True Knot in Baby’s Umbilical Cord During Pregnancy

A knot in a baby’s umbilical cord is called a “True Knot of Umbilical Cord.” It can be caused by high levels of amniotic fluid in the womb, or occur when the baby inadvertently experiences cord entanglement while being active inside the womb. While in most cases, there aren’t any complications during birth, some cases have risks involved. In this article, we shall address all the concerns/ questions you may have about a knot of the umbilical cord, its symptoms and treatment.

What Is True Knot in the Umbilical Cord?

The umbilical cord connects a foetus to the mother and helps provide blood rich in oxygen and nutrients. It resembles a cord and consists of two arteries and one vein which are protected and held together by a substance called “Wharton’s Jelly”. When this umbilical cord forms a knot inside the womb, it is called a True Knot of Umbilical Cord. The condition is also known as cord knots, placental Knots and umbilical cord knots.

There’s also something called a false knot in the umbilical cord. The medical practitioner needs to be sure about the kind of knot it is to ensure he/she takes appropriate measures during childbirth.

So, what is the difference between these two knots? Let’s find out.

Difference Between True Knot And False Knot in the Umbilical Cord

A false knot is simply an excess covering of Wharton’s Jelly, which makes it look very similar to a true knot. False knots never endanger the foetus whereas true knots might.

The next obvious question in your mind must be – how common a true knot is. Read on to know more.

How Common Is True Knot in the Umbilical Cord?

A knot in the umbilical cord is surprisingly common during pregnancies. One in every 100 pregnancies has been diagnosed with this condition. However, the fatality rate due to true knot in the umbilical cord is low; with only one in every 2,000 births causing complications. In the case of twins sharing the same amniotic sac in the uterus, chances of true knots are generally higher as there are two cords within the same sac.

So, what is it that causes a true knot in the umbilical cord? Let’s find out.

Causes of True Knot in the Umbilical Cord

Here are some factors that can cause a knot in the umbilical cord:

• Elevated foetal activity in the womb increases the chances of your baby getting entangled in the umbilical cord.
• Long umbilical cords can wrap around the baby and could form a knot.
• Babies that are relatively small have a high chance of getting entangled in the umbilical cord.
• Too much amniotic fluid in the sac allows for lots of movement of the foetus, which could also lead to the umbilical cord getting entangled.

Symptoms of True Knot in the Umbilical Cord

Decreased foetal activity after the 37^th week of pregnancy might be associated with knot in the umbilical cord. Foetal activity slows down when the blood circulation is compromised. The degree depends on how tight the knot is, thereby compromising the flow of oxygen and nutrients to the child. The condition can be confirmed with an ultrasound after the gynaecologist makes a thorough diagnosis, which we shall talk about in the next sub-head.

Diagnosis of True Knot in the Umbilical Cord

These are the modules used when diagnosing this condition:

• Ultrasound Scan – Ultrasound scans are used to detect and assess the seriousness of the knot. An abnormal or decreased heart rate of the foetus can also be detected during an ultrasound which could be because of the knot.
• Colour Doppler Sonogram – Colour doppler sonograms can be used to check for problems with blood flow to the baby in the womb.

True knots are difficult to diagnose prenatally. This is because, they have been reported to form in all three trimesters and during scanning, the whole length of the umbilical cord is not routinely seen.

Risk Factors of True Knot in the Umbilical Cord

Some people are at greater risk of having knot formations in the uterus. These include:

• Older women
• Multiple pregnancies with twins, triplets, etc.
• Long umbilical cord
• Excess of amniotic fluids
• Anaemia
• Gestational Diabetes

By now, you are probably wondering if this condition can be treated. Let’s find out.

Treatment of True Knot in the Umbilical Cord

Unfortunately, there are no treatments available for a true knot in the umbilical cord. However, there are ways the gynaecologist can carry out your childbirth to ensure minimal or no damage to your little one. Here’s what is usually done when the doctor has diagnosed a true knot in the umbilical cord:

• Keep a watchful eye on your baby’s development inside the womb.
• If a diagnosed knot is tight, your gynaecologist will suggest a C-Section delivery to reduce the chances of the knot tightening even further during delivery. 

These actions are taken depending on how tight the knot is. But, there are cases where the condition can lead to medical complications.

Complications Due to True Knot in the Umbilical Cord

Here are some health complications that might occur when a baby is born with a true knot in the umbilical cord:

• Negative changes in the heart rate of the foetus.
• Brain damage.
• Death of the foetus or stillbirth.

Let’s also take a look at the prognosis of a true knot in the umbilical cord.

Prognosis of True Knot in the Umbilical Cord

One the following could be the prognosis of this condition:

• High chance of survival with care and management.
• Possible chance of brain damage.
• Stillbirth
• Uncertain risk of foetal  morbidity and mortality

All the information about true knots in the umbilical cord might sound daunting, making you think if there are preventive measures you could take. The next section should answer your question.

Prevention of True Knot in the Umbilical Cord

Studies have shown that detecting knot formation can be difficult to observe even with an ultrasound. This is because they have no characteristic patterns associated with them. However, sudden distress in the baby due to lack of proper oxygen and nutrients could indicate the presence of a true knot. To identify these sudden changes, one of the following can be done.

• Perform ultrasounds on a regular basis during pregnancy.
• If diagnosed, close monitoring is required for the rest of the gestation period.

The formation of a true knot in the umbilical cord is a dangerous phenomenon as it could lead to the blockage of oxygen and nutrients. Despite advances in modern medicine, medical professionals are yet to find a reliable way to detect the condition. Thankfully, true knot formation is something that is rare and medical institutions have reliable systems to ensure the survival of the baby during childbirth.

Reference:

• DoveMed