The Significance of True Knot of the Umbilical Cord in Long-Term Offspring Neurological Health.

Yael Lichtman,Eyal Sheiner,Asnat Walfisch,Tamar Wainstock

doi:10.3390/jcm10010123

Yael Lichtman, Eyal Sheiner + Show 2 more

Open Access

https://doi.org/10.3390/jcm10010123

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Abstract

We aimed to study both the short- and long-term neurological implications in offspring born with confirmed knotting of the umbilical cord—“true knot of cord”. In this population based cohort study, a comparison of perinatal outcome and long-term neurological hospitalizations was performed on the basis of presence or absence of true knot of cord. A Kaplan–Meier survival curve was constructed to compare the cumulative incidence of neurological hospitalizations between the study groups. Multivariable regression models were used to assess the independent association between true knot of cord, perinatal mortality and long term neurological related hospitalizations, while controlling for potential confounders. The study included 243,639 newborns, of them 1.1% (n = 2606) were diagnosed with true knot of the umbilical cord. Higher rates of intrauterine fetal demise (IUFD) were noted in the exposed group, a finding which remained significant in the multivariable generalized estimation equation, while controlling for confounders. The cumulative incidences of neurological hospitalizations over time were comparable between the groups. The Cox regression confirmed a lack of association between true knot of cord and total long term neurological related hospitalizations. While presence of true knot of the umbilical cord is associated with higher IUFD rates, in our population, however, its presence does not appear to impact the long term neurological health of exposed offspring.

Highlights

Knotting of the umbilical cord—“true knot of cord”—is a rather rare event [1] and a challenging antepartum diagnosis [2]
Adjusted Hazard Ratio (Confidence Interval). In this large retrospective cohort study with a long follow up period, we found increased rates of adverse obstetrical outcomes in pregnancies associated with true knot of cord, and with intra-uterine fetal demise, as well as low Apgar scores, preterm deliveries, cesarean deliveries, and meconium stained amniotic fluid
In the long term perspective, no association was found between true knot of cord and long term adverse neurological outcome in the offspring, up to 18 years of age

Summary

Introduction

Knotting of the umbilical cord—“true knot of cord”—is a rather rare event (about 1%of term deliveries) [1] and a challenging antepartum diagnosis [2]. The exact timing of formation of these cord knots is a matter of debate—some argue that knotting of the umbilical cord takes place early in the antenatal course during the late first trimester due to increased amniotic fluid volume/fetal size ratio, while others think that this event mainly takes place during labor [8]. Attempts to diagnose this condition antepartum have been disappointing [2], even with the latest advancements in Doppler sonography, and most cases are recognized only postpartum [9]

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