الفهرس 
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Abstract
The umbilical cord (UC) is the essential life-sustaining connection between fetus and placenta. It constitutes a stable connection to the feto maternal interface, while allowing fetal mobility that is essential for fetal development in general and neuromotor development in particular (Bosselmann and Mielke, 2015).
In its embryonic stage the UC develops in the region of the body stalk to become the embryo’s connection to the fetal portion of the placenta (fetal placenta). The amniotic cavity expands from dorsal to ventral while the chorionic cavity shrinks in volume. During cephalocaudal and lateral folding, the early UC arises as it is “enveloped” by the expanding amnion (Krzyżanowski et al., 2019).
Umbilical cord abnormalities can have important prognostic implications for perinatal morbidity and mortality.The defects in the umbilical cord can be divided into: - Abnormal length – too long/too short; abnormal cord twist, coil, thin cord; Cord insertions site abnormalities; Cystic abnormalities: true cysts, pseudocysts; Cord hematomas; Solid or complex malformations: angiomyxoma, teratoma; Knots: true, false; Nuchal cord; Vascular anomalies: single umbilical artery, hypoplasia of one umbilical artery, supernumerary vessels, aneurysm and varix, persistent right umbilical vein (PRUV); Funic presentation and prolapse cord (Krzyżanowski et al., 2019).
A nuchal cord occurs when the umbilical cord becomes wrapped around the fetal neck 360 degrees (Peregrine et al., 2005).
Nuchal cord may be considered worse than strangulation, since in nuchal cord, umbilical cord itself acts as a noose while carrying blood supply and the oxygen and lead to umbilical vein meconium, which is
probably an indication of vagal collapse (Stapczynski and Dietrich, 2010).
Ultrasound diagnosis of a nuchal cord was first described in 1982 by Jouppila and Kirkinen and since then there have been a few case reports in which ultrasound diagnosis has aided obstetric management. More recently color Doppler imaging has been used as an aid to sonographic diagnosis. Generally, the sensitivity of diagnosis is higher with color Doppler imaging and it may have a particular advantage in the presence of ruptured membranes .Three-dimensional ultrasound has also been used (Peregrine et al., 2005).
Nuchal cords may not significantly increase the risk of acute or labor-associated fetal hypoxia, but are an independent risk factor of mild, chronic, pre-labor fetal hypoxia (Hashimoto and Clapp, 2003).
Severe prolonged partial asphyxia could be one of the rare complications of tight nuchal cords (Vykuntaraju, 2014).
A significant umbilical arterial acidosis can occur in nuchal cord infants even in the setting of normal or near normal APGAR scores (Martin et al., 2005).
The obstetrical challenge of the clinical management of nuchal cords depends upon number of involved nuchal loops, the amniotic fluid index, the gestational age, and the fetal growth, among other factors. Induction of labor considered as independent risk factor for nuchal cords. A prolonged persistent nuchal cord with poor fetal growth deserves close monitoring and delivery as appropriate. Some obstetricians opt to deliver early when multiple nuchal cord loops are noted on fetal scans. Presence of variable decelerations during fetal heart rate monitoring is indicative of possible presence of nuchal cord (Peesay, 2017).
The aim of this study is to assess the effect of umbilical cord entanglement during labor on perinatal outcomes.
This was a prospective observational study carried out to assess the presence of a nuchal cord. The presence of a nuchal cord was classified as present or absent and if present the number of loops. And also, to assess any association between umbilical cord entanglement and pregnancy outcome.
In our study Nuchal cords are responsible for poor fetal outcome in the form of low Apgar score, NICU admission and perinatal fetal death and there is positive correlation between number of loops and fetal complications. Abnormal length of the cord is significantly associated with poor fetal outcome. The mode of delivery in our study is not affected by nuchal cord or abnormal length of the cord separately, but tight nuchal cord with short cord length may affect the progression of delivery.