Double nuchal umbilical cord and breech presentation: The value of close follow-up

We report the management of a fetus with breech presentation and double nuchal cord in a mother desiring external cephalic version (ECV). The patient was a 26-year-old woman, gravida 1, para 0, with an unremarkable prenatal course, who was found to have a breech presentation at 34 weeks 1 day. She consented for external cephalic version (ECV) and upon evaluation at 36 weeks 2 days, the fetus was found to have double nuchal coils of the umbilical cord. ECV was not attempted. Subsequent fetal surveillance consisted of fetal movement counts, non-stress tests and Doppler ultrasound of the umbilical artery. At 38 weeks 1 day, ultrasound revealed absence of the nuchal coils. ECV was attempted and was successful. The fetus maintained the cephalic presentation and the patient delivered uneventfully. This case report illustrates the value of follow-up ultrasound in a patient who desires an ECV and for whom such a procedure was declined due to the presence of double nuchal coils. Cesarean delivery was successfully avoided.