True knot of the umbilical cord, intrapartum diagnosis and favorable outcome
Keywords:
fetal tachycardia, parturition, true knot, umbilical cord, vaginal deliveryAbstract
Introduction: True umbilical cord knot is an uncommon anomaly with the potential to cause fetal hypoxia and adverse perinatal outcomes, particularly when tightened. Prenatal diagnosis remains limited, although advanced imaging techniques such as 4D ultrasound and Doppler improve detection. Nevertheless, most cases are identified at delivery.
Objective: To describe a case of true umbilical cord knot diagnosed intrapartum with a favorable neonatal outcome, and to contextualize the finding through a review of the literature.
Clinical Case: A 24-year-old woman, G3P2001, at 38 weeks and 5 days of gestation, was admitted in active labor. Meconium-stained amniotic fluid and early decelerations on fetal monitoring were observed. During spontaneous vaginal delivery, a loose true umbilical cord knot was identified, without complications. The newborn was male, with Apgar scores of 8 at 1 minute and 9 at 5 minutes and required no resuscitation.
Conclusion: True umbilical cord knot should be considered in the presence of predisposing factors. Intrapartum detection and appropriate fetal monitoring may help prevent complications. Further studies are needed to determine its long-term impact on neonatal health.
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References
1. Collins JH. Umbilical cord accidents [Internet]. BMC Pregnancy Childbirth. 2012;12(Suppl 1):A7. DOI: 10.1186/1471-2393-12-S1-A7
2. Hershkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M, et al. Risk factors associated with true knots of the umbilical cord [Internet]. Eur J Obstet Gynecol Reprod Biol. 2001;98(1):36-9. DOI: 10.1016/s0301-2115(01)00312-8
3. de Laat MW, Franx A, van Alderen ED, Nikkels PG, Visser GH. The umbilical coiling index, a review of the literature [Internet]. J Matern Fetal Neonatal Med. 2005;17(2):93-100. DOI: 10.1080/14767050400028899
4. Guzikowski W, Kowalczyk D, Więcek J. Diagnosis of true umbilical cord knot [Internet]. Arch Med Sci. 2014;10(1):91-5. DOI: 10.5114/aoms.2013.33068
5. Airas U, Heinonen S. Clinical significance of true umbilical knots: a population-based análisis [Internet]. Am J Perinatol. 2002;19(3):127-32. DOI: 10.1055/s-2002-25311
6. Chen S, Liu Z, Lin Q, Huang L. Risk factors and outcomes associated with true umbilical cord knots: a retrospective study[Internet]. Taiwan J Obstet Gynecol. 2025;64(1):40-5. DOI: 10.1016/j.tjog.2024.07.019
7. Castro Rezende G, Macedo Bastos F, Amorim de Barros C, Kfoury Pereira A, Vitor Leite H, Vieira Cabral A. P24.07: Case report: umbilical cord true knot diagnosed by 3D power Doppler [Internet]. Ultrasound Obstet Gynecol. 2014;44(Suppl 1):327. DOI:10.1002/uog.14467
8. Houri O, Bercovich O, Wertheimer A, Pardo A, Berezowsky A, Hadar E,et al. Clinical significance of true umbilical cord knot: a propensity score matching study[Internet]. BMC Pregnancy Childbirth. 2024;24(1):59. DOI: 10.1186/s12884-024-06249-w
9. Cao J, Chen Z, Zou M, Liu Y, Wang H, Zhang Q, et al. Real umbilical cord knot detection by active scanning: a prospective study on accuracy and visualization factors [Internet]. BMC Pregnancy Childbirth. 2025;25(1):514. DOI: 10.1186/s12884-025-07629-6
10. Arriaga López A, Álvarez Torres A, Leyva Díaz A, Cuevas Arellano GG, Chavira Anaya CF. Nudo verdadero de cordón umbilical, hallazgo incidental al nacimiento. Reporte de 4 casos en un hospital de tercer nivel [Internet]. Rev Fac Med (Méx). 2022;65(4):30-7. DOI: 10.22201/fm.24484865e.2022.65.4.04
11. Geraldo-Murillo JA, Pérez JC, Rivera Rojas JA. Nudo verdadero como causa de taquicardia fetal persistente: reporte de un caso[Internet]. Rev Fac Med (Méx). 2022;65(6):20-5. DOI: 10.22201/fm.24484865e.2022.65.6.04
12. Ramón y Cajal CL, Martínez RO. Prenatal diagnosis of true knot of the umbilical cord [Internet]. Ultrasound Obstet Gynecol. 2004; 23(1):99-100. DOI: 10.1002/uog.900
13. Houri O, Wertheimer A, Hadar E, Krispin E, Rony C, Wiznitzer A, et al. Risk factors and clinical significance of fetuses with true umbilical cord knot: a cohort study [Internet]. Am J Obstet Gynecol. 2022;226(1 Suppl):S533. DOI: 10.1016/j.ajog.2021.11.880
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