Abstract

The association of true knot and overcoiling of cord is a rare and risky condition during pregnancy. Most knots are loose with no clinical significance, but when becoming tight, they may damage fetal circulation and give a sudden Intrauterine Death (IUD). Coils number/cm identifies Umbilical Coiling Index (UCI). Hypercoiled cords is defined when UCI exceeds 0.3 coils/cm. We report one case of a double rare congenital anomaly occurred at Catania S. Marco’s University-Hospital. A 37 years old, para 1: a previous Caesarean Section (CS), gravida 2, was admitted to hospital and an unexplained intrauterine fetal demise at 37th week of gestation was diagnosed. Following CS, a female stillborn of 2,300 grams with large areas maceration signs was extracted. A combination of true knot and spiralization of umbilical cord was observed and identified finally, as death trigger following fetal hyper mobility. Since the movements of the child and the onset of both knot and coiling cord with mechanical ischemic alterations, do not depend on the correct management but often on fortuity, this event is unpredictable, and no fault can be attributed to the medical team.

Keywords: Umbilical cord; True knot; Intrauterine death; Legal problems

Abbreviations: IUD: Intrauterine Death; UCI: Umbilical Coiling Index; CS: Caesarean Section; MCA-F: Middle Cerebral Artery Flowmetry; PI: Pulsatility Index; UA-F: Umbilical Artery Flowmetry