Abstract
True knot of the umbilical cord is a very rare condition. Usually a true knot is noticed after delivery and does not lead to problems. It is relatively less common than the other umbilical cord anomalies. Most authors agree that there is little that can be done to prevent fetal death in undiagnosed true knot. In our case, the patient gave birth to a healthy male baby weighing 2700 grams by normal vaginal delivery after an ultrasound was suggestive of intrauterine growth restriction (IUGR). The baby’s Apgar scores were 8 at one minute and 9 at five minutes. The umbilical cord measured 125 cm and contained two loose true knots. It was surprising that the baby could survive until term with these two knots and we hypothesize that this was the cause of the IUGR. Our case was interesting as neither neurologic sequela nor intrauterine death developed, despite two true umbilical cord knots.
Highlights
True umbilical cord knots may occur in approximately 0.3-2% of all births.[1]
The umbilical cord measured 125 cm and contained two loose true knots. (Figure 1) It was surprising that the baby could survive until term with these two knots, and we hypothesize that this was the cause of the intrauterine growth restriction (IUGR)
Other indicators of potential true umbilical knot include the occurrence of IUGR or chronic hypertension, grand multiparity, gender, hydramnios and, history of amniocentesis
Summary
True umbilical cord knots may occur in approximately 0.3-2% of all births.[1]. The placenta is a discoid reddish-brown structure attached to the uterine wall that binds the fetus to the mother via the umbilical cord. True knot of the umbilical cord in advanced weeks of pregnancy: a case report. Diagnosis of a true umbilical cord knot includes routine ultrasound examination during pregnancy, color Doppler ultrasound, examination of the placenta and umbilical cord during delivery. Additional ultrasound findings showed the umbilical artery Doppler (S/D) was 2.80, uterine artery Doppler (S/D) was 1.71, middle cerebral artery Doppler (S/D) was 4.21 She was hospitalized due to labor and a spontaneous vaginal delivery was planned. She had regular prenatal care with ultrasound examinations; an umbilical knot was not detected. She gave birth to a healthy male baby weighing 2700 gram by normal vaginal delivery. The umbilical cord measured 125 cm and contained two loose true knots. (Figure 1) It was surprising that the baby could survive until term with these two knots, and we hypothesize that this was the cause of the IUGR
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