What should be done if the umbilical cord is wrapped once around the fetal neck at 32 weeks of gestation?

At 32 weeks of gestation—i.e., the third trimester—pregnant women often experience increasing anxiety. During this stage, the fetus has relatively unrestricted movement within the uterine cavity, making nuchal cord (umbilical cord around the fetal neck) relatively common. If ultrasound reveals a nuchal cord, there is no need for excessive concern—as long as it does not form a tight, unyielding knot, it typically poses no significant risk. In most cases, the fetus can spontaneously reposition itself and resolve the entanglement through normal movement.

However, if the cord is tightly wrapped, it may compromise fetal oxygenation and lead to hypoxia or even asphyxia. If the nuchal cord persists without resolution near term, cesarean delivery is generally recommended to minimize potential risks. Once the cord is no longer tightly encircling the neck—or if the fetal position normalizes—vaginal delivery may be safely attempted.

Throughout pregnancy, close attention should be paid to fetal movements. Doppler ultrasound assessment of umbilical artery blood flow, routine non-stress tests (NST) with fetal heart rate monitoring and scoring, and home-based fetal heart rate monitoring using a fetal phonocardiogram (fetal “talking” monitor) are all recommended. Standardized monitoring curves should be plotted regularly. Additionally, sleeping in the left lateral decubitus position helps optimize umbilical blood flow and supports healthy fetal development. Pregnant women should also engage in appropriate physical activity, consume ample fresh vegetables and fruits, maintain perineal hygiene, and attend scheduled prenatal check-ups at the hospital.