Diagnosis of true umbilical cord knot

Abstract

IntroductionMany abnormalities are observed in the morphology and pathology of the umbilical cord. The aim of the study was to assess the role of 3D sonography in pathology of true umbilical cord knots.Material and methodsIn our materials we observed 10 cases of true umbilical cord knots in a population of 2,864 deliveries. The 2-dimensional transverse scan of the umbilical cord was shown in 3- and 4-dimensional volume scan in order to get a precise image.ResultsFour knots were diagnosed prenatally, 3 knots were not diagnosed before the delivery and in the 3 remaining cases ultrasound examinations were not undertaken because the patients were in the course of delivery. In the pregnant subjects with diagnosed true umbilical cord knot once a week the Doppler blood flow indices were examined in the umbilical cord sections before and after the knot. In the three shown cases there were no signs of constriction or tightening of the knot. Four newborns were delivered spontaneously and five by caesarean section. In none of the cases was a pathological FHR trace an indication for emergency delivery.ConclusionsFour-dimensional and Color Doppler examination is very important to diagnose a true umbilical cord. To make a precise diagnosis a longer observation of the abnormality is necessary and its repeated confirmation by color Doppler and power Doppler. This diagnosis requires strict monitoring of fetal wellbeing during pregnancy and the delivery. Perfection of true umbilical cord knot diagnoses may reduce sudden and unforeseen fetal distress.

HDlive for Assessment of Placenta and Umbilical Cord

“…31 Although, many umbilical cord abnormalities are detectable by conventional 2D sonography, [32][33][34][35] the demonstration of their entire view is impossible, especially in the third trimester of pregnancy. 1,4,6,9 Three-dimensional ultrasound allows visualization of umbilical cord abnormalities in all three dimensions at the same time, providing an improved overview and a more clearly defined demonstration of adjusted anatomical planes. 1,6,36,37 HDlive pictures of umbilical cord abnormalities are more readily discernible than those obtained by conventional 3D ultrasound.…”

“…[1][2][3][4][5][6][7][8][9] Three-dimensional ultrasound has the potential to provide improved visualization of the placental and umbilical cord anatomic morphology compared to twodimensional (2D) sonographic imaging. 10 HDlive, the latest ultrasound technology, facilitates the creation of clearer placental and umbilical cord images than those obtained using conventional 3D ultrasound owing to better depth perception and the depiction of skin-like colors, which gives the placental and umbilical cord images a more realistic appearance.…”

True knot of the umbilical cord in advanced weeks of pregnancy: a case report

“…5 Guzikowski et al detected 10 true umbilical knots in 2864 deliveries (3.5%). 6 Most of the patients were multiparous (80%). Four of the patients were diagnosed with knots in the prenatal period while the remaining three were not examined with ultrasound as knots were found while they were in the delivery process.…”

“…Four of the patients were diagnosed with knots in the prenatal period while the remaining three were not examined with ultrasound as knots were found while they were in the delivery process. 6 Definitive diagnosis and ongoing monitoring of true umbilical knot may not only provide an explanation for UIGR but will also reduce abrupt and unexpected fetal distress. 6 A literature review suggests that a true umbilical knot does not have a specific ultrasound image.…”

“…6 Definitive diagnosis and ongoing monitoring of true umbilical knot may not only provide an explanation for UIGR but will also reduce abrupt and unexpected fetal distress. 6 A literature review suggests that a true umbilical knot does not have a specific ultrasound image. 7 However, the pairing of anomalous images with one or more other factors may suggest a need for weekly follow-up monitoring, especially when the patient is a grand multipara or when amniotic fluid volume is above normal.…”