True knot of the umbilical cord: a difficult prenatal ultrasonographic diagnosis

Sepúlveda, Waldo; Shennan, Andrew; Bower, Sarah; Nicolaidis, Peter; Fisk, Nicholas M.

doi:10.1046/j.1469-0705.1995.05020106.x

Cited by 54 publications

(63 citation statements)

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“…Multiple true knots of the umbilical cord are considered to be even rarer, although the exact incidence has not been reported. Predisposing factors include a long umbilical cord, polyhydramnios, multiparity, monoamniotic twin pregnancy and small for gestational age fetuses [4,5] . We report a case of 5 true umbilical cord knots associated with severe fetal growth restriction and an abnormal hemodynamic pattern.…”

Section: Introductionmentioning

confidence: 99%

Multiple True Umbilical Knots: A Silent Risk for Intrauterine Growth Restriction with Anomalous Hemodynamic Pattern

Clerici

Koutras²,

Luzietti³

et al. 2007

Fetal Diagn Ther

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True knots of the umbilical cord can represent a serious complication for the fetus due to the possible alteration in the fetal circulation with consequent intrauterine growth restriction or fetal death. We report a case of 5 true umbilical cord knots associated with severe fetal growth restriction and an abnormal hemodynamic pattern. The Doppler examination showed a hemodynamic pattern characterized by an early alteration in the waveform profile in the fetal venous districts with normal impedance to flow values in both uterine and umbilical arteries. This normal profile of the umbilical arteries remained unchanged until the last stage of hemodynamic decompensation, while the profiles of the uterine arteries remained normal until delivery. This case report suggests that it is important to pay close attention to the evaluation of the fetal cord in situations in which the above described hemodynamic pattern is noted. Although the ultrasound diagnosis of true knots is extremely difficult, the presence of a true knot should always be suspected in the presence of an intrauterine growth restriction fetus when the venous district is altered before the fetal arterial districts after exclusion of other detectable reasons for growth restriction.

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Section: Introductionmentioning

confidence: 99%

Multiple True Umbilical Knots: A Silent Risk for Intrauterine Growth Restriction with Anomalous Hemodynamic Pattern

Clerici

Koutras²,

Luzietti³

et al. 2007

Fetal Diagn Ther

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“…Diagnóstico ultrasónico de nudo: los signos descritos (imagen en hoja de trébol con cuatro hojas, imagen multicoloreada al Doppler color) son inseguros y deben considerarse sugerentes, pero inespecíficos para el diagnóstico (6,7). En el falso positivo, la imagen sospechosa de nudo se origina por aposición de múltiples asas aglutinadas en planos perpendiculares y puede ser transitoria, pero en este caso, fue persistente y sin variaciones en todas las exploraciones del período de observación.…”

Section: Discussionunclassified

Experiencia Comunicacional en El Diagnóstico Y Manejo Antenatal De Nudo Del Cordón Umbilical

2010

Rev. chil. obstet. ginecol.

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RESUMENSe comunica caso clínico de una madre que consulta en semana 31 de gestación por ausencia de movimientos fetales, y cuyo ultrasonido (US) con escala de grises, Doppler color y tridimensional (3D), demostró imágenes altamente sugerentes de nudo verdadero de cordón umbilical. Se efectuó vigilancia con prueba de movimientos fetales diaria, monitoreo electrónico, hemodinamia fetal y umbilical con doppler, alternados cada tres días, durante siete semanas, demostrando bienestar fetal. Se efectuó operación cesárea cumplida la semana 37 por antecedente de cicatriz uterina previa. El hallazgo intraoperatorio fue una aglutinación de asas del cordón y recién nacido sano. Se discute el diagnóstico falso positivo de nudo por US, el manejo antenatal orientado a la pesquisa oportuna de una eventual oclusión vascular y la experiencia comunicacional con la paciente, que permitió esperar la madurez fetal sin incidentes y con aceptabilidad de la madre, pese al riesgo implícito del diagnóstico presuntivo. Conclusión: En el manejo de alto riesgo se requiere experiencia, apoyo tecnológico y técnicas de comunicación adecuadas con las pacientes, para que una alianza empática permita alcanzar la mayor edad gestacional y la comprensión de un falso positivo. PALABRAS CLAVE: Cordón umbilical, nudo verdadero, ultrasonido prenatal SUMMARYWe report a case of a pregnant woman who presented with absence of fetal movement at the 31st gestational week. The ultrasound (US) images (gray scale, color Doppler and 3 dimensional) clearly suggested a true knot of the umbilical cord. A close surveillance regime with daily fetal movement test, fetal electronic monitoring and umbilical hemodynamics with Doppler, alternated every three days, was kept for seven weeks, showing fetal wellbeing. At week 37, a cesarean section was performed because of a previous uterine scar. The intraoperative finding confirmed agglutinated and twisted loops, but not a knot of the umbilical cord. The antenatal management is discussed with a close fetal monitoring to detect eventual vascular occlusion in a tight knot and the communication experience with the mother in order to understand and accept a false positive US diagnosis. Conclusion: During a maternal and fetal high risk management is important the professional experience and technological support. On the other hand, the best medical patient communication through an empathetic alliance is required in order to reach a psychological support, longer gestational age and better understanding a false positive test.KEY WORDS: Umbilical cord, true knot, prenatal ultrasound 207 REV CHIL OBSTET GINECOL 2010;75(3): 207 -212

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“…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. Gembruch They also present demographic and clinical characteristics according to the presence or absence of a true knot.…”

Section: Introductionmentioning

confidence: 99%

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

Karakecili

Barut

Çakmak

et al. 2017

Proc Obstet Gynecol

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True knot of the umbilical cord: a difficult prenatal ultrasonographic diagnosis

Cited by 54 publications

References 0 publications

Multiple True Umbilical Knots: A Silent Risk for Intrauterine Growth Restriction with Anomalous Hemodynamic Pattern

Multiple True Umbilical Knots: A Silent Risk for Intrauterine Growth Restriction with Anomalous Hemodynamic Pattern

Experiencia Comunicacional en El Diagnóstico Y Manejo Antenatal De Nudo Del Cordón Umbilical

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

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