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Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 227-228

Nuchal cord: Gray-scale ultrasound and color doppler imaging features

Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India

Date of Submission16-Aug-2020
Date of Decision15-Nov-2020
Date of Acceptance21-Dec-2020
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Varun Singh
Department of Radiology, JLN Medical College, Sawangi, Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_307_20

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How to cite this article:
Singh V, Phatak S, Pandey S, Nagendra V. Nuchal cord: Gray-scale ultrasound and color doppler imaging features. J Datta Meghe Inst Med Sci Univ 2021;16:227-8

How to cite this URL:
Singh V, Phatak S, Pandey S, Nagendra V. Nuchal cord: Gray-scale ultrasound and color doppler imaging features. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:227-8. Available from: http://www.journaldmims.com/text.asp?2021/16/1/227/322626

Respected Sir,

Nuchal cord, or commonly termed cord around the neck, is the 360° wrapping of the cord around the fetal neck. It is commonly seen in the advancing gestational age due to increased fetal activity and decreased liquor.[1] About 14%–30% of pregnant females have fetus with a nuchal cord, but those with increased degree of tightness and number of loops (>1) have higher incidence of mortality and morbidity due to compression over the cord, causing fetal bradycardia, increased umbilical artery acidemia, increased passage of meconium, and fetal demise.[2]

A 32-year-old pregnant female with a gestational history of G2P2 L1 came for routine follow-up scan. Gray-scale imaging depicted a single intrauterine live fetus having an average gestational age of 35 weeks and 6 days and weight of 2115 g with a slightly decreased liquor index of 6. There was evidence of two varied sized indentations over the fetal nuchal skin posteriorly, suggestive of Divots sign [Figure 1] and on Doppler imaging, the indentations showed two loops of three-vessel umbilical cord wrapped 360° around the neck, suggestive of a double nuchal cord [Figure 2] and [Figure 3].
Figure 1: Posterior nuchal skin showing corrugations typical of Divots sign

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Figure 2: Color Doppler image showing two loops of cord having three vessels each

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Figure 3: Color Doppler imaging showing two loops of umbilical cord wrapping around the neck

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Ultrasonography being highly accurate, widely available, and cost-effective, it is considered the modality of choice for the diagnosis of cord around the neck. Divots sign is the characteristic gray-scale finding in nuchal cord; it is described as the circular indentation of the fetal nuchal skin in sagittal plane during antenatal scan.[2]

However, one should be careful in diagnosing nuchal cord and confirm on color Doppler as posterior nuchal skin corrugations on gray-scale imaging can be mistaken for posterior cystic mass, skin fold, and liquor pocket.

Hence, Divots sign clubbed with color Doppler imaging helps in diagnosing cord around the neck accurately.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Peesay, M. Nuchal cord and its implications. matern health, neonatol and perinatol 2017;3:28.  Back to cited text no. 1
Moshiri M, Zaidi SF, Robinson TJ, Bhargava P, Siebert JR, Dubinsky TJ, et al. Comprehensive imaging review of abnormalities of the umbilical cord. Radiographics 2014;34:179-96.  Back to cited text no. 2


  [Figure 1], [Figure 2], [Figure 3]


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