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2022, Number 4

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Rev Fac Med UNAM 2022; 65 (4)

True Umbilical Cord Knot, an Incidental Finding at Birth. Report of 4 Cases in a Third Level Hospital

Arriaga LA, Álvarez TA, Leyva DA, Cuevas AGG, Chavira ACF

Language: Spanish
References: 24
Page: 30-37
PDF size: 251.03 Kb.


ABSTRACT

The true umbilical cord knot is a pathology with an incidence relatively low. It is associated with the risk of loss of fetal well-being and stillbirth. There are both maternal and fetal risk factors, with different associated perinatal outcomes. Prenatal diagnosis of a true knot is a diagnostic challenge for the obstetrician, however, nowadays it is possible by ultrasound for incidental finding or by intentional search, mainly in patients with risk factors. In the same way it should be suspected in the presence of a non-reassuring cardiotocography, especially when there is no response to the usual intrauterine resuscitation maneuvers, such as left lateral decubitus position, supplemental oxygen and maternal hydration. The purpose of this report is to describe 4 cases of true knot in term pregnancies, in a third level hospital, where an incidence of 0.03% was estimated,, with a mean gestational age of 39.3 weeks and a mean maternal age of 32.2 years. The main intrapartum findings were alterations in the cardiotocography, such as variable and late decelerations. The route of pregnancy resolution was equitable among the patients, 2 were resolved by vaginal delivery and the other 2 by cesarean section. Pregnancy was resolved by vaginal delivery in 2 of the patients, while the other 2 were resolved by cesarean section. One case of stillbirth was registered


REFERENCES

  1. Szczepanik ME, Wittich AC. True Knot of the UmbilicalCord: report of 13 cases. Mil Med. 2007;172(8):892-4.https://doi.org/10.7205/MILMED.172.8.892.

  2. Spellacy WN, Gravem H, Fisch RO. The umbilical cordcomplications of true knots, nuchal coils, and cords aroundthe body. American J Obstet Gynecol. 1966;94(8):1136-42. http://dx.doi.org/10.1016/0002-9378(66)90777-0.

  3. Castro T, Gomez-Suarez D. Diagnóstico prenatal de unnudo verdadero de cordón umbilical mediante 4D. ClinInvest Ginecol Obstet. 2007;34(5):208-10.

  4. Ramón y Cajal CL, Martínez RO. Prenatal diagnosis oftrue knot of the umbilical cord. Ultrasound Obstet Gynecol.2004;23(1):99-100. http://dx.doi.org/10.1002/uog.900.

  5. Peesay M, Nuchal cord and its implications. Matern HealthNeonatol Perinatol. 2017;3(1):1-11. http://dx.doi.org/10.1186/s40748-017-0068-7.

  6. Bernardete H, Niza D. Nudos verdaderos de cordón umbilical.Reporte de 4 casos. An Med (Mex). 2015;60(2):137-40.

  7. Guzikowski W, Kowalczyk D, Więcek J. Diagnosis of trueumbilical cord knot. Arch Med Sci. 2014;10(1):91-5. http://dx.doi.org/10.5114/aoms.2013.33068.

  8. Olaya-Contreras M, Vargas-Moreno W, Bernal-VillegasJE. Una aproximación desde la física a las consecuenciaspatológicas de la longitud excesiva del cordón umbilical.Rev Colomb Obstet Ginecol. 2015;66(1):53. https://doi.org/10.18597/rcog.

  9. Srinivasan A, Graves L. Four true umbilical cord knots.J Obstet Gynaecol Can. 2006;28(1):32-5. https://doi.org/10.1016/S1701-2163(16)32053-9.

  10. Clerici G, Koutras I, Lizietti R, Di Renzo GC. Multipletrue umbilical knots: a silent risk for intrauterinegrowth restriction with anomalous hemodynamic pattern.Fetal Diagn Ther. 2007;22(6):440-3. http://dx.doi.org/10.1159/000106351.

  11. Chung Delgado K, Gil Oliden E. Desaceleración intrapartopor nudo verdadero ajustado de cordón umbilical.RCCI. 2014;5(2):89-92.

  12. Pasquale G, Pasquale O. Fatal True Umbilical Cord Knot: aCase Report. EuroMediterranean Biomed J. 2019;14(7):30-3. http://dx.doi.org/10.3269/1970-5492.2019.14.07.

  13. Ayres D, Spong CY, Chandraharan E, FIGO IntrapartumFetal Monitoring Expert Consensus Panel. FIGOconsensus guidelines on intrapartum fetal monitoring:Cardiotocography. Int J Gynaecol Obstet. 2015;131(1):13-24. http://dx.doi.org/10.1016/j.ijgo.2015.06.020.

  14. Pinas A, Chandraharan E. Continuous cardiotocographyduring labour: Analysis, classification and management.Best Pract Res Clin Obstet Gynaecol. 2016;30:33-47.http://dx.doi.org/10.1016/j.bpobgyn.2015.03.022.

  15. Macones GA, Hankins GD, Spong CY, Hauth J, Moore T.The 2008 National Institute of Child Health and HumanDevelopment workshop report on electronic fetal monitoring:update on definitions, interpretation, and researchguidelines. Obstet Gynecol. 2008;112(3):661-6. http://dx.doi.org/10.1097/AOG.0b013e3181841395.

  16. Hamilton E, Warrick P, O’Keeffe D. Variable decelerations:do size and shape matter? J Matern Fetal NeonatalMed. 2012;25(6):648-53. http://dx.doi.org/10.3109/14767058.2011.594118.

  17. Holzmann M, Wretler S, Cnattingius S, Nordström L.Cardiotocography patterns and risk of intrapartum fetalacidemia. J Perinat Med. 2015;43(4):473-9. http://dx.doi.org/10.1515/jpm-2014-0105.

  18. Cahill AG, Roehl KA, Odibo AO, Macones GA. Associationand prediction of neonatal acidemia. Am J Obstet Gynecol.2012;207(3):206.e1-8. http://dx.doi.org/10.1016/j.ajog.2012.06.046.

  19. Hershkovitz R, Siberstein T, Sheiner E, et al. Risk factorsassociated with true knots of the umbilical cord. EurJ Obstet Gynecol Reprod Biol. 2001;98(1):36-9. http://dx.doi.org/0.1016/S0301-2115(01)00312-8.

  20. Chasnoff IJ, Fletcher MA. True knot of the umbilical cord.Am J Obstet Gynecol. 1977;127(4):425-7. http://dx.doi.org/10.1016/0002-9378(77)90501-4.

  21. Ugianskiene A, Bor P. A rare case with multiple true knotstogether with single artery and four umbilical cord nuchalloops. Eur J Obstet Gynecol Reprod Biol. 2013;168(1):117-8. http://dx.doi.org/10.1016/j.ejogrb.2012.12.020.

  22. Sepulveda W, Shennan AH, Bower S. True knot of theumbilical cord: a difficult prenatal sonographic diagnosis.Ultrasound Obstet Gynecol. 1995;5:106-8. http://dx.doi.org/10.1046/j.1469- 0705.1995.05020106.x.

  23. Bohîltea RE, Turcan N, Cîrstoiu M. Prenatal ultrasounddiagnosis and pregnancy outcome of umbilical cord knot– debate regarding ethical aspects of a series of cases. JMed Life. 2016;9:297-301.

  24. Sherer DM, Amoabeng O, Dryer AM, Dalloul M. CurrentPerspectives of Prenatal Sonographic Diagnosis andClinical Management Challenges of True Knot of theUmbilical Cord. Int J Womens Health. 2020;12:221-33.http://dx.doi.org/10.2147/IJWH.S192260.




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