Background: Nuchal cord, defined as the encirclement of the fetal neck by the umbilical cord, is frequently encountered during term labor. Although often benign, increasing evidence suggests that multiple and/or tight loops may influence labor progression and neonatal health. This study aimed to determine the incidence of nuchal cord, its effect on labor duration, mode of delivery, fetal heart rate patterns during labor, and immediate neonatal outcomes as evaluated by APGAR scores and NICU admissions. Methods: A prospective observational study was conducted over 12 months at Narayana Multispeciality Hospital, Jaipur. A total of 400 term pregnant women, presenting with cephalic singleton pregnancies and spontaneous onset of labor, were enrolled after obtaining informed consent and ethical committee approval. Exclusion criteria included antenatal complications such as hypertensive disorders, diabetes, and preterm or post-date pregnancies. Detailed maternal histories, clinical and ultrasonographic evaluations, and intrapartum monitoring (including cardiotocography) were performed. At delivery, the presence, number, and tightness (categorized as “loose” or “tight”) of nuchal cords were recorded. Neonatal outcomes were assessed by APGAR scores at 1 and 5 minutes and the need for NICU care. Statistical analysis was carried out using MedCalc (v16.4), with significance set at p < 0.05. Results: The overall incidence of nuchal cord was 21.25%. Single loops predominated (64.71%), while multiple loops were observed in 35.29% of cases. Tight nuchal cords were noted in 45.88% of patients. Notably, the time from the onset of labor to delivery was significantly prolonged in cases with tight cords (mean first stage: 10.33 hours vs. 9.17 hours; p = 0.010). Moreover, abnormal fetal heart rate patterns were more common in multiple and tight cord cases, leading to increased instrument-assisted deliveries (forceps and cesarean section). APGAR scores <7 at 1 minute were significantly associated with tight nuchal cords (p < 0.05), and these neonates had a higher rate of NICU admissions. Conclusion: Our findings indicate that while nuchal cords occur in approximately one‐fifth of term pregnancies, the subset with multiple and tight loops may experience prolonged labor and suboptimal neonatal outcomes. These results underscore the need for vigilant intrapartum monitoring and prompt intervention when adverse fetal heart rate patterns are detected.