FATAL TRUE UMBILICAL CORD KNOT: A CASE REPORT

Pasquale Giuliano; Pasquale Orabona; Alfonso Maiellaro; Marco Trabucco Aurilio; Giuseppe Cenname; Francesco La Sala; Mauro Arcangeli

doi:10.3269/1970-5492.2019.14.07

Authors

Pasquale Giuliano

Unit of Legal Medicine, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy, Italy.

Pasquale Orabona

Unit of Anatomical Pathology, A.O.R.N. “Sant’Anna e San Sebastiano”, Caserta, Italy, Italy.

Alfonso Maiellaro

Unit of Legal Medicine, A.O.R.N. “Antonio Cardarelli”, Naples, Italy, Italy.

Marco Trabucco Aurilio

studiotrabuccoaurilio@gmail.com

Legal Medicine Governance Unit, INPS- Italian Institute of Social security, Rome, Italy, Italy.

Giuseppe Cenname

Section of Legal Medicine, Health Governance Unit, Arma dei Carabinieri, Rome, Italy, Italy.

Francesco La Sala

Department of Experimental Medicine, University of Campania “L. Vanvitelli”, Naples, Italy, Italy.

Mauro Arcangeli

Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy, Italy.

A true umbilical cord knot can be defined as an entwining of a segment of the umbilical cord. These knots are usually due to fetal slippage through a loop of the cord. A true knot is a rare event with a rate ranging from 0.1% to 2.1% of all umbilical cords at delivery. However, in 1.4% to 2.7% of such pregnancies, a true knot causes intrauterine fetal death (IUFD). Wharton’s jelly and hydrostatic pressure of the umbilical vessels usually do not allow knots to completely tighten, but just before or during labor, a previously loose knot can tighten and cause asphyxia. Prenatal diagnosis of such an alteration is difficult and, even if diagnosed, there is no consensus on the therapy. We describe a case of a true umbilical cord knot that led to IUFD of a female fetus at the 40th week of gestation