Twice in the last few weeks a baby has been born with a true knot in the cord. This is not a common occurrence and so having two is interesting especially since they only live a few streets apart. For people into quantum physics and epigenetics I wonder if there is some external link? A true Knot only happens 1.4% of the time which is about 1 in 80 births.
This came from a study done in 2005
The finding of 13 true knots in this series of 967 deliveries (1.4%) is within the previously reported incidence.3-7 Eight true knots were incidental findings at delivery, with no clinical significance. Four cases demonstrated signs of fetal distress during labor, necessitating cesarean delivery. One IUFD resulted from a true knot, hanging-type injury of a preterm fetus at gestational age of 19 weeks.
The conclusion was that a true knot posed a significant risk even to the point of considering a section for a true knot as the best course of delivery if the knot was found on a scan.
This seems a terrible conclusion to make as 1/3 of the population have a section. With the figures given to us in this study 1/3 of the women with a true knot ended up a section. That could be seen as nothing more than chance. They blamed the true knot as a reason after the fact in all the cases. How about that for fueling the section rate.
knot in cord
This is an interesting article that appeared in the press this week. Always more interesting if it’s published and not just blogged.
Is the Cord Around the Baby’s Neck Really Dangerous?
Misha Safranski
As a confirmed birth junkie, I have heard over and over again birth stories where the baby was born by cesarean for either fetal distress or failure to descend, and the difficulties are blamed on “the cord was around the baby’s neck”. Is this condition – scientifically termed “nuchal cord” – actually dangerous? A new study backs up previous research showing that nuchal cord is not the threat it’s perceived to be.
A study published this year in the Journal of Perinatal Medicine showed there were no statistically significant differences in outcomes of post-term pregnancies involving a nuchal cord verses no nuchal cord. Drs. Ghosh and Gudmundsson performed color ultrasound on 202 women with post-term pregnancies. Nuchal cords were detected in 69 of the women. There were no significant differences in Apgar scores, umbilical cord anomalies, cesarean section, perinatal death or admission of the baby to the NICU (neonatal intensive care unit).
These findings confirm what has been found in most of the past research on nuchal cord outcomes. A 2006 study from the Archives of Obstetrics and Gynecology was on a much larger scale, looking at the outcomes of 166,318 deliveries during a 15 year study period, 24,392 of which had a documented nuchal cord at birth. The authors, Sheiner et. Al, conclude: “Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.”
The interesting thing about the Sheiner study is that despite the equivalent outcomes among nuchal cord babies and those without the cord wrapped around the neck, there were higher rates of labor induction and non-reassuring fetal heart tones during labor among the nuchal cord cases.
These two factors are most likely related. We know without a doubt that induction of labor can cause fetal distress. The fact that there were higher induction rates in the nuchal cord group could very well explain the higher rate of transient fetal distress. Induction is nearly always accompanied by AROM (artificial rupture of membranes), which can cause undue pressure on the cord, which can in turn result in blips in the hearttones. Regardless of the cause, the outcomes were still good.
Finally, we look at yet another study which demonstrated that nuchal cord does not result in worse outcomes. In a 2005 study looking at the effects of nuchal cord on birthweight and immediate neonatal outcomes, Mastrobattista, et. Al examined the outcomes of 4426 babies, 775 of whom had a nuchal cord. They found that there were no significant differences between the two groups in birthweight, non-reassuring fetal hearttones, Apgar scores below 7, or operative vaginal deliveries. The cesarean rate was actually highest among the women whose babies did not have a nuchal cord.
Here is a previous post by me about the cord around the neck.
The most important thing to keep in mind is that unborn babies do not breathe through their mouth and neck – they receive oxygen through the umbilical cord. This is why it normally doesn’t matter if the cord is around the neck (unless the cord is being compressed too much, which is fairly rare). The baby cannot “choke to death” before she/he is born. What we can conclude from the overwhelming majority of data is that nuchal cord – or “cord around the neck” – is not pathological; that is to say, it’s not an abnormality. It is a normal condition of the umbilical cord and typically causes no problems with the delivery, even though doctors frequently try to convince parents otherwise.
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Hooray! Common sense!
Hi Lisa,
I wonder what the incidence of two true knots in the cord is? Was at a birth where the cord was really long and there was one knot close to the placenta and the other close to the baby.
Andrea
Oh and you've doubled up on a lot of text you might want to remove.
You can delete this comment too. *lol*
Note to self. READ ALL WORK BEFORE PRESSING PUBLISH.
Thanks Sheelnagig.
Andrea the incidence is 1 in 80 births. 1.4%
So does this mean that I could have birthed Mr B at home?? Or was my case different??
Thanks for this, Lisa!
Is there a direct link to the article by Misha Safranski?
I thought maybe it was the 'publish post' but it is not working for me.
Is the rate for two knots in the one cord the same as for one knot? I would have thought it less common. Either way, it was an interesting but incidental finding – they had no bearing on the birth or baby
As a certified nurse-midwife, I've seen a fair number of true knots of the cord. Only one has occured in a fetal demise, at 22 weeks of age. I made the mistake of assuming that the knot was the cause of death.
The mother returned to me a few months later, pregnant again with her second baby. This time, she made it to 32 weeks, and then I discovered, at a routine prenatal visit, that her baby was having a drop in her heart rate. After diagnostic tests confirmed the baby was in trouble, an emergency c-section was done. We sent the placenta for an examination by a pathologist, as we had no idea what had caused this baby's distress.
It turned out the mother had a rare syndrome which the obstetrician who did the surgery had not even heard of. The syndrome is a frequent cause of fetal demise in the second and third trimesters. It was the likely cause of death for the first baby, rather than the knot in the cord.
To schedule someone for a c-section because a knot in the cord is identified is ridiculous. Monitoring of the baby's heart rate would easily enable the midwife or physician to make sure the knot wasn't causing any problems for the baby.
How cool to see pictures of the knots!
I had a c-section because during the early stages of labour my childs heart rate dropped as low as 68 beats a minutes with each contraction and got slower and slower at going back up to a regular heart beat between contractions. This was a result of the cord being around her neck and compression with each contraction. If the doctors did not intervene and perform a c-section I am certain I would not have a healthy girl today!
I have five children. The youngest three all had true knots in the cord. It has been assumed that this is due to long cords, but I was wondering if this could be genetic in any way. I was told after the first that it would be next to impossible for it to happen again. And then after the second, I was strongly reassured that there would be no way that it could happen. What will happen when I have number six?
I am a student midwife and recently I cared for a couple who were to be induced at 37 weeks (ish) as they had previously had a baby die in utero at 38 weeks due to a very tight true knot. They were a beautiful couple and understandably nervous. They were reassured over and over again throughout their pregnancy that the chances of the same accident occurring again was virtually nil. In the end they weren’t induced that day because the baby’s head had come up and out of the pelvis and there was no reason to induce other than to get the event out of the way, they understood it was wrong to risk the induction and went home, devastated but understanding.
When I was back at prac the next week I found out that the couple had indeed given birth to a healthy baby a few days later, with, you guessed it…another true knot!!!
So lightning can strike twice, luckily with a different outcome the second time round.
My second child had a knot in his cord. We didn’t find out about it until he was born via emergency c-section for loss of heartbeat. His heart rate had been flucuating with contractions, but always returned to normal afterwards and all the sudden it just started dropping rapidly and then it was gone. He was born 4 mins later, totally blue(I was given general anesthesia) and he didn’t have a heartbeat and had to be given CPR. Luckily after about 2 minutes, they were able to get his heart going again and got him breathing on his own. My OB told me when I woke up that the cord had a very tight knot in it and she even saved the umblical cord to show me in recovery. I wish I’d taken a picture of it. I am glad he was born safely and feel lucky that he is alive today and a thriving four year old. However, my OB said this is very rare and she has delivered babies with knots in their cords vaginally with no problems and it just seems to depend on the baby, how long the umblical cord is, and how tight the knot is. Had she seen a knot on ultrasound, she said she would not automatically consider doing a c-section, she’s still want the mom to attempt a vaginal birth.
I was born with two true knots in my umbilical cord. I was induced 2 weeks early because they didn’t know why my heart rate was so erratic. It was 1973 – they did an ultrasound but it was mostly static. It was the first time the OB had seen 2 knots in the one cord. I think it’s pretty rare!