Two true knots in the umbilical cord: a rare case report

Abstract

True knots of the umbilical cord are infrequent but significant complications in obstetrics, occurring in approximately 0.3% to 2% of pregnancies. Their formation is often associated with factors such as increased fetal mobility, excessive amniotic fluid, and maternal conditions like diabetes. These knots can lead to serious outcomes, including fetal distress and stillbirth, necessitating careful monitoring and management. We present the case of a 30-year-old woman Gravida 1 Para 1 Live birth 1 (G2P1L1) with a known case of type 2 diabetes mellitus who presented at 36 weeks and 6 days of gestation with mild labor pains. Upon evaluation, she exhibited persistent fetal tachycardia and non-progressing labor despite augmentation efforts. An emergency lower segment cesarean section (LSCS) was performed, revealing two true knots in a lengthy umbilical cord measuring approximately 70 cm, along with one loop wrapped around the neck. The timely intervention resulted in a favorable outcome for both mother and baby. This case highlights the importance of recognizing and managing true knots in pregnancies complicated by diabetes and other risk factors. As these noted are mostly obscured on ultrasound and diagnosis is made only post placental delivery, it underscores the need for vigilant prenatal monitoring and a low threshold for surgical intervention in cases of fetal distress.