True umbilical cord knot, an emergency during labor

Noval, Begoña Díaz de la; Llaneza, Iris Porcel; Sepúlveda, Manuel Rueda; Barriendos, Francisco Javier Ferrer; Blanco, Carmen Fernández

doi:10.1002/ccr3.2441

Cited by 7 publications

(13 citation statements)

References 4 publications

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confidence: 78%

“…Twin pregnancy once rare, has seen an increase in its incidence worldwide by the advent of medically assisted reproduction techniques [1] with a doubling of its incidence between 1970 and 2010 from less than 8‰ to nearly 16‰ in developed countries [2]. In sub-Saharan Africa its incidence seems to be increasing with an average of 17 and 20 twin deliveries per thousand (‰) total deliveries [2].…”

Section: Introductionmentioning

confidence: 99%

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True Nodes of the Umbilical Cords of a Mono-Amniotic Pregnancy

Niassy¹,

Rahadat²,

Sankhare³

et al. 2023

OJOG

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The incidence of twin pregnancies, has increased due to assisted reproductive technologies [1]. We note a doubling between 1970 and 2010 from less than 8‰ to nearly 16‰ of pregnancies (Pison et al., 2014; Pison et al., 2015) in developed countries [2] and 17‰ to 20‰ in sub-Saharan Africa. Monozygotic twins are the product of fertilization of a single egg by a single sperm, with the egg splitting into two within the first few days after fertilization. If the division takes place after the 8 th day, the pregnancy is mono-chorionic mono-amniotic (less 1% of cases of monozygotic pregnancies) and represents 1 in 30,000 pregnancies. It is the development of two fetuses within the same amniotic sac, representing the rarest type of twin pregnancy (1% of monozygotic twin pregnancies) but being the one with the highest fetal and maternal morbidity. The main complication feared is coiling and knots of the umbilical cords responsible for abnormal heartbeat, fetal suffering and eventual fetal death. We report the case of in utero fetal death of twins from a mono choral mono amniotic pregnancy secondary to knots and coiling of the cord in order to discuss the diagnostic and therapeutic aspects.

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mentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

True Nodes of the Umbilical Cords of a Mono-Amniotic Pregnancy

Niassy¹,

Rahadat²,

Sankhare³

et al. 2023

OJOG

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“…However, currently, there are no clinical management guidelines. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of a true knot of the umbilical cord are often disregarded, not documented, and patients are not aware of this potentially life-threatening condition [18,19].…”

Section: Discussionmentioning

confidence: 99%

Umbilical Cord Knots: Is the Number Related to Fetal Risk?

Stabile

Carlucci²,

Bonis

et al. 2022

Medicina

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True knots of the umbilical cord (UC) are a rare occurrence and are reported in 0.4–1.2% of deliveries. The compression of true knot of the UC can cause obstruction of the fetal circulation, leading to intra-uterine growth retardation or fetal death. Predisposing factors for the genesis of the true UC knot are numerous and include all the conditions, which lead to a relatively large uterine volume. This situation may predispose to free and excessive fetal movements. Although not all true knots lead to perinatal complications, they have been associated with adverse pregnancy outcomes, including fetal distress, fetal hypoxia, intra-uterine growth restriction (IUGR), long-term neurological damage, caesarean delivery and stillbirth. We present a rare case of operative delivery with vacuum in a multiparous woman at term of pregnancy with a double true knot of the UC. As in most cases, the diagnosis was made after delivery, as there were no fetal symptoms during pregnancy. Some authors assume that 3D power sonography may be useful in the diagnosis of true UC knots. However, 3D power Doppler cannot be considered as a definitive method. There are no specific prenatal indications to induce the physician to look for ultrasound signs suggestive of umbilical true knot. Some studies argue that cases of fetal death and fetal risk are directly related to the number of knots. We also support this thesis, even if further observational and retrospective studies are needed to demonstrate it.

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“…Thus, infants with umbilical cord true knots often suffer extents of hypoxia in their prenatal course, which may cause fatal stress or even intrauterine death. 1,2 In fact, even the process of delivering these babies is precarious, and in case of fatal distress and severe hypoxia of the fetus, it can evolve from a normal delivery to a high-risk urgent cesarean section. 2,3 In this article, the case of a fetus is reported that despite two true knots in the 70-cm umbilical cord have an uneventful perinatal and postnatal course with no need to NICU admission.…”

Section: Introductionmentioning

confidence: 99%

“…While the presence of Wharton jelly surrounding the vessels reduces the probability of collapse of vessels and, consequently, loss of perfusion to fetus, true knots may tighten and decrease or even stop blood flow. Thus, infants with umbilical cord true knots often suffer extents of hypoxia in their prenatal course, which may cause fatal stress or even intrauterine death 1,2 . In fact, even the process of delivering these babies is precarious, and in case of fatal distress and severe hypoxia of the fetus, it can evolve from a normal delivery to a high‐risk urgent cesarean section 2,3 …”

Section: Introductionmentioning

confidence: 99%