Aims The umbilical cord is a vital conduit between the placenta and the fetus during intrauterine life, and loses its physiological function after birth. Neonates can present with various umbilical cord anomalies. This study aimed to report a rare case of sextuple nuchal cord associated with a true knot, combined with a single umbilical artery and bilateral clubfoot.
Case Presentation A 26-year-old pregnant woman presented with premature membrane rupture and regular contractions. Fetal ultrasonography at 19 weeks of gestation revealed a single umbilical artery and bilateral clubfoot.
Findings Following the appearance of late decelerations unresponsive to supportive measures, the patient underwent an emergency Cesarean section. During the procedure, a sextuple nuchal cord and a true knot were observed. The neonate weighed 3100 g and presented with bilateral clubfoot and a single umbilical artery.
Conclusion This case demonstrates that the presence of multiple nuchal cords combined with a true knot, even in the presence of good Apgar scores, may be associated with abnormal fetal heart rate patterns. Prompt decision-making in such scenarios can prevent adverse outcomes.