Background: Entanglement of umbilical cord around the foetal neck is a common finding at ultrasonography. A nuchal cord occurs when the umbilical cord becomes wrapped around the foetal neck by 360°. Nuchal cord is very common, with the prevalence rates of 6-37%. Up to half of nuchal cords resolve before delivery.Methods: This study was conducted on 100 women irrespective of parity with healthy singleton term pregnancies with cephalic presentation in the department of obstetrics and gynaecology, SMS Medical College Jaipur. They were included in study after applying inclusion criteria and a written informed consent was taken. Strict fetomaternal monitoring was done during labour and data was interpreted in terms of percentage.Results: Out of 100 cases 71% delivered vaginally, 29% underwent caesarean section. None of the caesarean was done for cord around neck as the only indication. The indications for caesarean section were previous caesarean (34.4%), preeclampsia (13.7%), severe oligohydramnios (31%) and non-reassuring foetal heart rate (20%). Among the women who delivered normally, 53% had single loop, 29.5% had two loops, 14% had three loops and 2% had more than 3 loops. Among women who underwent caesarean section, 65% had single loop, 31% had two loops and 14% had more than two loops. Regarding neonatal outcome 9% neonates were admitted in NICU for reasons like meconium aspiration (33.3%), preterm (44%) and preeclampsia (22%).Conclusions: Cord around neck per se is not an indication for caesarean section and these cases can be delivered vaginally if careful intrapartum monitoring is done.

Emergency surgical management of patients who are COVID-19 positive is extremely challenging for the treating doctors as there is a need to keep the balance between delivering optimal medical care to the patient, preventing spread to others and protecting ourselves. COVID-19 manifestations in pregnant women are similar to non-pregnant patients. The patient may be asymptomatic or may present with symptoms like cough, cold, fever and shortness of breath. In obstetric emergencies like ruptured ectopic pregnancy, when a patient presents in casualty with history of amenorrhea, pain abdomen and features of shock, main priority for the clinician is to stabilize them and treat the underlying cause so as to save their life. We report the emergency management of a hemodynamically unstable ruptured ectopic pregnancy at 9 weeks of gestation in a COVID-19 positive patient. It was stressful for the treating doctors because of high infectivity of the disease, scarcity of resources during the pandemic and precarious condition of the patient.