Prenatal Surveillance Research Articles

Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios

ObjectiveThe purpose of this report is to describe the results of a pregnant woman demonstrating breech fetal presentation who was managed with Webster technique in the presence of oligohydramnios. Clinical FeaturesA 23-year-old primigravida woman sought chiropractic care for the management of breech presentation and bilateral sacroiliac arthralgia at 34 weeks’ gestation. Intervention and OutcomeSacral manipulation and abdominal effleurage (Webster Technique) was used to address breech presentation and sacroiliac arthralgia for a total of 7 treatments over a 3 1/2-week duration. The patient’s sacroiliac pain reduced from 8/10 to 3/10. However, breech presentation was unchanged at each treatment. At a scheduled prenatal surveillance during the 37th week of gestation, the midwife detected vaginal bleeding and reduced fundal height, which resulted in hospitalization, diagnosis of oligohydramnios, and an emergency cesarean delivery. ConclusionFor this particular patient, the breech presentation was not corrected using the Webster technique. Clinicians who use the Webster technique to manage breech fetal presentation should be aware of undiagnosed comorbidities as a complicating factor in clinical presentation. Screening for previously undiagnosed comorbidities, such as oligohydramnios, must be considered.

989 A Retrospective Cohort Study to Assess the Association Between Outdoor Air Quality and Low Birth Weight

IntroductionLow birth weight (LBW) is defined by the World Health Organization as weight at birth of less than 2500 g. Epidemiological observations suggest that LBW contributes to a range of...

Risk factors for obstetric vesicovaginal fistula at University Teaching Hospital, Yaoundé, Cameroon

International Journal of Gynecology & ObstetricsVolume 118, Issue 3 p. 256-258 Brief communications Risk factors for obstetric vesicovaginal fistula at University Teaching Hospital, Yaoundé, Cameroon Pierre Marie Tebeu, Corresponding Author Pierre Marie Tebeu pmtebeu@yahoo.fr Department of Obstetrics and Genecology, University Centre Hospital, Yaoundé, Cameroon Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, Switzerland Geneva Foundation for Medical Education and Research, SwitzerlandCorresponding author at: Department of Obstetrics and Gynecology, University Centre Hospital, 4772 Yaoundé, Cameroon. Tel.: + 237 77 67 55 33.Search for more papers by this authorSuzy Dorine Maninzou, Suzy Dorine Maninzou Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, SwitzerlandSearch for more papers by this authorGisele Kengne Fosso, Gisele Kengne Fosso Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, SwitzerlandSearch for more papers by this authorBonaventure Jemea, Bonaventure Jemea Department of Anesthesia and Reanimation, University Centre Hospital, Yaoundé CameroonSearch for more papers by this authorJoseph Nelson Fomulu, Joseph Nelson Fomulu Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, SwitzerlandSearch for more papers by this authorCharles Henry Rochat, Charles Henry Rochat Geneva Foundation for Medical Education and Research, SwitzerlandSearch for more papers by this author Pierre Marie Tebeu, Corresponding Author Pierre Marie Tebeu pmtebeu@yahoo.fr Department of Obstetrics and Genecology, University Centre Hospital, Yaoundé, Cameroon Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, Switzerland Geneva Foundation for Medical Education and Research, SwitzerlandCorresponding author at: Department of Obstetrics and Gynecology, University Centre Hospital, 4772 Yaoundé, Cameroon. Tel.: + 237 77 67 55 33.Search for more papers by this authorSuzy Dorine Maninzou, Suzy Dorine Maninzou Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, SwitzerlandSearch for more papers by this authorGisele Kengne Fosso, Gisele Kengne Fosso Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, SwitzerlandSearch for more papers by this authorBonaventure Jemea, Bonaventure Jemea Department of Anesthesia and Reanimation, University Centre Hospital, Yaoundé CameroonSearch for more papers by this authorJoseph Nelson Fomulu, Joseph Nelson Fomulu Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Geneva, SwitzerlandSearch for more papers by this authorCharles Henry Rochat, Charles Henry Rochat Geneva Foundation for Medical Education and Research, SwitzerlandSearch for more papers by this author First published: 20 June 2012 https://doi.org/10.1016/j.ijgo.2012.04.011Citations: 8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume118, Issue3September 2012Pages 256-258 RelatedInformation

Outcomes of prenatally diagnosed sacrococcygeal teratomas: the results of a Japanese nationwide survey

Background/PurposeFew large multicenter surveys have been performed on sacrococcygeal teratomas (SCTs) describing both the prenatal and postnatal courses. The aim of this study was to review and report on the prenatal surveillance and postnatal outcome of a large cohort of fetuses with SCTs in Japan. MethodsA nationwide retrospective cohort study was conducted on 97 fetuses prenatally diagnosed with SCTs between 2000 and 2009. The prenatal course, perinatal data, and postnatal outcome were reviewed. ResultsEleven pregnancies were terminated before 22 weeks of gestation. Of the 86 remaining fetuses, 3 died in utero, and 83 were delivered. Three infants died before surgery, and 8 infants died after excisional surgery. The overall mortality was 26%, with a mortality excluding terminations of 16%. The gestational age at delivery was younger than 28 weeks in 5, 28 to 31 weeks in 13, 32 to 36 weeks in 27, and 37 weeks or more in 37 cases, with mortality rates of 60%, 38%, 11%, and 0%, respectively. The tumor component was predominantly cystic in 54 and predominantly solid in 32 cases, with mortality rates of 2% and 33%, respectively. ConclusionsThe overall mortality of prenatally diagnosed SCTs excluding terminations was 16%. Early delivery and predominantly solid component tumors were associated with an increased risk of mortality.

Chorionicity and perinatal complications in twin pregnancy: a 10 years case series

OVERVIEW AND AIMS: Multiple pregnancy accounts for about 3% of all pregnancies. The monochorionic pregnancy presents a relatively constant incidence (1:250 pregnancies) unlike the dichorionic, which is influenced by race, heredity, maternal age, parity and medically assisted procreation. The purpose of this work was to evaluate the impact of chorionicity on perinatal morbidity of twin pregnancy. Retrospective, longitudinal, descriptive and analytical study of women with twin pregnancy whose birth occurred in our maternity hospital since January/1999 until December/2008. monochorionic and dichorionic twin pregnancies confirmed by ultrasound. monochorionic monoamniotic gestation. Demographic data, delivery variables and perinatal morbidity and mortality were studied. Data were evaluated using the χ2 test (qualitative variables), t-Student (continuous quantitative variables) and Mann-Whitney test (quantitative discrete variables). We studied 504 pregnancies (356 dichorionic diamniotic and 148 monochorionic diamniotic). The monochorionic pregnancy had a higher incidence of threatened preterm labor (43,9% vs 31,5%, p<0,05), of oligohydramnios/hydramnios (9,8% vs 3,3%, p<0,001), discordant fetal growth (26,8% vs 14,8%, p<0,001) and intrauterine growth restriction (7,4% vs 3,7%, p<0,05). Prematurity was more common in the monochorionic group (p<0,001). The cesarean delivery rate was higher in monochorionic pregnancy (58,8% vs 50,3%, p<0,05) and the average weight of newborns was lower in monochorionic pregnancies (1983g vs 2233g, p<0,001). Newborns in the monochorionic group had higher incidence of hyaline membrane disease (5,8% vs 2,8%, p<0,05) and intraventricular haemorrhage (2,1% vs 0,4%, p<0,05). The perinatal mortality was higher in the monochorionic group (7,8% vs 1,8%, p<0,001). As the morbidity and mortality associated with monochorionic pregnancies are higher, it is essential to perform an early detection of chorionicity by ultrasound (11-13 weeks) in order to place differentiated prenatal and appropriate peripartum surveillance.

158: Prenatal diagnosis, antenatal surveillance, and timing of delivery for vasa previa: a national survey

home administration group vs. physician’s office group for both those with 1 PTD (25.6% vs. 39.4%) and with 2 or more PTD (34.7% vs. 50.7%). Logistic regression model results are presented in Table. CONCLUSION: Women enrolled in a 17P home administration program received a greater number of 17P injections and had lower rates of SPTD than those women that received 17P in an office setting. After controlling for significant clinical differences between the groups those having 17P home administration had a 43% lower risk for SPTD compared to women receiving 17P injections at their physician’s office.

OP06.06: Prenatal surveillance of growth restricted fetus in late second trimester

OP06.06: Prenatal surveillance of growth restricted fetus in late second trimester

Influence of ethnicity on the clinical and biologic expression of pre-eclampsia in the ECLAXIR study

Objective To determine whether ethnic origin is related to the clinical and biologic expression of pre-eclampsia. Methods In a secondary analysis of information collected in the ECLAXIR study in France between May 2003 and October 2006, the data from 284 white European, 84 Maghrebian and 158 African women were evaluated in a case–control study of the genetic and endothelial determinants of pre-eclampsia. Results African origin was a risk factor for pre-eclampsia before 28 weeks of gestation. Symptoms related to hypertension, such as neurologic signs and changes in biologic parameters (e.g. hemolysis elevated liver enzymes, low platelet count [HELLP] syndrome), occurred more frequently among white European women. After logistic regression, gestational age at delivery was lower for African women than for white European women (33.4 weeks versus 34.4 weeks of gestation, P = 0.04). Conclusion The results suggest that ethnic origin may have a role in the expression of pre-eclampsia, and should therefore be taken into account in prenatal surveillance. Further research on the genetic factors involved in endothelial dysfunction is warranted.

Entrecruzamiento de cordones en la gestación gemelar monocorial monoamniótica

Monochorial monoamniotic twins are at high risk of fetal death due to the general complications seen in multiple gestations, as well as those specific to this type of pregnancy. The most severe complication in these pregnancies is fetal death due to cord entanglement, which occurs in almost all cases. Early ultrasonographic diagnosis and intensive prenatal surveillance are essential for the early detection of cord entanglement and the prevention of fetal death. The need for in-hospital management and the exact gestational age for delivery continue to generate controversy in the literature.

Sonographic evaluation of the fetal conus medullaris at 20 to 24 weeks' gestation

To determine the normal level of the conus medullaris (CM) of the spinal cord of normal fetuses at 20 to 24 weeks' gestation using abdominal sonography. Using a 4 to 8 MHz ultrasound abdominal transducer, CM was imaged in the midsagittal plane with the fetal spine facing toward the transducer. The CM ending level was located by counting the vertebrae caudal starting at T12, which was identified by lowest fetal rib. The CM locations were defined according to their positions relative to the vertebrae. One hundred and ten consecutive pregnant women were included in the study. The CM was clearly demonstrated in 78 (71%) of these cases. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 inter-space and L3 (73/78, 93%). The L1-2, L2, L2-3, and L3 vertebral groups did not differ in mean gestational weeks, maternal age, or fetal gender. The level of the CM can be determined at 20 to 24 weeks' gestation in about 70% of fetuses. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 vertebral space, and L3 (73/78, 93%). When detected lower than the third lumbar vertebra it should prompt prenatal and postnatal surveillance.

Imagens construídas em torno da gravidez

The present article is based on a study carried in six municipalities of Braga district where we performed semi-structured interviews to 100 women who had just given birth in a maternity hospital in the northern area of the country and whose residence were located in the municipalities of Amares, Braga, Póvoa de Lanhoso, Vila Verde, Vieira do Minho and Terras de Bouro. We tried to identify the representations of these women in reference to their pregnancy experience, where we point out that the origin of these representations is connected to a triangulate vision of the concept of health, illness and of the body. And all these concepts constitute extraordinarily positive aspects since some contribute towards an affectionate connection to the baby or a prenatal bond. It is important to point out that the knowledge hereby revealed is at most times a result of beliefs culturally rooted and that should be analysed or demystified upon the prenatal surveillance consultation.

P18.07: Managing severe fetal anemia due to a new form of εγγδβ thalassemia in a Nordic family: intrauterine transfusions prior to final diagnosis

This case highlights the need to consider diagnoses of rare conditions not normally associated with a particular population. A hydropic fetus presented at 29 + 1 weeks with extensive ascites, pericardial fluid, enlarged heart and hyperkinetic circulation. Maximum velocity in the middle cerebral artery was 76 cm/s. The etiology of the fetal anemia was unknown. Both parents were of Nordic origin. The family history revealed that the father was born with anemia, in need of neonatal transfusions. No conclusive explanation for his anemia was found. His physical and neurological development was normal, although the microcytic anemia persisted. The family history made us consider a hereditary anemia in the fetus. The first cordocentesis revealed a microcytic anemia with Hb 5.8 g/dl, Hct 0.19, MCV 91 fl. Six intrauterine transfusions, until 34 completed weeks, were performed. The female infant was delivered by Cesarean section at 36 weeks. Her initial Hb level (transfused) was 14.1 g/dl; at one month of age her Hb was 8.8 g/dl, MCV 78 fl. She was transfused at this stage and again at about 2 months; since then her Hb has been stable at about 9 g/dl. She is healthy and her physical and neurological development has been normal. In the father, a deletion of the 5′ end of the β globin gene cluster was characterised, the breakpoints sequenced and a new type of eγγδβ thalassemia identified. Analysis of the daughter’s DNA by MPLA and Southern blotting confirmed that she had inherited the deletion chromosome from her father. The clinical presentation of eγγδβ thalassemia may vary but neonatal transfusions are frequently required due to marked neonatal anemia. A thorough family history may provide the suspicion of the potential diagnosis. Intrauterine transfusions should always be considered while further investigation takes place. A correct diagnosis provides a probable prognosis and also allows early prenatal diagnosis and optimal surveillance in future pregnancies.

Sacrococcygeal Teratomas: Prenatal Surveillance, Growth and Pregnancy Outcome

Objective: Prenatal surveillance and growth characteristics are evaluated in a cohort of fetuses with sacrococcygeal teratomas (SCT) as part of risk assessment. Methods: Retrospective review of 23 fetuses with SCT: prenatal diagnosis, surveillance, delivery, and early postnatal outcome are reported. Results: Cardiac output failure physiology requires serial evaluation. The size of the SCT determines obstetrical risks and mode of delivery. An SCT growth rate approaching >150 cm³ per week may be associated with increased perinatal mortality risks. Maternal morbidity is related mainly to polyhydramnios and preterm labor. Conclusions: Perinatal mortality is approximately 43%. Maternal-fetal surgery for fetal physiologic deterioration is not frequent, but serial surveillance is required to minimize fetal morbidity/mortality and maternal morbidity. Rapid SCT growth rates may be associated with increased risk of perinatal mortality.

Neonatological and pulmonological management of bilateral pulmonary sequestration in a neonate

Bronchopulmonary sequestration is a lung malformation characterized by nonfunctioning lung tissue without primary communication with the tracheobronchial tree. Intrauterine complications such as mediastinal shift, pleural effusion or fetal hydrothorax can be present. We present the case of a newborn with bilateral intralobar pulmonary sequestration. Prenatal ultrasonography in a primigravida at 20 weeks of gestation revealed echogenic masses in the right fetal hemithorax with mediastinal shift towards the left side. Serial ultrasound confirmed persistence of the lesion with otherwise appropriate fetal development. Delivery was uneventful and physical examination revealed an isolated intermittent tachypnea. Chest CT scan and CT angiography showed a bilateral intrathoracic lesion with arterial supply from the aorta. Baby lung function testing suggested possible multiple functional compartments. Right and left thoracotomy was performed at the age of 7 months. A bilateral intralobar sequestration with vascularisation from the aorta was resected. Pathological and histological examination of the resected tissue confirmed the surgical diagnosis. At the age of 24 months, the child was doing well without pulmonary complications. Bilateral pulmonary sequestration requires intensive prenatal and postnatal surveillance. Though given the fact of a bilateral pulmonary sequestration, postnatal outcome showed similar favourable characteristics to an unilateral presentation. Baby lung function testing could provide additional information for optimal postnatal management and timing of surgical intervention.

Discovery of soft markers on fetal ultrasound: maternal implications

Objective to explore women's experiences of referral to tertiary care on the basis of uncertain ultrasound findings. Design a qualitative method using Rice and Ezzy's thematic analysis approach. Data were gathered through two in-depth interviews over a six to eight-month period. Participants a total of 20 interviews were conducted among pregnant women, purposively recruited at a tertiary facility. Inclusion criteria were based on detection of an isolated soft marker in an otherwise normal pregnancy. Data analysis interview data were transcribed and data were subjected to thematic analysis. Findings mothers journeyed through a temporal sequence of adjustment following referral to specialist services. Four distinct phases were identified: realisation; making sense of events; anxious waiting; and having no clear resolution. Conclusion trends of increasing prenatal surveillance together with advancing technology make this study timely and of global interest. Findings suggest that women identified as ‘at risk’ before being discharged uneventfully may be prone to attachment issues and a host of other difficulties. The complexities inherent in this experience should be of interest to a broad range of health professionals. An appreciation of this experience may assist midwives and other health professionals to provide more meaningful maternal support to women identified as ‘at risk’.

The outcome of gastroschisis after a prenatal diagnosis or a diagnosis only at birth: Recommendations for prenatal surveillance

Objectives To establish in infants with gastroschisis whether outcome is different when comparing a prenatal diagnosis with a diagnosis only at birth with the intention to develop a prenatal surveillance protocol. Intestinal atresia established after birth and preterm versus term delivery were studied as risk factors. Study design All 24 fetuses and 9 infants diagnosed with gastroschisis and referred to our tertiary center between January 1991 and June 2003 were studied retrospectively. Results The infants of the prenatal subset delivered at our tertiary center and 18 survived. There were two pregnancy terminations, three intrauterine deaths at 19, 33 and 36 weeks respectively and one neonatal death. All nine infants in the postnatal subset survived. Eight were out born and one was delivered at our tertiary center. Prenatal bowel dilatation did not correlate with outcome. Between the prenatal and postnatal subset no significant difference in outcome of live-born infants was established. For four infants with intestinal atresia a significant difference was demonstrated for induction of preterm labour ( P < 0.05), duration of parenteral nutrition ( P < 0.01), number of additional surgical procedures ( P < 0.001) and length of hospital stay ( P < 0.01). The fifteen infants born prior to 37 weeks of gestation spent a significantly longer period in hospital compared to those delivered at term. When the cases with bowel atresia were excluded this difference was no longer present. Five of the 33 cases were diagnosed with associated anomalies which mainly involved the urinary tract. Conclusion Neonatal outcome of live born infants following a prenatal diagnosis of gastroschisis is not different from a diagnosis at birth. The presence of intestinal atresia is the most important prognostic factor for morbidity. The supplemental value of prenatal diagnosis to the outcome of infants with gastroschisis may be in the prevention of unnecessary intrauterine death and detection of intestinal complications. A proposed surveillance protocol for fetuses with gastroschisis focused on intrauterine signs of pending distress such as a dilated stomach, intra abdominal bowel dilatation with peristalsis, notches in the umbilical artery Doppler signal, development of polyhydramnios and an abnormal CTG registration may improve outcome.

Regional and International Prenatal Telemedicine Network for Computerized Antepartum Cardiotocography

The objective of this work was to review the activity of TOCOMAT, a system for antepartum cardiotocographic telemonitoring. Nine peripheral units recorded the traces, transmitted them via modem to the University operation center, where the computerized analysis was performed, and received the medical report within a few minutes, via fax or e-mail. Traces were classified as reassuring, nonreassuring, or pathological. The parameters of computerized analysis were grouped together for each week of gestation. The perinatal outcome was also evaluated. In 5 years, 5830 traces were analyzed: 4372 (75%) from 1344 high-risk patients and 1458 (25%) from 529 patients at apparent low risk. The system allowed the identification of high-risk patients (32.8% with nonreassuring traces and 7.1% with pathologic traces) and lowrisk patients (16.3% with nonreassuring traces and 4.3% with pathologic traces) that required further evaluation. The neonatal outcome was good overall. At each week of pregnancy, the mean values of computerized parameters resulted in normal ranges. The TOCOMAT system allowed a decentralization of prenatal surveillance and improved the patients quality of life and the level of prenatal care.

Pilot test of prenatal surveillance for birth defects in South Texas.

The Texas Birth Defects Registry (TBDR) does not access prenatal diagnostic facilities to ascertain cases. Objectives of the study were to determine how many cases may be missing from the registry as a result, and to assess the feasibility and utility of prenatal surveillance for birth defects, through a pilot test in one region of Texas. A trained abstractor reviewed medical records of all patients with abnormal ultrasound findings during 2004 in all prenatal diagnostic facilities in Texas Health Region 11 (n = 6 facilities). When birth defects were prenatally detected, demographic and diagnostic data were abstracted. Prenatal abstractions were matched to cases in the TBDR. Those that did not match to registry cases were matched to vital records to determine where and when the pregnancy ended; delivery hospital medical records were reviewed for these cases. Approximately 760 patient charts were reviewed at prenatal diagnostic facilities and 365 were abstracted. Of these, 165 (45%) matched to cases in the TBDR. Delivery medical records were located and reviewed for 177 prenatal abstractions, with 170 (47%) indicating at delivery no defects monitored by the registry. Delivery records for one (0.3%) prenatal abstraction were not found by the hospital. Date and place of delivery were unknown for 22 (6%) prenatal abstractions. Only eight additional infants and fetuses (one twin pair) eligible for the registry were identified. For Texas Health Service Region 11, it is not necessary to conduct surveillance in prenatal diagnostic facilities, and to do so would be very labor-intensive.

Gestion anténatale et issue postnatale des fœtus atteints de laparoschisis

To assess the relevance and the quality of gastroschisis's care in a mid level referral centre. A retrospective analysis was performed for infants diagnosed or born with gastroschisis between 1992 and 2003 at the Citadelle hospital, Department of Obstetrics and Gynaecology, University of Liège. Twenty-four cases of gastroschisis were identified. For 22 of them (92%) antenatal sonographic diagnosis was performed at a mean gestational age of 23 weeks. Antenatal diagnosis did not allow to identify additional malformation or chromosomal anomaly. Postnatal diagnosis allows to identify 3 infants with minor cardiac anomalies without functional consequence and one X fragile syndrome. One pregnancy was electively terminated at 24 weeks and one late intrauterine death was reported at 35 weeks. Bowel atresia, stenosis or ischemia were present at birth for 8 cases (33%). Out of 24 cases 22 were live born. 10 infants out of 22 (45%) underwent uncomplicated primary surgical repair. Three infants out of 22 (14%) underwent delayed closure without complications. Nine infants out 22 (41%) underwent multiple surgery (2 to 6). In this group all had postnatal complications, some with multisystem complications, including 3 deaths, 6 with infectious complications, 5 with gastrointestinal complications and 2 with genitourinary or haematological complications. Hospital stay range from 19 to 378 days (median, 51 days). Length of stay and time to full enteral feeding were longer if oligohydramnios or sonographic signs of intestinal damage were found. Among infants born before 35 weeks, only those with intestinal damage at birth had length of stay or time to full enteral feeding longer. Out of 22 live born infants 19 survived (86%) after one year. Survival rate without handicap due to gastroschisis is 84%. Sonographic examination is a valid method for prenatal diagnosis and surveillance. Our survival rate agrees with recent data in the literature. It has to be noticed that hospital stay is lengthy and complications are frequent. The most important prognostic factor is the condition of the bowel at birth and there is no antenatal means to predict severe damage.

True Knot of the Umbilical Cord: A Report of 13 Cases

True knots of the umbilical cord are complications that can result in obstetric disasters, including fetal asphyxia and eventual fetal death. This study reports on 13 patients with a true knot of the umbilical cord in a delivery population of 967 deliveries during a 1-year period. In this group, there was one second-trimester fetal demise, four cases of fetal distress during labor necessitating cesarean delivery, and eight cases with a true knot found incidentally at delivery. No abnormal sequelae were found for the 12 viable newborns. True knots of the umbilical cord can be incidental findings; however, a tightened knot is reported to be associated with a fourfold increased risk of fetal death. Prenatal fetal surveillance, including targeted sonographic examination and Doppler studies, may identify true knots of the umbilical cord. Identification of high-risk patients and clinical expertise in the management of these patients have not been established.