Elongated umbilical cord with four loops around neck

A 32 years old woman at 37.5 weeks of gestation (G2P1L1A0) visited the antenatal clinic at the hospital with decreased foetal movements. Her second-trimester ultrasound showed mild intrauterine growth retardation. The first baby was normal vaginal delivery with no evidence of a loop of cord around the neck or any entanglements. On Doppler ultrasonography, decreased foetal heart rate was recorded with oligohydramnios and the patient was taken for caesarean delivery. A male neonate weighing 2.3 kgs was born with four loops of umbilical cord around the neck with no knots in the cord. The baby cried immediately after birth with a good tone & activities with a normal Apgar score. On examination, the placenta was normal with no retroplacental clot. The umbilical cord was abnormally long measuring 86 cm with three vessels.