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Background: Umbilical cord true knot is a rare condition which affects about 1% of all pregnancies. Though the incidence is lower, it often goes undetected in antenatal period despite the availability of prenatal sonography and may lead to a compromised fetal outcome as presented in this case. In this case the presence of true knot of umbilical cord was missed despite routine sonography done just 1 week prior to delivery, when patient presented to casualty with complains of decreased fetal movements since 24 hours. This modality is said to be associated with adverse fetal outcome such as birth asphyxia or in adverse cases intra uterine fetal demise. Risk factors include long cord, polyhydramnios, small sized fetus, etc. Case Summary: 27 years old gravida two, para two, with 1 live issue with k/c/o hypothyroidism with previous lesions came with complaints of decreased fetal movement since 24 hours at 36 weeks 3 days of gestational period. The patient recorded regular ANC checkups and routine investigations within normal limits. Her USG scan done at 34.2 wks showing single loop of cord around neck and normal doppler findings. On examination her vitals were normal .Her abdominal examination showed uterus of 34 wks size, longitudinal lie, cephalic presentation and irritable with mild contractions present with scar tenderness . Her FHS were present/irregular/112 bpm with less variability. On p/v examination os was admitting tip of finger, cervix soft, 25% effaced, station high up, presenting part vertex, membrane present. She was advised admission and a cardio-tocography (CTG) was done which showed recurrent deep atypical variable decelerations with decreased beat to beat variability. An emergent cesarean section was taken. Newborn was a female diagnosed with true umbilical cord knot, 2 cm away from fetal insertion with cord length of 84 cm. The baby was shifted to NICU in view of respiratory distress. Conclusion: Despite of modern day ultrasonography and Doppler studies, true umbilical cord knot still remains a lesser diagnosed entity and so every pregnant patients should be monitored carefully with a watch for daily fetal movement count (DFMC)and weekly non stress test (NST) for fetal well being.

Objective:To analyse the prenatal diagnostic value of ultrasound in umbilical cord knot(UCK) and the correlation of UCK and fetal perinatal outcome.Methods:Firstly, retrospective analysis was conducted on the prenatal ultrasound and clinical data of newborns or induced fetuses with UCK.Secondly,the incidence of UCK and its relationship with fetal perinatal outcome were summarized and analyzed.Then,the value and image characteristics of prenatal ultrasound in diagnosing UCK were analyzed.Finally,fetuses who were diagnosed as UCK after delivery were UCK group, and control group was 200 cases randomly selected from other normal fetuses.The differences of ultrasonic parameters and related clinical parameters were compared.Results:During 5 years, there were 40346 fetuses were born, including 209 cases stillbirths in the third trimester.99 fetuses were confirmed with UCK by postnatal diagnosis (including 3 stillbirths died of UCK),accounting for 3% of the diagnosis of UCK.2D ultrasonic images can be classified as excessively distorted, stacked or cloverleaf.The 3D-US can clearly identify the true and false UCK,which can be divided into loose UCK,tight UCK,spiraling umbilical cord and twisted and stacked umbilical cord.RI of middle cerebral artery in UCK group was lower than that in normal control group (P

An umbilical cord knot is an unexpected event that should not change obstetric approach for delivery.

Umbilical cord knots occur in 1-2% of all deliveries can lead to increase in fetal death and asphyxia. A thorough cord examination is important to discern abnormalities. Although there are not set guidelines for diagnosing and managing umbilical cord knots; increase of reporting with complications will aid in decision making for better future patient management. We describe one such case in a primigravida who was found to have an umbilical cord knot.

A true umbilical cord knot (TUCK) is a rare event, complicating 0.3-1.3% of all pregnancies. Prenatal diagnosis is not usual, as it is mostly discovered at delivery, when the knot is identified. True cord knots are mostly asymptomatic, but can be associated with adverse perinatal outcomes such as birth asphyxia and foetal demise, owing to compression of the umbilical vessels within the knot. This compression, however, is largely dependent on how tightly the knot is formed. We report a 30-year-old booked gravida 2, para 1, with a living child, who had spontaneous vaginal delivery of a healthy male baby at term, with incidental finding of a single loose TUCK at delivery. The umbilical cord was 81 cm long. The baby weighed 3600 g at birth, with 1- and 5-minutes Apgar scores of 9 and 10 respectively, and no adverse perinatal occurrence.

The author reports the following case from his practice

Graphical abstract, Highlights • A novel two-stage pipeline for automated placental examination and assessment. • A novel application of “similar/overlapped domains, different tasks” transfer learning. • Curation of the first-of-its-kind large-scale dataset for placenta research. • A fast and objective solution for placental measurement and assessment. • Highly promising results for a number of diagnoses that may possess clinical impact., Post-delivery analysis of the placenta is useful for evaluating health risks of both the mother and baby. In the U.S., however, only about 20% of placentas are assessed by pathology exams, and placental data is often missed in pregnancy research because of the additional time, cost, and expertise needed. A computer-based tool that can be used in any delivery setting at the time of birth to provide an immediate and comprehensive placental assessment would have the potential to not only to improve health care, but also to radically improve medical knowledge. In this paper, we tackle the problem of automatic placental assessment and examination using photos. More concretely, we first address morphological characterization, which includes the tasks of placental image segmentation, umbilical cord insertion point localization, and maternal/fetal side classification. We also tackle clinically meaningful feature analysis of placentas, which comprises detection of retained placenta (i.e., incomplete placenta), umbilical cord knot, meconium, abruption, chorioamnionitis, and hypercoiled cord, and categorization of umbilical cord insertion type. We curated a dataset consisting of approximately 1300 placenta images taken at Northwestern Memorial Hospital, with hand-labeled pixel-level segmentation map, cord insertion point and other information extracted from the associated pathology reports. We developed the AI-based Placental Assessment and Examination system (AI-PLAX), which is a novel two-stage photograph-based pipeline for fully automated analysis. In the first stage, we use three encoder-decoder convolutional neural networks with a shared encoder to address morphological characterization tasks by employing a transfer-learning training strategy. In the second stage, we employ distinct sub-models to solve different feature analysis tasks by using both the photograph and the output of the first stage. We evaluated the effectiveness of our pipeline by using the curated dataset as well as the pathology reports in the medical record. Through extensive experiments, we demonstrate our system is able to produce accurate morphological characterization and very promising performance on aforementioned feature analysis tasks, all of which may possess clinical impact and contribute to future pregnancy research. This work is the first for comprehensive, automated, computer-based placental analysis and will serve as a launchpad for potentially multiple future innovations.

True umbilical cord knot appears to be a relatively common complication that occurs in 0.3%-1.3% of all pregnancies and it is correlated with an increased incidence of SGA infants, premature birth, need for neonatal intensive care and fetal death. The aim of the article was to evaluate the incidence of the true umbilical cord knot in the University Emergency Hospital, Bucharest, for a period of 5 years and its association with premature birth, low birth weight, low Apgar score at 1 minute and the need for neonatal intensive care. By reviewing the total number of women who delivered in this unit between January 1st 2011 and December 31st 2015, the percentage of the diagnosis antepartum and intrapartum, the outcome of these pregnancies, and the reflection of this condition on the fetal status, were evaluated. During 5 years, 133 (0.71%) of 18.500 deliveries were diagnosed with true umbilical cord knot, only 16 (0.08%) cases were diagnosed by ultrasound antepartum. The mean maternal age was 34.3 years. About 30% of the studied cases (39) presented this condition at the third delivery or more. A personal history for diabetes corresponded to 27 cases (20.3%). From our database, it resulted that only 12 fetuses (10.5%) required neonatal intensive care and presented an Apgar score lower than 7 at 1 minute. Prenatal diagnosis of a true umbilical cord knot is rarely encountered and sonography skills are needed. Complementary methods such as color Doppler and 3D HD Flow are reliable for the diagnostic when true umbilical cord knots are suspected after a 2D scan. Several risk factors can guide the expectancy, such as advanced maternal age, polyhydramnios, multiparty or diabetes.

We report the case of a 33 weeks pregnant woman who was admitted in our hospital for recent jaundice. The controversial results of medical investigations and the patient’s clinical outcome indicated the necessity for immediate caesarian-section along with exploratory laparotomy. The surgeons extracted gelatinous membranes from the main biliary duct. At the Department of Pathology from University Emergency Hospital from Bucharest, we received the placental components, were we noted the presence of one true umbilical cord knot and meconium impregnation, a non-slatted gallbladder of 18 cm long and the numerous, heterogeneous membranes. On histopathological examination we found uteroplacental hypoxia-related features in the placenta together with retroplacental hematoma, umbilical cord edema, and inflammatory content of the gallbladder and hydatid cyst fragments on the common bile duct samples. The premature new-born survived and both the mother and the infant were discharged in good health condition after 2 weeks.

a Fetal Medicine, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, RS, Brazil b Graduation in Medicine, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil c Graduate Program in Pathology, Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil d Clinical Genetics, Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA) and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil e Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, RS, Brazil

The incidence of true knot of the umbilical cord is not only very low but it is often undiagnosed antenatally when present despite the availability of prenatal ultrasonography. When the true knot remains tight, it may impede the circulation of the fetus and may result to fetal death in utero especially in labor. We report a very uncommon case of true knot of the umbilical cord that ultimately led to a fetal demise. A 39‑year‑old booked G7 P5+1 with four living children, who booked for antenatal care at a gestational age (GA) of 17 weeks. The fundal height was compatible with the GA throughout pregnancy. An ultrasound done at a GA of 36 weeks showed normal findings. She had onset of labor at a GA of 40 weeks and 5 days following cervical ripening with two courses of 50 μg misoprostol inserted at the posterior fornix 6 h apart. The fetal heart tones were monitored using Doppler sonicaid. They remained normal throughout labor that lasted 13 h. She subsequently had spontaneous vertex delivery with poor Apgar score. The baby died immediately after birth. The umbilical cord was more than double the normal length and a true knot of the umbilical cord was diagnosed after delivery of the baby. We have reported a case of true umbilical cord knot in Nnewi, South‑East Nigeria. Although this entity can be diagnosed antenatally, current experience is limited to incidental observation and consequent fetal demise.Keywords: Fetal demise, True knot, Umbilical cord