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The perils of true knot of the umbilical cord: antepartum, intrapartum and postpartum complications and clinical implications

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

True knot of the umbilical cord (TKUC) is found in 0.3–2.1% of pregnancies and is associated with an increased risk of adverse perinatal outcomes.

Methods

A retrospective cohort study including all singleton pregnancies delivered from 2011 to 2019 was performed. Diagnosis of TKUC was made postnatally, immediately after delivery of the baby. Comparison was made between pregnancies with and without TKUC regarding maternal, fetal and neonatal adverse outcome.

Results

Overall, 867/85,541 (1%) pregnancies were diagnosed with TKUC. Maternal age, BMI, gravidity and parity were significantly higher in pregnancies with TKUC as well as higher rate of induction of labor, meconium-stained amniotic fluid, and delivery prior to 37 weeks. The rate of cesarean deliveries due to non-reassuring-fetal monitor was significantly higher in pregnancies with TKUC. Overall, there were 2.5% IUFD in pregnancies with TKUC vs. 1% in pregnancies without TKUC (p < 0.001). Importantly, the rate of IUFD prior to 37 weeks of gestation was not significantly higher in the group with TKUC, however, the rate of IUFD after 37 weeks of gestation was 10 folds higher in fetuses with TKUC, 0.9% vs. 0.08% (p < 0.001). Significantly, more neonates with TKUC needed phototherapy or suffered from hypoglycemia. There were no differences in the 5 min Apgar scores, admission to the NICU and number of days of hospitalization.

Conclusion

Pregnancies complicated with TKUC are associated with a tenfold higher risk of IUFD beyond 37 weeks of gestation. To the results of this study suggest that it would be prudent to induce labor around 37 weeks of gestation in pregnancies with prenatal diagnosis of TKUC. It may be warranted to use continuous fetal monitoring during labor and delivery in those cases were antenatal diagnosis of TKUC is made.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

No funding was given for this study.

Author information

Authors and Affiliations

  1. The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel

    Alina Weissmann-Brenner, Raanan Meyer, Noam Domniz, Rakefet Yoeli-Ullman, Shali Mazaki-Tovi, Tal Weissbach & Eran Kassif

  2. The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel

    Alina Weissmann-Brenner, Raanan Meyer, Noam Domniz, Natav Hendin, Rakefet Yoeli-Ullman, Shali Mazaki-Tovi, Tal Weissbach & Eran Kassif

  3. The Department Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Gabriel Levin

Authors
  1. Alina Weissmann-Brenner
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  2. Raanan Meyer
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  3. Noam Domniz
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  4. Gabriel Levin
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  5. Natav Hendin
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  6. Rakefet Yoeli-Ullman
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  7. Shali Mazaki-Tovi
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  8. Tal Weissbach
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  9. Eran Kassif
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Contributions

AW-B: conception, planning, carrying out, analyzing and writing; RM, GL: carrying out, analyzing; ND, NH, TW: carrying out; RY-U: conception; SM-T: writing; EK: conception, carrying out, writing.

Corresponding author

Correspondence to Alina Weissmann-Brenner.

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Conflict of interest

All the authors have made substantial contributions to the concept, data interpretation, drafting or critical revision of the manuscript for intellectual content and have approved the final version. There are no conflicts of interest for the authors.

Ethical approval

The study was approved by the IRB board of the Chaim Sheba Medical center No. 2987-16-SMC.

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Weissmann-Brenner, A., Meyer, R., Domniz, N. et al. The perils of true knot of the umbilical cord: antepartum, intrapartum and postpartum complications and clinical implications. Arch Gynecol Obstet 305, 573–579 (2022). https://doi.org/10.1007/s00404-021-06168-7

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  • DOI: https://doi.org/10.1007/s00404-021-06168-7

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