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

Umbilical Cord Abnormalities

The umbilical cord is the connection between mother and fetus through which gases and nutrients are exchanged. It's remarkable structure allows for freedom of movement while providing a cushioned, protected conduit from mother to fetus. Fetal development and survival are dependent upon the umbilical cord. This article reviews abnormalities of the umbilical cord that can be seen with structural and chromosomal abnormalities and altered umbilical cord flow associated with fetal growth restriction and poor pregnancy outcomes.

Risk factors and outcomes associated with true knots of the umbilical cord: A retrospective study

OBJECTIVE

To investigate the pregnancy outcomes and independent risk factors associated with true knots of the umbilical cord (TKUC).

MATERIALS AND METHODS

This retrospective study included 8140 deliveries at Fujian Maternal and Child Health Hospital from 2017 to 2021. Mothers and newborns diagnosed with TKUC were included in the TKUC group, while the others were included in the control group. The data were obtained from the hospital's electronic medical record system. Multiple pregnancies were excluded.

RESULTS

The incidence of TKUC was 0.61 %. The TKUC group had significantly higher proportions of advanced maternal age, multiparae and mothers with more than two pregnancies (P < 0.05). The neonates in the TKUC group were more male, had longer lengths and umbilical cords, heavier placentas, and a higher incidence of umbilical cord entanglement (P < 0.05). In terms of pregnancy outcomes, the TKUC group exhibited higher rates of cesarean section and preterm birth (P < 0.001; P < 0.05). However, there were no significant differences in birthweight, Apgar scores, stillbirth rate, and neonatal malformation rate between the two groups (P > 0.05). The results of logistic regression indicated that multiparae (OR = 1.386, P = 0.001), male fetus (OR = 1.499, P < 0.001), excessive long umbilical cord (OR = 11.022, P < 0.001), and umbilical cord entanglement (OR = 1.284, P = 0.019) were risk factors for TKUC.

CONCLUSION

Male fetus, multiparae, umbilical cord entanglement, and especially excessively long umbilical cord were identified as independent risk factors for TKUC. TKUC had a minimal impact on the newborn's condition at birth, while it's associated with higher rates of cesarean section and preterm birth.

Double true umbilical cord knots coexisting with a nuchal cord with successful fetal outcome: A case report

Umbilical nodes and cords play a crucial role in fetal development and are essential for the transfer of nutrients and oxygen between the mother and the fetus. Sonographic diagnosis of umbilical nodes and cords has become an integral part of prenatal care, allowing for the early detection of abnormalities and potential complications. The umbilical cord is a vital structure connecting the fetus to the placenta, providing essential nutrients and oxygen for fetal growth and development. Sonographic examination of the umbilical cord and its associated nodes has become an indispensable tool in prenatal care, enabling the early detection of abnormalities and potential complications. This review aims to analyze the current literature on sonographic diagnosis of umbilical nodes and cords, highlighting the key points and advancements in this field. A 37-year-old booked G4P2+1A2 Nigerian woman was registered for prenatal tertiary health care at 12 weeks of gestation. The booking investigations were normal and the booking packed cell volume was 37%. She was compliant with scheduled clinic visits and routine drugs. Pregnancy was carried to term uneventfully. Elective cesarean section was successfully performed at 38 weeks of gestation owing to the patient's prior history of third-degree perineal tear. The intraoperative findings included a loose cord around the neck of the baby and double true knots along the length of the 65 cm umbilical cord. The baby was delivered with appearance, pulse, grimace, activity and respiration (APGAR) scores of 7 in the first minute, 9 in the fifth minute, and the birth weight was 3.0 kg. Mother and baby were discharged 48 h postpartum in stable clinical condition. Although the presence of true double umbilical knots is rare, its coexistence with the nuchal cord is even rarer. There are risk factors associated with true umbilical knots. The possible risk factor implicated in this index case is the gender of the fetus and maternal multiparity. True umbilical knots are usually associated with certain fetal negative outcomes of pregnancy. There are currently no evidence-based treatment options available.

Morphological and clinical findings in placentas and newborns with a history of tobacco, alcohol, and other substance abuse during pregnancy

BACKGROUND

Exposure to toxins during pregnancy is the main modifiable behavior that affects the placenta and, consequently, the fetus. In particular, smoking is a recognized risk factor for negative outcomes. Our study pretended to examine gross and microscopic placental features in women who reported exposure to tobacco, alcohol, or other psychoactive substances.

METHODS

In this observational case-control study, we collected 706 placentas to assess precise substance exposure histological-interaction features of in the placenta. We examined gross and microscopic placental features, and then recorded maternal and newborn clinical conditions.

RESULTS

We found that 4.8% of mothers admitted to consumption of some type of (harmful) substance. The most common pre-existing maternal condition was obesity (20.3%); predominant complications included amniotic infection (32.3%), urinary tract infection (14.5%) and hypertensive disorders of pregnancy (14.5%). In newborns, we discovered positive associations as respiratory distress syndrome. Macroscopically, exposed mothers had heavier placentas, more true knots, and single umbilical artery; microscopically, they were more likely to exhibit fetal vascular malperfusion (FVM).

CONCLUSIONS

Until our present study, no research linked umbilical cord defects to toxic substance exposure; our study results do confirm association with adverse outcomes in neonates and alterations in the neuro-cardio-placental circuit through FVM.

IMPLICATIONS

The results are confirming the importance of this modifiable risk factor and how its presence may potentially affect the course of pregnancy, as well as the health of both mother and child.

Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes

BACKGROUND

(1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.

A misdiagnosed case of a 150-cm umbilical cord coiled twice around the fetal neck with a true cord knot: A rare Syrian case report

The normal umbilical cord is a crucial component during pregnancy, but sometimes it could become compromised due to some abnormalities such as excessive long umbilical cord, and though they usually end up with a healthy baby, they may lead to severe consequences. Excessive long umbilical cords are found in 4% of pregnancies and represent a risk factor for nuchal cords and true knots. We report a case of a 37-year-old Syrian pregnant woman who presented to the hospital at 37 weeks of gestation asking for a C-section for a fear of ambiguous ultrasound findings that have been interpreted as fetal malformation. At delivery, a healthy baby was born with a 150-cm umbilical cord, a true knot, and double-looped nuchal cords; the formation of the loops and the knot had been attributed to the elongated cord. Besides, ultrasound imaging could sometimes be deceptive and lead to unnecessary interventions; therefore, cord anomalies should always be kept in mind because they do not always represent a justification for a C-section.