Four‐dimensional and Doppler sonography in the diagnosis and surveillance of a true cord knot

Scioscia, Marco; M, Fornalè; Bruni, Francesco; Peretti, Daniela; Trivella, Giamberto

doi:10.1002/jcu.20757

Cited by 12 publications

(23 citation statements)

References 5 publications

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“…Subsequently, three-dimensional ultrasound has enabled precise depiction of a true knot of the umbilical cord ( Figures 5, 6, 7). [67][68][69][70][71][72][73][74][75][76] Notwithstanding the Figure 4 Power Doppler image depicting a true knot of the umbilical cord. Note the "smiley face" features (almost complete circle of umbilical cord [face outline] surrounding "eyes" and "mouth/smile"), representing the en-face presenting two umbilical arteries and umbilical vein, respectively.…”

Section: True Knot(s) Of the Umbilical Cordmentioning

confidence: 99%

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

Sherer

Amoabeng

Dryer

et al. 2020

IJWH

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Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of nonhypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.

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Section: True Knot(s) Of the Umbilical Cordmentioning

confidence: 99%

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

Sherer

Amoabeng

Dryer

et al. 2020

IJWH

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“…However, Marco Scioscia et al suggested 4-dimensional and color Doppler sonography as a diagnostic modality in this regard. 12 This case was a neonate who had an uneventful prenatal, perinatal, and postnatal course, despite having two true knots in the navel string. However, in two other similar cases, published in 1998 13 and 2017, 14 both embryos experienced IUGR and the fact that their umbilical cords showed two true knots is believed to be the probable cause of this situation.…”

Section: Discussionmentioning

confidence: 99%

Two knots in an umbilical cord with seventy centimeter length: A case report

Haghighi

Jahanshahi

Dini

2020

Clinical Case Reports

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“…The true knots are identified with increased tension and thus with a higher risk for obstetric and neonatal outcome intervention. The loose knots can tighten during pregnancy due to fetal movements, or during labor, leading to decreased flow in the cord blood [11]. The true knot of the umbilical cord has a relatively high incidence at birth [6,12].…”

Section: Classification and Epidemiologymentioning

confidence: 99%

“…Usually the true knot of umbilical cord is presented as an unexpected discovery at delivery and there is no increased risk to obstetric intervention or worsening in neonatal outcomes because most of them are loose [12]. On the other hand, the loose knot can tighten during pregnancy due to fetal movements or during delivery, leading to decreased blood flow through umbilical cord and consequent fetal distress, asphyxia and death [5][6][7]11]. This would happen especially after rigorous fetal movements.…”

Section: Pathophysiologymentioning

confidence: 99%

True Knot of Umbilical Cord: A Diagnosis and Prognostic Challenge

Pai¹

2014

BJMMR

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Introduction: True knot of the umbilical cord is characterized by a cord loop with increased tension and hence higher risk for obstetric and neonatal outcome intervention. It is a finding observed in 1-2% of births. Aim: Review the etiology, physiopathogeny, diagnosis and prognosis of true knot of the umbilical cord. Methodology: We carried out a review searching for scientific articles present in the electronic database PubMed, using the descriptors "true knot", "umbilical cord", "Doppler sonography" and "prenatal diagnosis". Articles published until 2013 were included in the review. Discussion: True knot of the umbilical cord is a relatively common finding at birth. However, its diagnosis in uterus is still quite rare. Several factors have been related to its etiology, including the size of the umbilical cord. Its appearance occurs mostly between 9 and 28 weeks of gestation, in the fetal period of greater mobility. The major part of the true knot of the umbilical cord is not associated to an increased risk of obstetric intervention and neonatal outcomes because most are loose. However, the true knots can tighten during pregnancy due to fetal movement or during labor, leading to reduced blood flow and consequent fetal asphyxia and death. As a result, the close monitoring of pregnancy in cases of true knot of umbilical cord is required. The prenatal diagnosis of a true knot of the umbilical cord can be a challenge. Sonographic complementary techniques, including color Doppler and Dopplervelocimetry can improve the detection rate and help to differentiate true from false knots. And this has important implications for the management and prognosis of pregnancy, besides consequences for the fetus and newborn.

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Four‐dimensional and Doppler sonography in the diagnosis and surveillance of a true cord knot

Cited by 12 publications

References 5 publications

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

Two knots in an umbilical cord with seventy centimeter length: A case report

True Knot of Umbilical Cord: A Diagnosis and Prognostic Challenge

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