A Fatal True Knot of Cord

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A Fatal True Knot of Cord Avi Tsafrir, MD,1 Yoel Shufaro, MD2 1

Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem, Israel

2

Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Centers, Jerusalem, Israel

32-year-old woman was referred for delivery at 38 weeks’ gestation because of absent fetal movements. Sonography on admission demonstrated a term fetus with no heartbeat. Labour was induced with oxytocin. A 2990 g male was delivered 10 hours later.

in 1.4% to 2.7% of such pregnancies. Sonographic prenatal diagnosis is difficult but has been reported. However, the management of pregnancies complicated by a true umbilical knot is unclear, given the acute and unpredictable nature of intrauterine death due to this cause.

A tight true knot was apparent in the placental third of the umbilical cord (Figure).

REFERENCES

A

The cord was severely edematous and engorged proximally to the knot. Microscopic examination revealed fresh parenchymal placental infarctions and focal engorgement of fetal stem vessels. Macroscopic examination of the fetus was normal. Autopsy was refused. The incidence of a true umbilical cord knot is approximately 1% of all deliveries.1–3 Intrauterine fetal death occurs

1. Sornes T. Umbilical cord knots. Acta Obstet Gynecol Scand 2000;79:157–9. 2. Herschkovitz R, Silberstein T, Sheiner E, Shoham-Vardi I, Holcberg G, Katz M, et al. Risk factors associated with true knots of the umbilical cord. Eur J Obstet Gynecol Reprod Biol 2001;98:36–9. 3. Airas U, Heinonen S. Clinical significance of true umbilical knots: a population-based analysis. Am J Perinatol 2002;19:127–32.

J Obstet Gynaecol Can 2008;30(11):993

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993