{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T09:02:48Z","timestamp":1779786168573,"version":"3.53.1"},"reference-count":9,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australas J Ultrason Med"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nuchal cord, or wrapping of the umbilical cord around the fetal neck, is a common obstetric finding; however, multiple loops are uncommon, and entanglement exceeding four loops is rare. High\u2010order nuchal cords (\u2265\u20095 loops) may predispose to cord compression, abnormal fetal heart rate tracings and intrauterine compromise. Advances in prenatal ultrasonography, particularly colour Doppler imaging, have improved detection, but the optimal management of these cases remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Findings<\/jats:title>\n                    <jats:p>We present a case of a 42\u2010year\u2010old gravida 6, para 3124 woman (three term deliveries, one preterm delivery, two prior abortions and four living children) whose pregnancy was complicated by a sextuple (six\u2010loop) nuchal cord, identified antenatally at 24\u2009weeks 2\u2009days. Despite initially preserved Doppler flow, the patient later developed decreased fetal movement and recurrent variable and late decelerations on fetal monitoring, consistent with non\u2010reassuring fetal heart tracings. An emergent preterm caesarean delivery was performed, revealing six tight loops of umbilical cord around the fetal neck. A live preterm neonate was delivered and admitted to the NICU for ongoing care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case underscores the potential hemodynamic impact and perinatal risks associated with extreme nuchal cord entanglement. Antenatal detection using colour Doppler ultrasound, combined with vigilant fetal surveillance and timely intervention, is critical for optimising outcomes. Awareness of maternal symptom reporting and early response to non\u2010reassuring fetal heart tracings can facilitate favourable results even in rare, high\u2010order nuchal cord cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajum.70042","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:47:15Z","timestamp":1777448835000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sextuple Nuchal Cord Entanglement in a Preterm Neonate: A Case Report"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9913-1917","authenticated-orcid":false,"given":"Rebecca","family":"Hicks","sequence":"first","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine  Huntington West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0247-5443","authenticated-orcid":false,"given":"Jesse","family":"Cottrell","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Marshall University Joan C. Edwards School of Medicine  Huntington West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"issue":"3","key":"e_1_2_11_2_1","first-page":"632","article-title":"Ultrasonographic Investigation of Nuchal Cord in Late Pregnancy","volume":"173","author":"Jauniaux E.","year":"1995","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(95)91359-9"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211238"},{"issue":"7","key":"e_1_2_11_5_1","first-page":"380","article-title":"Nuchal Cord and Neurodevelopmental Performance at 1 Year","volume":"10","author":"Clapp J. F.","year":"2003","journal-title":"Journal of the Society for Gynecologic Investigation"},{"issue":"12","key":"e_1_2_11_6_1","first-page":"989","article-title":"Prenatal Detection and Management of Quadruple Nuchal Cord: A Case Report","volume":"37","author":"Steinfeld J. D.","year":"1992","journal-title":"Journal of Reproductive Medicine"},{"issue":"3","key":"e_1_2_11_7_1","first-page":"223","article-title":"Sextuple Nuchal Cord: Case Report and Review","volume":"30","author":"Jafri S. Z.","year":"2014","journal-title":"Ultrasound Quarterly"},{"issue":"6","key":"e_1_2_11_8_1","first-page":"381","article-title":"Diagnosis of Nuchal Cord at the 11\u201314\u2010Week Scan","volume":"5","author":"Sepulveda W.","year":"1995","journal-title":"Ultrasound in Obstetrics & Gynecology"},{"issue":"9","key":"e_1_2_11_9_1","first-page":"441","article-title":"In Utero Diagnosis of Multiple Nuchal Cord Loops: Clinical Significance and Implications","volume":"16","author":"Sherer D. M.","year":"1999","journal-title":"American Journal of Perinatology"},{"key":"e_1_2_11_10_1","volume-title":"Fetal Heart Rate Monitoring","author":"Freeman R. K.","year":"2012"}],"container-title":["Australasian Journal of Ultrasound in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajum.70042","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ajum.70042","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajum.70042","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T08:07:31Z","timestamp":1779782851000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajum.70042"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":9,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/ajum.70042"],"URL":"https:\/\/doi.org\/10.1002\/ajum.70042","archive":["Portico"],"relation":{},"ISSN":["1836-6864","2205-0140"],"issn-type":[{"value":"1836-6864","type":"print"},{"value":"2205-0140","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"2025-10-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70042"}}