1) A 24-year-old pregnant woman presented with severe acute polyhydramnios at 41 weeks gestation, where her amniotic fluid index was 40 cm. 2) An ultrasound revealed multiple loops of the umbilical cord wrapped around the fetus' neck. 3) The fetus was delivered via cesarean section and was found to have the umbilical cord tightly wrapped three times around its neck, limiting neck movement but without signs of strangulation.

1. Ultrasound Obstet Gynecol 2010; 35: 253–254
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.7543
Picture of the Month
Acute polyhydramnios in term pregnancy may be caused by multiple nuchal cord loops
Y. PERLITZ*†, I. BEN-SHLOMO* and M. BEN-AMI*†
*Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Tiberias and †Rappaport Faculty of Medicine,
Technion, Israeli Institute of Technology, Haifa, Israel
Acute severe polyhydramnios developing in the third
trimester or at term is a rare condition. Although there
are many possible fetal or maternal causes for this
phenomenon, in the majority of cases a specific etiology Multiple nuchal cord loops
cannot be found. We describe our imaging findings and
management of a case of severe acute polyhydramnios Fetal head
developing at the 40th gestational week.
A 24-year-old healthy mother of two children was
referred to our obstetrics department at 41+2 gestational Fetal body
weeks of her third pregnancy owing to very recent
distention of her uterus. Her pregnancy had been
uneventful, including a 22-week sonographic anomaly
scan. No other screening tests were performed during
pregnancy. During a visit for a routine check-up
1 week earlier, a sonogram revealed normal amniotic
fluid volume and adequate gross body and breathing
Figure 1 Doppler ultrasound image showing the fetus in the
movements. Current sonography at admission revealed longitudinal position, face down; multiple nuchal cord loops are
severe polyhydramnios, reaching an amniotic fluid index wrapped around its neck.
of 40 cm. A Doppler examination of the umbilical cord
discovered multiple cord loops wrapped around the in-utero ability to swallow amniotic fluid. This in turn
fetal neck (Figure 1). A healthy baby was delivered by could have led to accelerated, late-onset polyhydramnios.
Cesarean section. The estimated amniotic fluid volume We propose that in any case of such sudden and late devel-
was approximately 2.5 L. The umbilical cord was tightly opment of polyhydramnios, the fetal neck area should be
wrapped three times around the fetal neck, forming a scanned by ultrasonography, and the presence of nuchal
bulk which limited the free movement of the neck, but no cord loops should be considered as a possible cause of the
strangulation marks were evident around the baby’s neck. polyhydramnios.
Third-trimester or term pregnancy acute onset polyhy-
dramnios is rare, usually mild, and not associated with
structural defects1 . However, in the severe polyhydram- References
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Correspondence to: Dr Y. Perlitz, Department of Obstetrics & Gynecology, The Baruch Padeh Medical Center, Poriya, MPO Lower Galillee
15208, Tiberias, Israel (e-mail: yperlitz@poria.health.gov.il)
Copyright  2010 ISUOG. Published by John Wiley & Sons, Ltd. PICTURE OF THE MONTH

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