title: True knot of the umbilical cord: transient constrictive effect to umbilical venous blood flow demonstrated by Doppler sonography.
abstract: True knot of the umbilical cord is a rare occurrence, which is difficult to diagnose antenatally, even with the use of ultrasound. Constriction of a true knot of the umbilical cord may lead to obstruction of the fetal circulation and subsequent intrauterine death. We present a singleton pregnancy, in which the antenatal diagnosis of a true knot of the umbilical cord with entanglement of the cord around the fetal neck and body was made at 23 + 1 weeks' gestation. With the use of color-coded Doppler followed by pulsed wave Doppler spectral analysis, a stenotic effect on the umbilical venous blood flow, with normal arterial blood flow, was demonstrated for the first time. Marked acceleration of umbilical venous blood flow velocities from 15 cm/s pre-stenotically to 100 cm/s post-stenotically was demonstrated. This presented as an aliasing phenomenon and a mosaic pattern on color flow imaging in the variance mode. This phenomenon was only transient and could not be demonstrated again at follow-up examinations. A healthy newborn was delivered by Cesarean section at 33 + 1 weeks' gestation. The presence of a single knot was confirmed at delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University Lübeck, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Gembruch
authors.forename: A A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012039:Regional Blood Flow; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014470:Umbilical Cord / Q000000981:diagnostic imaging* / Q000473:pathology; D014471:Umbilical Veins / Q000502:physiology*