A true umbilical cord knot- one diagnosis and two different perinatal outcomes

Introduction and aims of the study: True umbilical cord knot (TUCK) reported in 0,3%–1,2% of all pregnancies is associated significantly with preterm birth, intrapartum fetal distress, fetal acidosis, low Apgar score at the first minute, higher risk of cesarean delivery and intrauterine fetal death. This study aims to identify possible associations between fetal heart rate (FHR) patterns, TUCK and perinatal outcome. Methods: Healthy 32-year-old gravida 2, para 2 and 28-year-old primipara at 41 weeks of gestation had premature rupture of membranes and lack of contractions. Both patients had induction of labour. Results and discussion: In the first case during labour cardiotocography(CTG) recorded increased baseline FHR with episodes of saltatory patterns on oxytocin and variable decelerations followed by late complicated decelerations with slow progress of labour. Neonate was born by Category II Caesarean section with a double TUCK and Apgar score was 9/9. Cord blood gases were normal. Whereas in the second case during labour CTG recorded normal baseline FHR with normal variability and variable decelerations followed by a ZigZag pattern(ZZP). ZZP is periodically repeated for at least 2 minutes and is followed by repetitive late decelerations and decreased variability. Normal frequency of uterine contractions. The fetus was born in a vacuum–assisted delivery with a tight nuchal cord and a TUCK. Apgar score was 4/5/7. Perinatal hypoxia resulted in fetal death after 21 h of living. Fetal CTG is a dynamically changing method of fetal well-being assessment in labour. Fetus itself, maternal positioning, oxytocin and other factors have an impact on CTG trace dynamics. It is important to diagnose fetal deterioration early to avoid bad perinatal outcome. Conclusions: The main finding of this study is that ZZP and decreased variability were associated with adverse perinatal outcomes.