Knot Of Cord Research Articles

The benefit of active management in true knot of the umbilical cord: a retrospective study

PurposeTo compare perinatal outcomes between active and routine management in true knot of the umbilical cord (TKUC).MethodsA retrospective study of singletons born beyond 22 6/7 weeks with TKUC. Active management included weekly fetal heart rate monitoring(FHRM) ≥ 30 weeks and labor induction at 36–37 weeks. Outcomes in active and routine management were compared, including composite asphyxia-related adverse outcome, fetal death, labor induction, Cesarean section (CS) or Instrumental delivery due to non-reassuring fetal heart rate (NRFHR), Apgar5 score < 7, cord Ph < 7, neonatal intensive care unit (NICU) admission and more.ResultsThe Active (n = 59) and Routine (n = 1091) Management groups demonstrated similar rates of composite asphyxia-related adverse outcome (16.9% vs 16.8%, p = 0.97). Active Management resulted in higher rates of labor induction < 37 weeks (22% vs 1.7%, p < 0.001), CS (37.3% vs 19.2%, p = 0.003) and NICU admissions (13.6% vs 3%, p < 0.001). Fetal death occurred exclusively in the Routine Management group (1.8% vs 0%, p = 0.6).ConclusionCompared with routine management, weekly FHRM and labor induction between 36 and 37 weeks in TKUC do not appear to reduce neonatal asphyxia. In its current form, active management is associated with higher rates of CS, induced prematurity and NICU admissions. Labor induction before 37 weeks should be avoided.

True Umbilical Cord Knot without Adverse Perinatal Outcome: A Brief Review

True umbilical cord knots are not a common occurrence, however when they do present, it is ironic that despite having availability of antenatal ultrasound, they are not diagnosed antenatally most of the time, due to cord length and loops of cord making visibility poor. However with 4 dimension ultrasound and serial doppler study there can be better pick up rate. There is controversy around risks with true knots and cases of meconium stained liquor, low Apgar scores, hypoxic ischemic encephalopathy, other neonatal complications necessitating neonatal intensive care unit admission and fetal still birth have been reported. The umbilical cord attaches to the placenta and transfers blood, oxygen and nutrition to the fetus. A true umbilical cord knot happens when the cord loops over itself with fetal movements, a tight knot can impair the fetal circulation and lead to fetal hypoxia. In such a situation, fetal surveillance shows sub optimal cardiotocograph tracing, and when the patient is taken for emergency cesarian section, a tight umbilical cord knot is seen, which was causing fetal hypoxia. Certain conditions are more predisposed for true knots such as polyhydramnios, longer length of the cord, smaller than average size fetus, monoamniotic twins and multiparity. Our case report presents a true umbilical cord at an elective cesarian section in a primigravida. The patient had an uneventful pregnancy with regular fetal surveillance through ultrasound and doppler scans and fetal heart tracing. An elective cesarian section was performed at 38 weeks at patient’s request and at the time a nuchal cord and true umbilical cord was noted.

Pneumo-Scrotum as Diagnosis of Ectopic Air in Other Locations

A 43-year-old woman presented spontaneous delivery at 35+4 weeks. An unreactive fetus was born in addition to abruptio placentae, joint exit of placenta and fetus and a true cord knot. We proceed to a deep resuscitation. During the ventilation it was observed that the scrotal volume was increased. A X-ray was done confirming ectopic air in chest, peritoneum and scrotum. Pneumo-scrotum is a rare disease that has been described in immature newborns. It has been reported secondary as infection, after aggressive resuscitation, as a consequence of mechanical ventilation and secondary to gastric perforations. Its treatment is etiological. The simple thoracic and abdominal radiography are sufficient for diagnosis. In the neonatal period, the presence of pneumo-scrotum during resuscitation may reveal ectopic air in the thorax or peritoneum.

A sustained decrease in the systolic/diastolic ratio may be a sign of severe adverse events in the umbilical cord: a report of eight cases.

A high systolic/diastolic (S/D) ratio of umbilical cord blood is a manifestation of intrauterine hypoxia. However, the clinical significance of a persistently decreased S/D ratio of umbilical cord blood has not been reported. We report eight cases of a persistently decreased S/D ratio of umbilical cord blood, with two cases of umbilical thrombus, five cases of excessive torsion, and one case of a true cord knot. Fetuses with a persistently decreased S/D ratio of umbilical cord blood may be at risk, and it may be an important indication of umbilical cord lesions.

Marginal cord insertion in placenta and true knot in umbilical cord: a case report

Background: The fetus and placenta are connected by the umbilical cord. Atypical cord attachment that occurs during pregnancy is called marginal cord insertion. However, placing the umbilical cord usually does not cause problems when a woman is pregnant. This study reported a case of marginal cord insertion in the placenta and a true knot in the umbilical cord. Case Presentation: We reported a case of a 39-year-old pregnant woman who was found to have an umbilical cord attached to the edge of the placenta on ultrasound in a singleton pregnancy. The appearance of the umbilical cord insertion was at the edge of the placenta, and there is a true knot in the umbilical cord that was not diagnosed during pregnancy.The incidence of true umbilical cord knots has been found to range from 0.04% to 3%. They are linked to four times the risk of stillbirth and significant perinatal morbidity (11%) rates. A four-dimensional and color Doppler examination is essential to diagnose a real umbilical cord. A more thorough examination of the anomaly and repeated confirmation with power and color Dopplers are required for an accurate diagnosis. Conclusion: We reported a case of a 39-year-old pregnant woman who was found to have an umbilical cord attached to the edge of the placenta on ultrasound in a singleton pregnancy. The appearance of the umbilical cord insertion is at the edge of the placenta, and there is a true knot in the umbilical cord that is not diagnosed during pregnancy.

A true umbilical cord knot- one diagnosis and two different perinatal outcomes

A true umbilical cord knot- one diagnosis and two different perinatal outcomes

Knots of the umbilical cord: Incidence, diagnosis, and management.

Knot(s) of the umbilical cord have received emphasis because the clinical assessments and sonographic literature show a crucial role in fetal outcomes. The true umbilical cord knot could be a knot in a singleton pregnancy or an entanglement of two umbilical cords in monoamniotic twins. Clinical manifestations are almost silent, which can raise clinical challenges. They worsen outcomes, and the pathology can be easily missed during prenatal visits because ultrasonographers do not pay attention to the cord during an obstetric ultrasound scan. However, most medical centers now have ultrasound machines that improve fetal assessment. The umbilical cord should be routinely evaluated during a fetal assessment, and suspicion of an umbilical cord knot can be more frequently diagnosed and is detected only incidentally. Clinical outcome is usually good but depends on the knot's characteristics and if it is tight or loose. In this review, we discuss pathophysiology, the theories on formation, the main risk factors, ultrasound signs and findings, different opinions in the management, and features of pregnancy outcomes feature.

Clinical significance of true umbilical cord knot: a propensity score matching study

ObjectiveTrue umbilical cord knot (TUCK) is a rare finding that often leads to intensified surveillance and patient anxiety. This study sought to evaluate the incidence, risk factors, and obstetric and neonatal outcomes of TUCK.MethodsA retrospective cohort study was conducted at a tertiary university medical center in 2007–2019. Patients with singleton pregnancies diagnosed postnatally with TUCK were identified and compared to women without TUCK for obstetric and neonatal outcomes using propensity score matching (PSM).ResultsTUCK was diagnosed in 780 of the 96,766 deliveries (0.8%). Women with TUCK were older than those without TUCK (32.57 vs. 31.06 years, P < 0.001) and had higher gravidity (3 vs. 2, P < 001) and a higher rate of prior stillbirth (1.76% vs. 0.43%, P < 0.01). Following covariate adjustment, 732 women with TUCK were compared to 7320 matched controls. TUCK was associated with emergency cesarean delivery due to non-reassuring fetal heart rate (2.54% vs. 4.35%, P = 0.008, OR 1.71, 95%CI 1.14–2.56) and intrapartum meconium-stained amniotic fluid (19.26% vs. 15.41%, P = 0.022, OR 1.31, 95%CI 1.04–1.65). Neonatal outcomes were comparable except for higher rates of 1-min Apgar score < 7 and neonatal seizures in the TUCK group. The stillbirth rate was higher in the TUCK group, but the difference was not statistically significant (1.23% vs 0.62%, P = 0.06, OR 1.96, 95%CI 0.96–4.03).ConclusionsTUCK has several identifiable risk factors. Pregnant women with TUCK may cautiously be informed of the relatively low risks of major obstetric or perinatal complications. The lower occurrence of stillbirth in the TUCK group warrants further study.

Association of placental and umbilical cord characteristics with cerebral palsy: national cohort study.

Cerebral palsy (CP) is a group of movement disorders usually diagnosed in childhood. A substantial proportion are thought to be caused by antenatal events. Abnormalities of the umbilical cord and placenta are associated with an increased risk of adverse neonatal outcomes, but it is unclear whether these conditions also carry an increased risk of CP. We aimed to determine whether abnormalities of the umbilical cord or placenta are associated with CP and assess if these associations differ by sex of the child or gestational age at birth. We performed a national cohort study by linking data from The Medical Birth Registry of Norway with other national registries. All liveborn singletons born between 1999 and 2017 (n = 1 087 486) were included and followed up until the end of 2019. Diagnoses of CP were provided by the Norwegian National Insurance Scheme and the Norwegian Patient Register. We used generalized estimating equations and multilevel log binomial regression to calculate relative risks (RR), adjusted for year of birth, and stratified analyses were carried out based on sex and gestational age at birth. Exposures were abnormal umbilical cord (velamentous or marginal insertion, single umbilical artery (SUA), knots and entanglement), and placental abnormalities (retained placenta, placental abruption and previa). A total of 2443 cases with CP (59.8% males) were identified. Velamentous cord insertion (adjusted RR (aRR), 2.11 (95% CI, 1.65-2.60)), cord knots (aRR, 1.53 (95% CI, 1.15-2.04)) and placental abnormalities (placenta previa (aRR, 3.03 (95% CI, 2.00-4.61)), placental abruption (aRR, 10.63 (95% CI, 8.57-13.18)) and retained placenta (aRR, 1.71 (95% CI, 1.32-2.22))) carried an increased risk of CP. Velamentous cord insertion was associated with CP regardless of gestational age or sex. A retained placenta was associated with a 2-fold increased risk for CP in males, while the associations of SUA and cord knot with CP were significant only among females. The detection of placental and umbilical cord abnormalities may help identify children at increased risk of CP. The associations between placental or umbilical cord abnormalities and the risk of CP do not vary substantially with gestational age at birth or sex of the child. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The role of the placenta in perinatal asphyxia, neonatal encephalopathy, and neurodevelopmental outcome: A review.

Perinatal asphyxia contributes significantly to neonatal deaths globally. This may occur due to the effects of various phenomena like uterine rupture, infections, maternal hemodynamic compromise (amniotic fluid embolus), placenta, and umbilical cord (umbilical cord knot, placental abruption, or compression). Perinatal asphyxia is the term used for interrupted blood flow or the exchange of gases in the fetus during the prenatal period. The reduced oxygenation induces a cascade of brain injuries, resulting in long-term damage to the infant's brain. Some infants exposed to perinatal hypoxia-ischemia will make an immediate recovery and have normal survival, while others may suffer from an evolving clinical encephalopathy. This review article focuses on the relationship between the placenta, neonatal encephalopathy, and neurodevelopmental outcome. It also aims to identify possible interventions and drive the focus of policymakers towards issues that evolve around perinatal asphyxia, neonatal encephalopathy, and neonatal care and that have a high impact on infant morbidity in sub-Saharan Africa.

TRUE KNOT OF UMBILICAL CORD- A HIDDEN HAZARD

The umbilical cord is the lifeline of the baby. It helps in performing various functions in utero. Abnormalities of the umbilical cord can compromise the fetus and pose a threat in utero. A true knot of the umbilical cord is one such entity, which is rare and challenging to diagnose in the antenatal period. It can be an incidental nding but sometimes a tight true knot is reported to be associated with a fourfold increased risk of fetal death. Prenatal fetal ultrasound and doppler studies may be helpful in the identication of the true knot.

True Knot of the Umbilical Cord and its Implications in the Fetal Well-Being

The true knot of the umbilical cord is a pathology with a relatively low incidence. However, it is associated with the risk of loss of fetal well-being and in severe cases with perinatal death. There are both maternal and fetal risk factors, with different associated perinatal outcomes. Prenatal diagnosis is a challenge for the attending physician and almost all cases are findings at birth once the cord has been observed. However, over time, ultrasound methods have been developed to search for it in cases where suspicion is high. and most cases are findings at birth, however, today ultrasound methods are available for their intentional search, mainly in patients with unidentified risk factors. Similarly, it should be suspected in the presence of an altered cardiotocographic record or one that shows a non-reassuring pattern, especially when there is no response to established intrauterine resuscitation maneuvers, such as left lateral decubitus position, supplemental oxygen and maternal hydration.

True Knot of the Umbilical Cord and its Implications in the Fetal Well-Being

True Knot of the Umbilical Cord and its Implications in the Fetal Well-Being

Nudo verdadero como causa de taquicardia fetal persistente. Reporte de un caso

Umbilical cord abnormalities are associated with adverse effects during pregnancy. The true umbilical cord knot is present in 0.3-2.1% of pregnancies and has been associated with fetal death. Risk factors include maternal age, high BMI, multiparity, hypertensive disorders, smoking, polyhydramnios, gestational diabetes, male sex of the fetus, and other malformations. Prenatal diagnosis of the true knot is rare and challenging. Most are diagnosed at birth and only 0.08% of true knots are diagnosed prenatally. Non-reassuring cardiotocography traces may be present, reflecting hypoxic or mechanical stress disrupting fetal oxygenation. The aim of this case report is to present a case of true umbilical cord knot presenting with persistent fetal tachycardia during labor, resolved by vaginal delivery. Keywords: True knot; umbilical cord; fetal achycardia; stillbirth; fetal asphyxia.

HUBUNGAN PENGETAHUAN IBU HAMIL TENTANG FAKTOR RESIKO ASFIKSIA PADA NEOANTUS DENGAN PERENCANAAN RUJUKAN PERSALINAN

Asphyxia is a condition in which the baby cannot breathe, thus reducing O2 and increasing CO2 which is bad. Risk factors for the incidence of asphyxia are maternal factors such as his disorder, presence of antepartum bleeding, maternal age less than 20 years or more than 35 years, primiparous and grande multiparous, low socioeconomic, preeclampsia and his disorders. Infant factors, namely respiratory depression due to anesthesia or analgesic drugs given to the mother, intracranial bleeding, congenital abnormalities, premature, postmature, location abnormalities, twins, shoulder dystocia, vacuum extraction, forceps, amniotic fluid mixed with meconium. Placental factors include umbilical cord twisting, short umbilical cord, umbilical cord knot, and umbilical cord prolapse. The purpose of this study was to determine the relationship between knowledge of pregnant women about risk factors for newborn asphyxia with delivery referral planning. This type of research is quantitative analytic with a cross sectional research design. This research was conducted at Puskesmas RI Sidomulyo with a research instrument in the form of a questionnaire. The results showed a relationship between mother's knowledge of risk factors for newborn asphyxia and delivery referral planning with p value = 0.007. This study is expected for midwives in providing midwifery services to pregnant women to provide knowledge about the risk factors for newborn asphyxia so that pregnant women can make a labor referral plan if during the delivery process they experience the risk of newborn asphyxia and the knowledge of pregnant women about risk factors for infant asphyxia. newborns so that they can plan a delivery referral if an emergency case is found in a newborn.

Adverse Perinatal Outcomes of True Knot of the Umbilical Cord: A Case Series and Review of Literature

A true knot of the umbilical cord (TKUC) is an actual knot formed in pregnancy. It is seen in approximately 0.3%-1.2% of all pregnancies. True knots are of significance as they can cause a wide spectrum of adverse perinatal outcomes like small for gestational age (SGA) fetus, low appearance, pulse, grimace, activity, and respiration (Apgar) score at birth, fetal hypoxia, and even fetal demise.Here, we report a case series of three patients with TKUC and the varied adverse perinatal outcomes associated with them. A low-risk primigravida at term gestation had a suspicious non-stress test (NST). Repeat NST after maternal resuscitation became pathological. Emergency cesarean delivery was performed in view of pathological NST persisting despite intrauterine resuscitation. A healthy male baby weighing 2920 g was delivered, and the umbilical cord had a true knot.A multigravida at 33 + 3 weeks of gestation was referred with fetal growth restriction (FGR). Color Doppler examination showed absent end-diastolic flow (AEDF) in the umbilical artery (UA). Cesarean delivery was performed in view of FGR stage two with AEDF in the UA at 34 weeks of gestation as per the Barcelona criteria. A male baby weighing 1505 g was delivered. The umbilical cord had a true tight knot. The baby had an Apgar score of 7 at one minute after birth but was shifted to the neonatal intensive care unit (NICU) in view of low birth weight and prematurity. The baby slowly gained weight and was discharged from NICU after 15 days in stable condition.A multigravida at 32 weeks of gestation was referred with intrauterine fetal demise. Ultrasonography confirmed the presence of a single intrauterine dead fetus corresponding to 30 + 4 weeks of gestation with an estimated fetal weight (EFW) of 1633 g, amniotic fluid index (AFI) equal to nine, and presence of Spalding’s sign. Induction of labor was done, and she expelled a dead macerated male fetus weighing 1825 g. The infantogram was normal. A true umbilical cord knot was found.The umbilical cord is the source of fetal blood supply; therefore, any cord abnormality can have a significant impact on the fetal outcome. There are various factors that can predispose to TKUC, such as polyhydramnios, increased cord length, monoamniotic twins, male baby, grand multiparity, small fetus, and amniocentesis. TKUC can lead to various adverse outcomes in pregnancy and labor like SGA fetus, low Apgar score at birth, fetal hypoxia, and fetal demise. TKUC increases the risk of fetal demise by as much as four times.With the development of advanced techniques such as three-dimensional/four-dimensional color Doppler ultrasounds, TKUC can be diagnosed antenatally in the form of a four-leaf-clover, a “hanging-noose sign,” or by an unusual multicolor pattern in the cord. The prenatal detection rate of TKUC is only 12%. It mostly remains undetected unless visualized incidentally. Although TKUC is not rare and can have serious outcomes, the importance of its antenatal diagnosis has not been determined. It should be suspected in patients with risk factors, and emphasis should be placed on its antenatal diagnosis on ultrasonography to avoid obstetric disasters in otherwise low-risk females. Though there is no specific management of these cases, a good clinical outcome can be achieved if TKUC is diagnosed antenatally and monitored closely until fetal maturity is attained.

Nudo verdadero de cordón umbilical, hallazgo incidental al nacimiento. Reporte de 4 casos en un hospital de tercer nivel.

The true umbilical cord knot is a pathology with an incidence relatively low. It is associated with the risk of loss of fetal well-being and stillbirth. There are both maternal and fetal risk factors, with different associated perinatal outcomes. Prenatal diagnosis of a true knot is a diagnostic challenge for the obstetrician, however, nowadays it is possible by ultrasound for incidental finding or by intentional search, mainly in patients with risk factors. In the same way it should be suspected in the presence of a non-reassuring cardiotocography, especially when there is no response to the usual intrauterine resuscitation maneuvers, such as left lateral decubitus position, supplemental oxygen and maternal hydration. The purpose of this report is to describe 4 cases of true knot in term pregnancies, in a third level hospital, where an incidence of 0.03% was estimated, with a mean gestational age of 39.3 weeks and a mean maternal age of 32.2 years. The main intrapartum findings were alterations in the cardiotocography, such as variable and late decelerations. The route of pregnancy resolution was equitable among the patients, 2 were resolved by vaginal delivery and the other 2 by cesarean section. Pregnancy was resolved by vaginal delivery in 2 of the patients, while the other 2 were resolved by cesarean section. One case of stillbirth was registered Keywords: Umbilical cord; true knot; perinatal outcomes; prenatal diagnosis.

Eating disorders and their impact during the gestational period

Introduction: Eating disorders can cause numerous problems for the physiology of the female body and consequences, such as infertility and difficulties during pregnancy and childbirth, can occur if they are present during a woman's reproductive age. Objective: The objective of this research was to analyze the impacts for mother and child that may be somehow related to the nutritional deficiency, whether active or not, of these women. Methodology: The methodology used was a bibliographic survey in the platforms PubMed, BIREME, SCIELO, using combinations of the following keywords in English: Eating Disorder AND Pregnancy, Anorexia, Bulimia. Result: According to the studies analyzed, the existence of some type of eating disorder, whether active or not, had a negative impact on the pregnancies of these women. Miscarriages, stillborn babies, premature birth, premature placental displacement, small newborn gestational age, umbilical cord knots and even neurological deficits could occur. Discussion: Low body mass index (BMI) was one of the main subjects of discussion in the studies, since it can increase the risk of pregnancy because the mother’s nutrients are crucial for a healthy gestation. Thus, it was concluded that medical, nutritional and psychological follow-up are essential for women with eating disorders, regardless of type, to be able to have a safe pregnancy for themselves and their babies. Keywords: Eating disorders; Mother-child impacts; Nervous bulimia; Anorexia nervosa; Gestational complications.

Antenatal Detection of True Knot in the Umbilical Cord - How Accurate Can We Be?

Umbilical cord knot (UCK) is associated with increased risk of fetal death, but is usually diagnosed only after delivery. Our objective was to examine the accuracy of prenatal ultrasound in the diagnosis of UCK and the outcomes of these pregnancies. A prospective study was performed on 56 patients in which UCK was suspected during a routine level-II anatomical scan (study group). Data included demographics, pregnancy outcome, and short-term neonatal follow-up. The control group included pregnant women with normal pregnancy without UCK in a 4:1 ratio matched for gestational age at delivery. True knot was observed postnatally in 54 out of 56fetuses (detection rate of 96.4 %). Gestational age at diagnosis of UCK was 22.1 ± 3.1 weeks. The female to male ratio was 1:1 in both groups. Maternal age and parity were significantly higher in pregnancies with UCK compared to controls. The mean gestational age at delivery was 37.1 weeks of gestation in the UCK group. There was no difference in the birthweight percentile. 47 patients (87 %) underwent induction of labor. There were no differences in the rate of cesarean section or Apgar scores. No neonate with UCK needed ventilation. None suffered from seizures and none needed brain imaging. There were no cases of fetal or neonatal death in the pregnancies with UCK. There is a high detection rate of UCK during targeted scan of the umbilical cord performed during the level-II anatomical scan. Careful pregnancy follow-up and early term delivery may result in excellent obstetrical outcomes.

Placental morphology – from theory to practice

The article provides a review of the literature on modern studies of macroscopic and microscopic changes in the placenta of the cases of complicated childbirth and diseases of the newborn. From a clinical point of view, the values ​​of such indicators as the length, tortuosity of the umbilical cord, its entry into the placenta are indicated. In particular, the influence of the length of the umbilical cord on the course of childbirth was considered – from an increased frequency of birth of children with a low Apgar score with a short umbilical cord to an increase in the risk of entanglement, prolapse, and a true knot of a long umbilical cord. The article explains the reasons for the formation of the tortuosity of the umbilical cord, data on its types and impact on the course of labor. The weight of the placenta is considered both in terms of absolute performance and from new perspectives on the assessment of placental-fetal ratio. In particular, its dynamics with the progression of the gestational period are presented, as well as the effect of its decrease on the increase in the risk of further development of diabetes mellitus and gestational hypertension in the mother. The researches that provide clinical rope of the macroscopic findings such as placental infarctions and retroplacental hematomas are analyzed. Acute and subacute infarction, as well as differences between retroplacental hematoma and clinically expressed premature placental abruption, are described. The processes and histological changes that accompany the maturation of chorionic villi, as well as the typical manifestations of insufficient remodeling of the spiral arteries, which, according to modern concepts, are the basis for the development of most gestational complications, are considered. A new concept for Ukrainian resources, such as the “villi maturity index”, which is defined as the ratio of the number of vascular syncytial membranes in 1 cm2 of the studied area of ​​the sample to the thickness of these membranes, is presented. It is known that a significant decrease of this indicator due to a decrease in the number of membranes and an increase in their thickness is typical in pregnancies complicated by severe preeclampsia and gestational diabetes mellitus.