Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth

Sherer, David M.; Dalloul, Mudar; Sabir, Sasha; London, V.; Haughton, Michele; Abulafia, Ovadia

doi:10.1002/uog.15940

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…33 A healthy newborn was delivered by Cesarean at 33 and 1/7 weeks' gestation with the presence of a true knot confirmed at delivery. 32 In contrast to single nuchal cords, which occur in between 15.8% and 30% of singleton fetuses at term, and have not been unequivocally associated with significant adverse perinatal outcome, 6,20,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] true knot(s) of the umbilical cord occur in 0.04% to 3% of deliveries, and have been associated with perinatal morbidity in 11% of cases, and a notable 4 to10 fold increase in stillbirth. 28,29,[53][54][55][56][57][58][59][60][61][62] Although (multiple) true knots of the umbilical cord have been infrequently implicated with fetal growth restriction, a causal association remains unproven.…”

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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“…High order nuchal cords comparable to this case are a rare occurrence in obstetrics. The incidence of a nuchal cord of three loops or greater was 0.5% in one study 6. Indeed, nuchal cords of the magnitude noted in our case are only noted in case reports, often with associated fetal demise.…”

Section: Discussionmentioning

confidence: 39%

Caesarean delivery of a breech singleton with eight loops of nuchal cord

et al. 2022

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Nuchal cord accidents comprise a third of stillbirths in the third trimester. These are often due to higher order nuchal cords, with more than three loops. In this report, we discuss a case of a gestation complicated by a nuchal cord with eight loops and severe fetal growth restriction, requiring expedited delivery due to non-reassuring fetal heart tones. Our case demonstrates the value of high-quality ultrasound in detecting complex nuchal cords, as well as highlighting the potentially dynamic and unstable fetal status in an affected gestation. Antenatal knowledge of nuchal cord in the setting of non-reassuring fetal status can help guide patient counselling and assist with identifying possible aetiologies. Finally, our case demonstrates that close monitoring and early intervention can prevent potentially catastrophic outcomes.

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“…Most are not associated with perinatal morbidity and mortality, but a few studies have shown that NC can affect the outcome of delivery with possible long-term effects on the infants [4]. The incidence of single, double, triple, or quadruple NC at delivery has been reported as 10.6 %, 2.5 %, 0.5 %, and 0.1 %, respectively [5]. Acute umbilical disorders (by compression, knot, or prolapse) are relatively common obstetric events that could significantly affect perinatal morbidity.…”

Section: Introductionmentioning

confidence: 99%

True umbilical cord knot and tight nuchal cord loops as a cause of fetal distress and emergent cesarean delivery: A Case report

2021

J Med Case Rep Case Ser

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Persistent quadruple nuchal cord throughout the third trimester associated with decelerating fetal growth

Cited by 5 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>

Caesarean delivery of a breech singleton with eight loops of nuchal cord

True umbilical cord knot and tight nuchal cord loops as a cause of fetal distress and emergent cesarean delivery: A Case report

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