Background: Cord entanglement is the most common cord abnormality detected in modern obstetric practice and is one of the reasons for the increase in cesarean section rate. The aim of our study is to detect the incidence of cord entanglement and effect on perinatal outcomes. Materials and methods: Our study is a prospective observational study conducted in a tertiary center over a period of 2 years. A total 375 patients were enrolled for the study, over a 2-year period. Among 375 patients, 257 control without cord entanglement, and 118 had cord entanglement. Results: In the cord entanglement group, 56.8% normal delivery, 15.3% instrumental delivery, and 33% emergency LSCS. In the group without cord entanglement, 77% has a normal delivery, 10.1% instrumental deliveries, and 12.8% emergency LSCS. Low APGAR scores at 1 and 5 minutes and NICU admission were high in the group with cord entanglement as compared to the group without cord entanglement and more significantly in the tight entanglement group. Conclusion: We conclude that pregnant women with cord entanglement require intense observation and close monitoring of labor with partogram and continuous fetal monitoring with cardiotocography to note any adverse events immediately during labor and to expedite delivery if necessary either by instrumental delivery or cesarean section to prevent neonatal compromise. But a fair trial for vaginal delivery can be given and the mother should not be stressed with unnecessary anxiety when cord entanglement is noted on ultrasonography.