyChakra is not intended or designed to replace your doctor's independent judgment about any symptom, condition, or the appropriateness or risks of a procedure or treatment for a given person.

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Cord Around the Neck – Is Normal Delivery Possible?

By Sitaram Bhartia Maternity Program | October 24, 2016 | Maternity | 2016-10-24 24 June 2023

When Divya Singh went for an ultrasound in her 37th week, she was told that she should have an elective cesarean section because her baby had a double loop of cord around neck . She couldn’t help wondering ‘Is normal delivery possible with cord around the neck?’.

Divya had been preparing for a normal delivery since she discovered she was pregnant. She was exercising, eating healthy and attending antenatal classes.

Read: Cord around the Neck in Hindi (गर्दन पर लिपटी हुई नाल – क्या शिशु के स्वास्थ्य के लिए घातक है ?

Everything was going smoothly for her until now.  Still keen to try for a normal delivery, Divya and her husband came to Sitaram Bhartia Hospital in Delhi for a second opinion. Anxious, she put forth all her questions to Dr. Anita Sabherwal Anand , Senior Obstetrician-Gynecologist at Sitaram Bhartia Hospital in South Delhi.

What happens if the cord is around the baby’s neck?

About 1 in 3 babies are born with a cord around neck without any adverse outcome.

Still, many expectant parents imagine that the cord around the neck is like a rope that will strangulate their baby during labour. This is not true.

Divya was relieved to hear that her baby was not in danger. She asked about what may cause a single or double loop of cord around the neck and any risks to know.

What causes umbilical cord around the neck?

The umbilical cord sometimes gets wrapped around the baby’s neck as it moves in the womb. The cord itself is long,  soft and filled with a jelly-like substance that cushions the blood vessels carrying oxygen and nutrients to the baby. 

What are the risks of umbilical cord around neck?

In the unlikely event that these blood vessels get compressed and there is reduced oxygen flow to the baby, your gynecologist will pick it up as part of their routine monitoring during labour. They might advise changes in your position to help relieve the compression or an emergency cesarean section. But it’s important to keep in mind that a cesearean section is needed in very few cases.

Also Read: C Section Delivery: 9 Indications Where It May Be Avoidable

Divya couldn’t help wondering how to remove a single loop of cord around the neck. 

What do you do when the umbilical cord is around the baby’s neck?

There is nothing that can be done to remove the cord around the baby’s neck . 

“All you need to do is remain optimistic and believe that your baby is well,” counseled Dr. Anita.

Is normal delivery possible with cord around the neck?

The Sitaram Bhartia Maternity team has delivered several babies with cord around the neck normally.  There have even been a few mothers whose babies had 4 loops of nuchal cord around the neck.

Divya relaxed when she heard that a cord around the neck does not harm the baby in most cases. She was even more glad to learn that a normal delivery with cord around the neck is possible.  

With all her worries put to rest by the gynecologist, Divya decided to continue consulting Dr. Anita for the rest of her pregnancy.

 In a few weeks, she went into labour and delivered a healthy baby girl. Her baby was born with the umbilical cord wrapped twice around her neck but did just fine.

Are you based in Delhi? Our hospital, Sitaram Bhartia, is located in South Delhi and has a team of experienced gynecologist who have handled many cases of cord around neck. If you are interested in seeking a second opinion, click the WhatsApp button below to book a paid consultation. 

Watch as new mother Divya excitedly shares her experience:

Many parents understandably panic when they find out about a single, double or four loops of cord around the fetal neck . If you or someone you know is in the situation, read on to know answers to commonly asked questions that may have crossed your mind.

FAQs about cord around neck

What percent of babies are born with the cord around their neck.

About 33% of babies are born with the umbilical cord around the neck.

Are there any symptoms for umbilical cord around neck? 

There are no symptoms that would indicate that the cord is wrapped around the baby’s neck in the womb. 

Is it normal to have umbilical cord around neck?

Yes, it is normal for the umbilical cord to be found around the baby’s neck at 32 weeks, 33 weeks, 35 weeks, 37 weeks or even 38 weeks . This may happen because the cord moves with the baby and may have tangled around the baby’s neck. Once detected, however, it is important to have regular check-ups with a gynecologist so they can monitor your situation continuously. 

Is normal delivery possible with cord around the neck wound multiple times?

Yes, many times a normal delivery is possible. Your gynecologist will keep monitoring your progress and your baby’s development to keep track of how things are going.  

Is cord around neck dangerous? 

In most cases, a cord around the neck is not dangerous and should not be a cause of concern. In few cases, if the cord is short, the blood vessels maybe compressed or the cord maybe stretched in labour.  This can be detected by your doctor/caregiver during routine care in labour. 

Are there any long term effects of having an umbilical cord around the neck?

Many babies are born with a single loop of cord around the neck. Sometimes, the umbilical cord is wound two, three or four times around the neck but in each of these cases, there are no short or long term effects that are known to have occurred. 

Are there any precautions for cord around neck?

According to gynecologists, there are no precautions to be taken or ways to prevent a cord around the neck. The umbilical cord can slip off the baby’s neck at any time. Even if it does not, in many cases you can still have a vaginal birth without any complications.

This blog post has been written with editorial inputs from Dr. Anita Sabherwal Anand who has been practicing in the field of Obstetrics & Gynecology for 24+ years.

MBBS, MD (Obstetrics & Gynaecology), DNB Secondary (Obstetrics & Gynaecology), National Board of Medical Education, New Delhi (1999)

You may like to read:

• 5 Easy Tips You Need to Know for a Normal Delivery
• Painless Delivery: Is it the Best Option for You?

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Cord Around the Neck

A cord around the baby’s neck at birth is a common occurrence. It happens in about a third of all births. This video shows how to manage a tight cord around the neck, including demonstrating a practice known as the somersault maneuver.

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Original Article

Volume 8, Number 2, June 2019, pages 48-53

The Presence of Nuchal Cord Does Not Hinder the Normal Progression of Labor

Kimitoshi Imai

Imai OB/GYN Clinic, Suehiro-cho 117-1, Aoi-ku, Shizuoka 420-0004, Japan

Manuscript submitted May 7, 2019, accepted June 25, 2019 Short title: Nuchal Cord and Progression of Labor doi: https://doi.org/10.14740/jcgo549

• Introduction
• Materials and Methods

Background: Nuchal cord is a common occurrence at birth, and its relation to some perinatal outcomes has been reported. The objective of this study was to investigate whether the presence of nuchal cord affects the normal progression of labor.

Methods: We retrospectively examined women who delivered their babies at our clinic. The inclusion criteria were ≥ 37 weeks of gestation, cephalic presentation and a singleton pregnancy. The rates of induction/augmentation of labor, cesarean section/vacuum extraction and prolonged labor and the durations of the first and second stages of labor were compared between women with and without a nuchal cord, separately among nulliparous and multiparous women.

Results: We enrolled 2,277 nulliparous and 2,548 multiparous women. A single nuchal cord was found in 559 (24.5%) nulliparous and 616 (24.2%) multiparous women. Multiple nuchal cords were found in 99 (4.3%) nulliparous and 104 (4.1%) multiparous women. Among nulliparous women, the use of vacuum extraction was higher in women with multiple nuchal cords; no such difference was observed among multiparous women. The rate of induction/augmentation of labor was similar between women with and without a nuchal cord in both nulliparous and multiparous women. Among nulliparous women, the median duration of the first stage of labor was 558, 635 and 550 min (P = 0.211), and that of the second stage of labor was 55, 59 and 60 min (P = 0.183), with no nuchal cord, a single nuchal cord and multiple nuchal cords, respectively. Among multiparous women, the corresponding values were 260, 270 and 256 min (P = 0.313) for the first and 13, 13 and 12 min (P = 0.616) for the second stage. The rate of prolonged labor was similar between nulliparous and multiparous women, regardless of the nuchal cord state.

Conclusion: A nuchal cord is not associated with labor induction, nor does it hinder the normal progression of labor.

Keywords: Labor duration; Labor induction; Prolonged labor; Nuchal cord

A nuchal cord, or cord around the fetal neck, is a frequent finding at birth, and accounts for 20-30% of births [ 1 - 5 ]. Due to its high prevalence, a nuchal cord is considered to be a physiologic event [ 6 ]. A nuchal cord, as well as its relationship to obstetrical and neonatal outcomes, has been extensively studied. It has been previously reported that a nuchal cord is associated with shoulder dystocia [ 2 ], non-reassuring fetal heart rate tracing [ 7 ], low umbilical cord arterial blood pH [ 4 , 8 ], acidosis [ 9 ], low Apgar score [ 4 , 8 - 13 ], neonatal admission [ 13 ], meconium stain [ 10 , 12 - 14 ], decreased fetal size relative to that of the placenta [ 15 ], operative vaginal delivery [ 11 , 16 ], fetal distress [ 10 , 12 , 16 ] and cesarean section [ 11 , 12 , 16 , 17 ]. However, several reports showed no relationship between the presence of a nuchal cord and adverse perinatal outcomes [ 3 , 18 - 28 ]. Indeed, from a forensic point of view, Walla et al [ 9 ] concluded that a nuchal cord is not associated with an adverse perinatal outcome. The association of a nuchal cord with induction of labor [ 2 , 10 ], and with a longer duration of labor [ 2 , 14 , 16 ], has also been reported. However, Karnanidhi et al [ 29 ] did not show such an association. Therefore, we investigated whether a nuchal cord hinders the normal progression of labor; namely, whether the normal descent of the fetus during labor is interrupted, leading to a prolonged labor.

We retrospectively examined women who delivered their babies in our clinic, from January 2004 to December 2017. Enrollment criteria were as follows: 37 weeks gestation or more, cephalic presentation and a singleton pregnancy. Cases with fetal demise before the onset of labor, non-cephalic presentation, a previous cesarean section, an elective cesarean section and cord entanglement other than around the fetal neck, were excluded. Our clinic is a private OB/GYN clinic, located in Shizuoka City in central Japan (population, about 700,000). The clinic mainly accepts women who are classed as low risk for pregnancy and delivery, namely, pregnant women with severe medical disease such as maternal heart disease, thyroid disease, and mental disease, or with severe pregnancy-induced hypertension; morbidly obese women were referred to tertiary hospitals. Vacuum extraction was used when appropriate; however, forceps delivery was not carried out in our clinic. Attending physicians, midwives, nurses and pregnant women and their families, did not know the presence or absence of nuchal cord before delivery. Women with nuchal cord were classified in two groups: a single nuchal cord (one turn around the neck) and multiple nuchal cords (two or more turns). This study was approved by the Local Ethical Committee (No. 18002).

Statistical analysis

Continuous data are reported as the mean ± standard deviation (SD) if normally distributed, and as the median and interquartile range (IQR), or 10 and 90 percentile, if not normally distributed. Categorical data are represented as n (%). Between-group comparisons among groups for continuous variables were made by one-way analysis of variance (ANOVA) if normally distributed, or Kruskal-Wallis test if not normally distributed, and by Fisher’s exact test for categorical variables. Comparisons of the means between groups were made using an unpaired t -test for normally distributed data and the Mann-Whitney U test for nonparametric data. Fisher’s exact test was used for ratio comparisons. Multiplicity of comparisons among groups was analyzed by using Bonferroni correction. All statistical analyses were performed with SPSS version 22.0 for Windows (IBM Japan, Tokyo, Japan). A P-value of less than 0.05 was considered statistically significant.

Two nulliparous women without nuchal cord and one multiparous woman with a single nuchal cord were excluded due to intrauterine fetal demise before the onset of labor. Cord entanglement other than around the fetal neck was noticed in 64 nulliparous women and 72 multiparous women, and they were also excluded from this study. A total of 2,277 nulliparous and 2,548 multiparous women were enrolled.

A single nuchal cord was found in 559 (24.5%) nulliparous and 616 (24.2%) multiparous women; multiple nuchal cords were noted in 99 (4.3%) nulliparous and 104 (4.1%) multiparous women ( Table 1 ). The rate of the presence of nuchal cord was similar in nulliparous and multiparous women. Clinical characteristics are shown in Table 2 .

The presence of multiple nuchal cords increased the likelihood of vacuum extraction in nulliparous women ( Table 3 ); however, the presence of nuchal cord did not affect the mode of delivery in multiparous women ( Table 3 ). The rates of using epidural analgesia and labor induction/augmentation were similar in nulliparous and multiparous women, with and without nuchal cord ( Table 3 ).

In nulliparous women, the duration of the first stage of labor was 558 min (215, 1,478), 635 min (222, 1,404) and 555 min (250, 1,490) (P = 0.211), and that of the second stage of labor was 55 min (19, 193), 59 min (22, 194) and 60 min (18, 182) (median (10th percentile, 90th percentile])) (P = 0.183) with no nuchal cord, a single nuchal cord and multiple nuchal cords, respectively ( Table 4 ). In multiparous women, the duration of the first stage of labor was 260 min (104, 593), 270 min (109, 592) and 256 min (90, 548) (P = 0.313), and that of the second stage of labor was 13 min (4, 39), 13 min (4, 37) and 12 min (5, 39) (P = 0.616) (median (10th percentile, 90th percentile), with no nuchal cord, a single nuchal cord and multiple nuchal cords, respectively ( Table 4 ).

The rates of prolonged first and second stages of labor were similar irrespective of the presence of nuchal cord in both nulliparous and multiparous women ( Table 5 ).

This study showed that the rate of augmentation/induction of labor was irrespective of the presence of nuchal cord ( Table 3 ) and that nuchal cord did not affect the duration of the first and second stage of labor in both nulliparous and multiparous women ( Tables 4 and 5 ). The study also revealed that nuchal cord was associated with a lower neonatal weight, a lower Apgar score at 1 min, a lower umbilical arterial pH and operative vaginal delivery, in nulliparous women ( Tables 2 and 3 ). Additionally, nuchal cord was associated with a lower neonatal weight, a lower Apgar score at 1 and 5 min, a lower umbilical arterial pH and base excess, in multiparous women ( Tables 2 and 3 ), as shown in previous reports [ 4 , 8 - 13 ].

A nuchal cord may be single or multiple, loose or tight, or the cord may entangle other parts of the fetus [ 6 , 30 ]. Usually, nuchal cords are labeled as being either tight or loose depending on whether or not the loop can be manually reduced over the fetal head [ 3 ]. If the nuchal cord could not be reduced easily over the head, it was clamped and cut before delivery, and regarded as a tight nuchal cord [ 2 ]. Henry et al [ 3 ] raised a question as to whether dichotomous classification as a loose or tight nuchal cord is suitable, given that the tightness of the nuchal cord is more likely to exist over a spectrum. Kobayashi et al [ 4 ] reported that umbilical cord entanglement around the trunk was associated with a higher risk of lower Apgar scores and a low umbilical artery pH. Therefore, in this study, the classification of a loose or tight nuchal cord was not employed, and cases with cord entanglement other than around the neck were excluded. Kong et al [ 24 ] reported that a nuchal cord of one turn and two turns accounted for 23.6% and 2.9%, respectively, which was similar to the present study ( Table 1 ).

Ogueh et al [ 2 ] reported that in a Canadian population study, the overall mean duration of labor and the first stage of labor was similar among women with and without nuchal cord; however, the second stage of labor was longer (53.8 vs. 51.7 min) in the presence of nuchal cord and if the nuchal cord was tight, the second stage of labor was even longer (56.1 min). Narang et al [ 14 ] showed that prolonged second stage of labor was more common among women with nuchal cords than those without. However, Karunanidhi et al [ 29 ] showed that the duration of the active phase of labor was no different with or without nuchal cord among nulliparous and multiparous women, as presented in this study ( Tables 4 and 5 ). The explanation of prolonged second stage of labor is failure of decent of the vertex in cases with nuchal cords [ 2 ]. Another explanation is that pregnancies associated with nuchal cords (with their association of small babies and abnormal fetal heart rate pattern) may be more intensively managed in labor with more vaginal examinations and so the onset of the second stage of labor is detected earlier and hence the longer stage of labor [ 2 ]. We speculate that even tight nuchal cord may not be always too short for the normal descent of the fetus [ 31 ].

Ogueh et al [ 2 ] reported that the requirement for augmentation with oxytocin was greater in the presence of nuchal cord (adjusted odds ratio (OR): 1.06) and that induction of labor was also higher among women with nuchal cord (adjusted OR: 1.09). Rhoades et al [ 10 ] reported that the induction rate doubled in women with nuchal cord compared to those without. However, Karunanidhi et al [ 29 ] showed that the requirement of induction and augmentation was similar with or without nuchal cord; the present study is in agreement with this report.

This study also showed that cesarean section delivery was not more frequent among women with nuchal cord than those without ( Table 3 ), consistent with previous reports [ 2 , 5 , 22 , 24 , 26 , 32 ]. Reed [ 33 ] claimed that when a cesarean section is carried out for reasons of “fetal distress” or “lack of progress” during labor, the presence of nuchal cord is often stated as the reason, as the cord prevents the fetal descent. The author continued to claim that the cord was unlikely to have had anything to do with the stress or lack of progress. Ogueh et al [ 2 ] reported that women with even tight nuchal cords had lower rates of cesarean sections (relative risk, 0.145, compared with no nuchal cord, P < 0.0001). As the Apgar score and umbilical artery pH were lower among women with nuchal cord ( Table 2 ), the nuchal cord does appear to induce a certain level of stress on the fetus. However, this study supports Reed’s opinion that the cord does not have anything to do with the lack of the progression of labor.

The present study has some limitations. Firstly, this study was conducted in a single private clinic where only low risk labor/deliveries were accepted; the results may be different in women with moderate or high-risk pregnancies. Secondly, in this study forceps delivery was not performed; forceps delivery is regarded as being more prompt and successful than vacuum extraction [ 34 , 35 ]. With the use of forceps, the duration of the second stage of labor would be shorter, and the rate of cesarean section would be lower.

There were also advantages of this study. For instance, no, single and multiple nuchal cords were analyzed separately. It is reasonable to suggest that if a single nuchal cord affected the normal onset and duration of labor, then multiple nuchal cords would have an even greater effect; this study did not show such a “dose effect’ ( Tables 3 - 5 ). In addition, nulliparous women and multiparous women were analyzed separately given that the duration of labor is quite different between the two groups.

The author hopes that this study will contribute to better understanding of the nuchal cord by the physician, coworkers, as well as pregnant women and their family, and that antenatally diagnosed nuchal cord will not provide undue cause for concern.

The presence of nuchal cord is not associated with the induction/augmentation of labor, nor is it associated with prolonged labor, in both nulliparous and multiparous women.

Acknowledgments

The author is grateful to Yousuke Sasaki (Department of Medical Statistics, Satista Co., Ltd, Uji, Japan, www.satista.jp) for his assistance with the statistical analysis and to Editage (www.editage.com) for English language editing.

Financial Disclosures

Conflict of Interest

Informed Consent

Not applicable.

Author Contributions

KI performed all the research including research design, data collection, analyzed the data and wrote the paper.

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) ) recommendations for manuscripts submitted to biomedical journals, the Committee on Publication Ethics ( ) guidelines, and the of Transparency and Best Practice in Scholarly Publishing. website: www.jcgo.org   editorial contact: [email protected]    [email protected] Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada © Elmer Press Inc. All Rights Reserved. : The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.         Fetal Presentation, Position, and Lie (Including Breech Presentation) Key Points | Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery . Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand) Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position. Abnormal fetal lie, presentation, or position may occur with Fetopelvic disproportion (fetus too large for the pelvic inlet) Fetal congenital anomalies Uterine structural abnormalities (eg, fibroids, synechiae) Multiple gestation Several common types of abnormal lie or presentation are discussed here. Transverse lie Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery. Breech presentation There are several types of breech presentation. Frank breech: The fetal hips are flexed, and the knees extended (pike position). Complete breech: The fetus seems to be sitting with hips and knees flexed. Single or double footling presentation: One or both legs are completely extended and present before the buttocks. Types of breech presentations Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery. Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia. Predisposing factors for breech presentation include Preterm labor Uterine abnormalities Fetal anomalies If delivery is vaginal, breech presentation may increase risk of Umbilical cord prolapse Birth trauma Perinatal death Face or brow presentation In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery. Brow presentation usually converts spontaneously to vertex or face presentation. Occiput posterior position The most common abnormal position is occiput posterior. The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis. Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required. Position and Presentation of the Fetus Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant patient's spine) with the face and body angled to one side and the neck flexed. Abnormal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing toward the pregnant patient's pubic bone) is less common than occiput anterior position. If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required. In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks. Copyright © 2024 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Cookie Preferences An official website of the United States government The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Publications Account settings The PMC website is updating on October 15, 2024. Learn More or Try it out now . Advanced Search Journal List Int J Womens Health PMC10724068 Retrospective Analysis of Pregnancy Outcomes Following External Cephalic Version for Breech Presentation 1 Department of Obstetrics, Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, 510800, People’s Republic of China 2 Department of Critical Care Medicine, Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, 510800, People’s Republic of China We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation. We retrospectively analyzed data from 158 singleton pregnant women with breech presentation at 36 weeks gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2018 to March 2022. 42 underwent ECV, categorized as the ECV group, while 116 without ECV comprised the control group. Systematic collection and evaluation of pregnancy outcomes were conducted for both groups. Within the control group, 16 cases experienced a spontaneous transition to head presentation, among which 14 cases resulted in successful vaginal deliveries. In 2 cases, cesarean deliveries were performed due to fetal macrosomia and persistent posterior occipital presentation. Furthermore, 2 cases of breech presentation in pregnant women were successfully delivered vaginally through breech traction, necessitating an emergency procedure due to the wide opening of the uterus. Within the ECV group, 28 cases were successfully inverted to the cephalic presentation. Among them, 1 case underwent an emergency cesarean delivery due to fetal distress during cephalic delivery, 3 cases required cesarean deliveries due to abnormal labor, and 24 cases were successfully delivered vaginally. The comparative analyses showed that the cesarean section rate (18/42 vs 100/116) and non-cephalic delivery rate (14/42 vs 100/116) in the ECV group were significantly lower than those in the control group ( P < 0.001). There was no statistically significant differences between the two groups with respect to the rate of newborns with Apgar score < 7 (1/42 vs 3/116), premature rupture of membrane (3/42 vs 20/116), acute fetal distress (2/42 vs 2/116), and cord prolapse (0/42 vs 1/116) ( P > 0.05). ECV can effectively reduce the rate of cesarean delivery and non-cephalic deliveries. However, it but requires strict adherence to indications and continuous monitoring. Introduction Breech presentation is one of the potential fetal positions during childbirth, constituting approximately 3%–4% of all full-term deliveries. This presentation is associated with a significantly higher perinatal mortality rate, ranging from 3 to 8 times that of cephalic presentation. 1 In cases of breech presentation, the cesarean section rate is as high as 80%–90%, making it the second or third most common indication for cesarean section. 2 , 3 A nationwide multicenter study in China revealed that cesarean sections conducted in cases of breech and transverse fetal positions accounted for 5.815% of the overall cesarean section procedures performed. It is essential to acknowledge the prevalent overuse of cesarean sections in clinical practice, a practice that has potential adverse effects on both maternal and fetal health. Reports from China, along with recommendations from the World Health Organization (WHO), emphasize the importance of maintaining the cesarean section rate below 15% in any region globally. However, some experts suggest a more reasonable threshold of 19% in order to strike a balance between necessary medical interventions and natural childbirth. 4 Minimizing breech deliveries can significantly contribute to controlling the overall cesarean delivery rate and, in turn, reduce the perinatal mortality rate. 5 Currently, various methods, such as acupuncture and moxibustion, are employed to alter the fetal position. 6 However, the effectiveness and safety of these techniques remain subjects of considerable debate within the academic community. External cephalic version (ECV) is a medical procedure employed to alter fetal presentation by applying pressure on the abdominal wall. This technique is utilized to convert a breech presentation into a cephalic presentation, effectively increasing the rate of cephalic deliveries and reducing the incidence of cesarean sections in pregnant women who are at or near term with abnormal fetal presentation before childbirth. 7 Since 2018, Guangzhou Hospital of Integrated Traditional and Western Medicine has been conducting ECV procedures without anesthesia, assisted by B-ultrasonography. In this study, we retrospectively analyzed data from 158 singleton pregnant women with breech presentation at ≥ 36 weeks of gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine between January 2018 and July 2021. The aim was to investigate the feasibility and safety of ECV, providing valuable evidence for clinical practice. Materials and Methods Study participants. Inclusion and Exclusion Criteria Inclusion criteria: Singleton pregnancy; breech presentation confirmed by B-ultrasonography at week 36 of gestation; amniotic fluid index ≥ 5 cm; cord around neck ≤ 2 loops. Exclusion criteria: Suspected intrauterine fetal distress; scarred uterus (a history of ≥ 2 cesarean sections or penetration of inner membrane in myomectomy or removed myoma > 6 cm); uterine anomalies (eg, septate uterus) or fetal anomaly (eg, sacrococcygeal teratoma); antepartum hemorrhage; contraindications to vaginal delivery. External Cephalic Version Pre-procedure preparation. Pregnant women who met the inclusion criteria received essential information and were admitted at 36–37 weeks of gestation. During their admission, they underwent various examinations, including routine blood tests, coagulation and biochemical tests, cross-matching tests, establishment of intravenous access, and fetal heart rate monitoring. Subsequently, the study participants provided written consent by signing the informed consent form after receiving comprehensive information regarding the surgical procedure. Preoperative fetal heart rate monitoring indicated normal patterns, ensuring the safety of the procedure. The ECV procedure was performed in a delivery room equipped for cesarean section, with the availability of a bedside ultrasound machine. Prior to the procedure, we conducted pre-procedural ultrasonography once more to assess fetal lie, breech type, fetal position, placental location, estimated fetal weight (EFW), and amniotic fluid index (AFI). Additionally, blood pressure measurements were also taken. In instances where fetal heart rate monitoring indicated uterine contractions, a 10 mg dose of nifedipine 8 was administered orally approximately 30 minutes before the procedure. Vital signs were meticulously monitored during this period. The ECV procedures were conducted by a single obstetrician with extensive experience, having performed over 500 ECVs. 8 ECV Procedure The pregnant women were positioned on their back with legs flexed and abdomen exposed. A suitable amount of lubricant was applied to the abdomen to minimize discomfort. The practitioner stood on the right side of the pregnant women and assessed the presentation. In cases of breech presentation within the pelvic cavity, the presenting part was carefully held, and gentle pressure was applied to push the breech upward, facilitating its movement out of the pelvic cavity. When the fetal spine was on the right side of the abdomen, the practitioner used their right hand to hold the fetal head and their left hand to hold the fetal buttocks. The practitioner applied gentle pressure, pushing the fetal head toward the pubic symphysis in a clockwise forward roll motion with the right hand, while simultaneously guiding the fetal buttocks clockwise toward the uterine fundus with the left hand (as depicted in Figure 1 ). Conversely, if the fetal spine was on the left side of the abdomen, the practitioner held the fetal head in their left hand and the fetal buttocks in their right hand, employing a counterclockwise inversion motion (as illustrated in Figure 2 ). Upon confirmation of the fetal presentation through ultrasonography, the practitioner used two hand towels to hold the fetal head and secured the presentation with an abdominal belt. If there was difficulty in turning the baby, the practitioner did not apply excessive force but attempted gentle maneuvers in both clockwise and counterclockwise directions. If these attempts were unsuccessful after two tries in each direction, the ECV procedure was considered unsuccessful. Regardless of the outcome of the ECV procedure, the fetal heart rate was promptly monitored after the intervention. Additional assessments, such as fetal heart monitoring and evaluation of cord blood flow, were conducted on the same day. If there were no abnormalities observed in the fetal heart rate monitoring and the pregnant women did not experience symptoms like abdominal pain, they were discharged on the following day, with the fetal presentation considered fixed until the head engaged. If abnormal fetal heart rate patterns were detected during intraoperative monitoring, the practitioner promptly halted the procedure. The position of the pregnant women was adjusted, and intrauterine resuscitation measures, such as oxygen inhalation, were initiated. If the fetal heart rate deceleration persisted and could not be restored to normal levels, an immediate cesarean section was performed to ensure the safety of both the mother and the baby. The fetal spine is on the right side of the abdomen. The practitioner used their right hand to hold the fetal head and their left hand to hold the fetal buttocks. The practitioner applied gentle pressure, pushing the fetal head toward the pubic symphysis in a clockwise forward roll motion with the right hand, while simultaneously guiding the fetal buttocks clockwise toward the uterine fundus with the left hand. The fetal spine is on the left side of the abdomen. The practitioner held the fetal head in their left hand and the fetal buttocks in their right hand. The practitioner applied gentle pressure, pushing the fetal head toward the pubic symphysis in a counterclockwise forward roll motion with the left hand, while simultaneously guiding the fetal buttocks counterclockwise toward the uterine fundus with the right hand. Observation Indicators We collected clinical data from postpartum women and newborns in both the ECV group and the control group. We observed and compared various factors, including the age, gravidity, parity, delivery gestational age, BMI, newborn birth weight of the mothers, as well as the rates of cesarean section, non-cephalic deliveries, and neonatal Apgar scores < 7 (at 5 minutes). Additionally, we examined the rates of premature rupture of membranes, cord prolapse, acute fetal distress, and fetal death between the two groups for comprehensive analysis. Statistical Analysis Statistical analysis was conducted using SPSS 19.0 software. Count data are presented as cases and percentages, and group comparisons were made using the chi-squared test. Logistic regression analysis was employed to assess the impact of maternal general condition on pregnancy complications in the context of EVC usage. A significance level of P < 0.05 was considered statistically significant. Comparison of General Conditions of the Puerpera Between the Two Groups There were no statistically significant differences between the ECV group and the control group in terms of age, gravidity, parity, delivery gestational age, BMI, and newborn birth weight ( P > 0.1). See Table 1 . Comparison of General Conditions of Puerperae Between the ECV Group and Control Group Variables ECV Group (n=42) Control Group (n=116) Age (year) −0.0111 (0.017) −0.00807 (0.008) Gravida (times) −0.876 (0.639) 0.144 (0.208) Parity (times) 0.323 (1.259) 0.514 (0.745) Delivery gestational age (w) 0.0447 (0.068) −0.0256 (0.028) Amniotic fluid index (cm) −0.0976 (0.123) −0.0609 (0.046) BMI (kg/m ) −0.0165 (0.030) −0.0135 (0.020) Newborn birth weight 0.0398 (0.182) 0.0101 (0.052) Cord around neck,1–2 loops (%) −0.619 (1.308) −0.288 (0.224) Note : Standard errors in parentheses (r 2 is a negative number, which is statistically meaningless). Comparison of Delivery Modes and Pregnancy Outcome Between the Two Groups In the control group, out of 116 pregnant women, 16 experienced a natural transition to head presentation, resulting in a total of 16 vaginal deliveries. Consequently, the cesarean section rate was 86.2% (100 out of 116 cases), the rate of non-cephalic deliveries was also 86.2% (100 out of 116 cases), and the proportion of newborns with an Apgar score at 5 minutes < 7 was 2.6% (3 out of 116 cases). There was 1 case with cord prolapse, who underwent emergency cesarean section, and the birth score was 5-9-10 points, with satisfactory prognosis; there was 1 case with breech extraction that had a birth score of 6-10-10 points, and 1 case where there was difficulty in emergence of the head delivered by cesarean section, with a birth score of 6-9-10 points. All 3 cases had satisfactory prognosis. Among the 42 pregnant women in the ECV group, 28 were successfully inverted, and 14 failed. The non-cephalic delivery rate was 33.3% (14/42 cases). Moreover, 24 pregnant women successfully delivered vaginally, and the cesarean section rate was 42.9% (18/42 cases). Due to 1 fetal death 42 hours after the operation, the rate of newborns with Apgar score < 7 was 2.4% (1/42 cases). The cesarean section rate and non-cephalic delivery rate in the ECV group were significantly lower than that in the control group ( P < 0.05), indicating a statistically significant difference; the difference in the rate of Apgar score < 7 between the two groups was not statistically significant ( P > 0.05). See Table 2 . Pregnancy Outcome and Pregnancy Complications Between the ECV Group and Control Group Pregnancy Outcome ECV Group (n=42) Control Group (n=116) Cesarean delivery [n, (%)] 18 (42.9) 100 (86.2) 30.65 < 0.001 Non-cephalic delivery [n, (%)] 14 (33.3) 100 (86.2) 42.90 < 0.001 Apgar score at 5 min < 7 (%) 1 (2.4) 3 (2.6) < 0.001 0.999 Premature rupture of membrane [n, (%)] 3 (7.1) 20 (17.2) 2.53 0.11 Cord prolapse [n, (%)] 1 (0.9) 0 (0) -b 0.27 Acute fetal distress [n, (%)] 2 (4.8) 2 (1.7) 0.25 0.62 Note : a Fisher’s exact test; χ 2 , Chi-squared test. Comparison of Incidence of Pregnancy Complications Between the Two Groups Among the 116 cases in the control group, 1 had cord prolapse, 20 (17.2%) had premature rupture of membrane, and 2 (1.7%) had acute fetal distress, including cord prolapse and late deceleration during breech traction. In the ECV group, 3/42 cases (7.1%) had premature rupture of membrane, no one had cord prolapse, and 2/42 cases (4.8%) had acute fetal distress, including 1 case of fetal death and 1 case who underwent emergency cesarean section due to suspected late deceleration of maternal-fetal blood transfusion within 6 hours after the ECV. See Table 2 . Effectiveness of ECV Breech presentation is one of the potential fetal positions during childbirth, occurring in approximately 3%–4% of all full-term deliveries. This presentation often leads to a high cesarean delivery rate. National cesarean delivery rates, reaching up to approximately 19 per 100 live births, have been associated with lower maternal or neonatal mortality in WHO member states. This suggests that previously recommended national target rates for cesarean deliveries may be underestimated and need to be reconsidered. 4 Cesarean delivery is generally considered a safe procedure, but it is not without risks and complications. Immediate intraoperative and postoperative complications, such as infection or hemorrhage, can occur, along with long-term issues that may complicate or prevent future pregnancies, including conditions like placenta accreta and uterine rupture. 9 The decision to perform a cesarean section is influenced by various clinical conditions, including obstructed labor, breech presentation, repeat cesarean sections, and cases of non-reassuring fetal breech presentation (10.8%). 10 , 11 Before the 30th week of gestation, breech presentation may spontaneously transition to cephalic presentation. However, when breech presentation persists beyond the 30th week, corrective measures are typically required. 1 At present, there are several methods of correcting breech presentation but their effects and safety are controversial. In 2020, the American College of Obstetricians and Gynecologists (ACOG) updated the guidelines for ECV issued in 2016: If there are no surgical contraindications, ECV should be strongly recommended in near full-term pregnant women with breech presentation. 12 In 2020, the French College of Gynaecologists and Obstetricians (CNGOF) issued its clinical practice guidelines for breech presentation: Acupuncture, moxibustion, and postural changes (knee-chest or lying supine with elevated breech) cannot effectively reduce breech presentation, while ECV can effectively lower the incidence of breech presentation and cesarean section rate. 13 The Royal College of Obstetricians and Gynaecologists (RCOG) issued obstetric guidelines and pointed out that the success rate of ECV performed by trained operators could reach 50% (30%–80%), with individual differences. 14 In full-term or near full-term pregnant women with breech presentation, External Cephalic Version (ECV) has been shown to reduce the rates of non-cephalic deliveries and cesarean sections. These findings are consistent with results from a prospective cohort study. 15 , 16 In line with these findings, the current study demonstrated that out of 42 pregnant women with breech presentation in the ECV group, 28 successfully converted to cephalic presentation. The cesarean section rate was 42.9%, and the non-cephalic delivery rate was 33.3%, both significantly lower than the control group (86.2%). These results indicate that ECV can substantially reduce both cesarean section and non-cephalic delivery rates. Safety of ECV In 2015, a meta-analysis involving 8 studies was conducted, and the results showed that, compared with breech presentation without ECV, the risk of non-cephalic delivery after ECV was reduced by about 60%, and the risk of cesarean section was reduced by about 40%. There was no significant difference in the incidence of adverse neonatal outcomes (low Apgar score, low umbilical vein pH, and death) between the two groups. 17 The CNGOF pointed out that, compared with the expectant management of breech presentation, ECV did not increase the risk of intrauterine death, whose incidence was close to 0.5% in both groups. Moreover, ECV reduced the rate of emergency cesarean section due to bleeding or change in fetal heart rate below l%. Collins et al 18 reported that the risks associated with External Cephalic Version (ECV) primarily include placental abruption, cord prolapse, premature rupture of membranes, intrauterine death, and fetomaternal transfusion. The overall incidence of these complications is lower than 1%, and the rate of emergency cesarean section was approximately 0.5%. Macharey et al 19 conducted a retrospective study and found that the incidence of ECV was 1.3%, which was close to the incidence of planned cesarean section. Some studies on the safety of ECV showed that ECV had a low rate of complications, but there was still a latent possibility of risk; therefore, it should be performed only in medical institutions with monitoring equipment and emergency delivery set-ups. For correcting full-term and near-full-term singleton breech presentation, it is essential for the medical staff performing the procedure to clearly identify the indications and contraindications. Adequate monitoring and adherence to appropriate techniques as per regulations are crucial steps to achieve a high success rate and ensure safety during the procedure. 20 , 21 ECV is a valuable management technique and, when applied to a properly selected population, presents minimal risks to both the mother and the fetus. If successful, ECV offers a distinct benefit to the mother by providing her with the opportunity for a successful vertex vaginal delivery. Given the small risk of adverse events associated with ECV and the significantly lower cesarean birth rate observed in women who have undergone successful ECV, it is recommended that all women near term with breech presentations should be offered ECV if there are no contraindications. 12 In the present study, the rate of Apgar score < 7 at 5 min in the ECV group was not significantly different from that in the control group, which is consistent with the current data. ECV did not increase the incidence of neonatal asphyxia. While the rate of premature rupture of membranes was low in the ECV group, it is important to note that, due to the inadequate sample size, there were no statistically valid data to conclusively demonstrate that ECV can reduce the incidence of premature rupture of membranes. Additionally, there was no statistically significant difference in the rate of cord prolapse and acute fetal distress between the two groups. The results mentioned above indicated that ECV did not lead to an increased incidence of pregnancy complications. However, it is noteworthy that one case in the ECV group experienced spontaneous repeated deceleration during routine fetal heart rate monitoring after the procedure, with frequent late deceleration occurring six hours post-ECV. While the outcome was satisfactory due to the prompt treatment of abnormalities detected through continuous postoperative fetal heart rate monitoring, this highlights the necessity for vigilant fetal monitoring and timely intervention during and after ECV to prevent adverse outcomes. Regrettably, in another case involving a 37-week pregnant woman, the fetus passed away 38 hours after ECV. During vaginal delivery, it was observed that the fetus had two loops of cord around the neck. Consequently, the cause of death was determined to be cord-around-The-neck and polyhydramnios. Following ECV, fetal heart rate monitoring revealed an atypical rate (without acceleration), and 34 hours later, the fetal presentation reverted to breech presentation once again. Under ultrasound guidance, the physician corrected the presentation and stabilized the fetal position. Despite normal findings in fetal blood flow and absence of cord entanglement around the neck during ultrasonography, the physician found that the fetal heart rate was not recorded four hours after the ECV. During delivery, it was observed that the umbilical cord was thin, approximately 100 cm in length, and wrapped in two loops around the neck. Additionally, the amniotic fluid volume was measured to be about 3000 mL. Lesson from this case: 1. The fetal heart rate monitoring displayed an atypical pattern (lacking acceleration), and further examination indicated the presence of polyhydramnios. The estimated fetal weight at 37 weeks was 2.5 kg. In this scenario, the physician should have taken into account the possibility that the abnormal fetal heart rate monitoring indicated intrauterine fetal distress, rather than solely relying on surgical indications. 2. Following ECV, the fetal heart rate monitoring displayed an atypical pattern with good baseline variation but without noticeable accelerations. The physician continued to monitor the fetal heart rate but attributed the abnormality to reduced fetal movement caused by the fixed presentation. Consequently, the physician loosened the abdominal belt. Unfortunately, the physician did not diagnose intrauterine hypoxia promptly. 3. The physician did not halt the procedure immediately upon detecting abnormal fetal heart rate patterns but instead chose to re-fix the inverted fetal presentation. 4. Prior to conducting ECV, a thorough assessment, including evaluating gestational age, fetal position, fetal size, placental location, cord entanglement, and amniotic fluid levels, is essential. In cases where the fetus has the cord wrapped around the neck for more than two loops, ECV should be approached with caution, and strict monitoring of the fetal heart rate is imperative. There were shortcomings in monitoring and treatment. In this study, 2 of the 42 cases that underwent ECV exhibited abnormal fetal heart rates, indicating an elevated likelihood of fetal distress and the risk of fetal demise associated with the procedure. ECV should be conducted following the principle of effectively enhancing the success rate while minimizing maternal and fetal risks. In summary, before performing ECV for singleton pregnant women with breech presentation, it is crucial to conduct a comprehensive evaluation of relevant factors, identify both indications and contraindications, provide complete information to the pregnant women, ensure adequate preparation for the procedure, and conduct it under conditions where emergency cesarean section is readily available. The procedure should be executed in a standardized manner, with vigilant monitoring of the maternal and fetal conditions afterward. Any issues that arise should be accurately assessed and promptly addressed. Limitations of the Study As a retrospective study, there may be some bias in the inclusion of cases, and the sample size was small. There was a significant difference in the number of cases between the two groups. All these factors could affect the accuracy of the findings. To ensure more reliable results, it is imperative to enlarge the sample size and conduct a prospective study. Additionally, adjustments should be made to the results to mitigate the influence of residual confounding variables. In 2014, a domestic multicenter study showed that cesarean sections with breech and transverse position accounted for 5.815% of the total number of cesarean sections In indications for cesarean section are fifth 22 perinatal mortality (0.5 / 1000) and vaginal delivery (2 / 1000) Compared with, slightly lower, but also face the risk of surgery. 23 The cesarean section rate and non-cephalic delivery rate significantly decreased following ECV without a corresponding increase in the incidence of pregnancy and delivery complications. However, there is still considerable progress needed in promoting the widespread adoption of ECV in China. Multi-center clinical studies with a large sample size are essential to investigate training methods for enhancing the success rate of the procedure, assess the necessity of preoperative anesthesia, and evaluate the use of contraction inhibitors to improve success rates. Furthermore, rigorous measures are needed to minimize procedural risks and to implement thorough intraoperative and postoperative monitoring and management to promote normal delivery. Acknowledgments We are particularly grateful to all the people who have given us help on our article. Funding Statement No external funding was received to conduct this study. Data Sharing Statement All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author. Ethics Approval and Consent to Participate The study was conducted in accordance with the Declaration of Helsinki (as was revised in 2013). The study was approved by Ethics Committee of the Guangzhou Hospital of Integrated Traditional And West Medicine (No.20220084). Written informed consent was obtained from all participants. The authors declare that they have no competing interests in this work. 296 IMAGES cephalic presentation four types of cephalic presentation Cephalic and breech presentation . What is a Cephalic Presentation: What is its Success Rate for a Normal Cephalic Presentation of Baby During Pregnancy What is cephalic position?| cephalic presentation VIDEO cord around neck #pregnancy #pregnancytips Cord around neck .. ultrasound appearance and what’s next Will cephalic presentation change after 32 weeks? Cephalic position of during delivery time /baby head down position 4 Signs of Cephalic Presentation Chp3 COMMENTS Cephalic Position: Understanding Your Baby's Presentation at Birth Cephalic occiput posterior. Your baby is head down with their face turned toward your belly. This can make delivery a bit harder because the head is wider this way and more likely to get stuck ... Your Guide to Fetal Positions before Childbirth The umbilical cord slipping around baby's neck or arms during delivery; Most babies settle into their final position somewhere between 32 to 36 weeks gestation. Head Down, Facing Down (Cephalic Presentation) This is the most common position for babies in-utero. In the cephalic presentation, the baby is head down, chin tucked to chest, facing ... Fetal presentation before birth Frank breech. When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. Delivery, Face and Brow Presentation The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. ... and black race. Fetal risk factors include anencephaly, multiple loops of cord around the neck, masses of ... Fetal Presentation, Position, and Lie (Including Breech Presentation) Head first (called vertex or cephalic presentation) Facing backward (occiput anterior position) Spine parallel to mother's spine (longitudinal lie) Neck bent forward with chin tucked. Arms folded across the chest . If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not ... Fetal Presentation, Position, and Lie (Including Breech Presentation) In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks. Nuchal Cord: What You Should Know What is a nuchal cord? Nuchal cord is the term used by medical professionals when your baby has their umbilical cord wrapped around their neck. This can occur during pregnancy, labor, or birth ... What happens if the umbilical cord is around my baby's neck? If the cord is looped around the neck or another body part, blood flow through the entangled cord may be decreased during contractions. This can cause the baby's heart rate to fall during contractions. Prior to delivery, if blood flow is completely cut off, a stillbirth can occur. In the 2018 study, 12 percent of deliveries had a nuchal cord. Incidence of Cord Around the Neck and its Effects on Labour and ... Cephalic presentation; Singleton pregnancy; Spontaneous onset of labour pain with intact membrane. Exclusion criteria. ... Although 15%-30% of pregnant women have cord around the neck of foetus, only a few of them have tight or multiple nuchal cord. It is only tightness of loop or multiple loops (≥) which adversely affect perinatal outcome ... Cephalic Position During Labor: Purpose, Risks, and More Turning a Fetus. The cephalic position is when a fetus is head down when it is ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery. About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of ... Cephalic Presentation: Meaning, Benefits, And More I BabyChakra Cephalic presentation is considered the safest birthing position. The good news is that most babies naturally settle in this position by the 36th week of pregnancy. ... Moreover, the umbilical cord may also get damaged or get wrapped around your baby's neck, cutting off their oxygen supply. ... Cord Around the Neck Yes, it is normal for the umbilical cord to be found around the baby's neck at 32 weeks, 33 weeks, 35 weeks, 37 weeks or even 38 weeks. This may happen because the cord moves with the baby and may have tangled around the baby's neck. Once detected, however, it is important to have regular check-ups with a gynecologist so they can monitor ... Cord Around the Neck A cord around the baby's neck at birth is a common occurrence. It happens in about a third of all births. This video shows how to manage a tight cord around the neck, including demonstrating a practice known as the somersault maneuver. Download Video. Fetal Presentation, Position, and Lie (Including Breech Presentation When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps Operative Vaginal Delivery Operative vaginal delivery is delivery using a vacuum extractor or forceps. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. Nuchal cord INTRODUCTION. A loop of umbilical cord around the fetal neck (nuchal cord) is a common finding at delivery. In most cases, it is not associated with a significant increase in the rate of any clinically important adverse fetal/neonatal events. In case reports and small case series, tight nuchal cords have been associated with adverse outcomes ... The Presence of Nuchal Cord Does Not Hinder the Normal Progression of A nuchal cord, or cord around the fetal neck, is a frequent finding at birth, and accounts for 20-30% of births ... cephalic presentation and a singleton pregnancy. Cases with fetal demise before the onset of labor, non-cephalic presentation, a previous cesarean section, an elective cesarean section and cord entanglement other than around the ... Sextuple loops of nuchal cord in breech presentation A 30-year-old primigravida presented at 35 + 5 weeks' gestation with persistent breech position for external cephalic version (ECV). Ultrasound examination showed a normally grown fetus with extreme looping of the umbilical cord around the fetal neck and head hyperextension (Figure 1).On three-dimensional ultrasound, an appearance resembling tribal neck rings was observed (Figure 2). Malpositions and malpresentations of the fetal head Cord around neck. Clinical presentation and diagnosis of malpresentation and malposition. ... (37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the ... Fetal Presentation, Position, and Lie (Including Breech Presentation In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks. Retrospective Analysis of Pregnancy Outcomes Following External This presentation is associated with a significantly higher perinatal mortality rate, ranging from 3 to 8 times that of cephalic presentation. 1 In cases of breech presentation, ... Cord around neck,1-2 loops (%) −0.619 (1.308) −0.288 (0.224) Open in a separate window. essay homework paper phd project resume review study thesis