Intrauterine fetal death due to true knot on umbilical cord: Report of two cases

Abstract

The incidence of a true knot of the umbilical cord is not only very low ranging from 0.3% to 2.1%, but also it often remains undiagnosed antenatally despite the availability of ultrasonography (USG). If the true knot remains tight, it may impede the circulation of the fetus and results in intrauterine fetal death (IUFD). We reported two cases of the true knot of the umbilical cord that ultimately led to fetal demise. Our first patient was a 25-year-old primigravida, with a singleton pregnancy of 35 weeks reported with complaints of absent fetal movements for the day. On examination, the patient was normotensive; the fundal height corresponded with the gestational age. The fetal heart sounds were absent on auscultation. The ultrasound confirmed IUFD. Labor was induced and the patient underwent uneventful vaginal delivery. However, the baby was stillborn. Two tight loops of the umbilical cord around the neck with true knots were found. Our second patient was gravida 2 with previous cesarean delivered 3 years back. She was pregnant 25 weeks and had a loss of fetal movement for the day. The fetal heart sounds were absent. She went into spontaneous labor and delivered vaginally. On examination, the true knot in the umbilical cord was seen.