True knotting of umbilical cord resulting in sudden unexpected fetal demise

Abstract

Knotting of the umbilical cord is a significant cause of perinatal morbidity and mortality. It could be loose or tight. Tightening of the knot rarely occurs and when present can cause fetal demise. Antenatal features of the knotting of the umbilical cord are not only difficult to elicit but also usually do not conclusively establish the diagnosis. We report a case of true knotting of the umbilical cord in a 32-year-old female, who suddenly experienced decreased fetal movement and within 60 min had a fetal demise at 39 weeks of gestation. Intraoperative findings showed a stillborn female fetus, with no sign of maceration or congenital abnormality. The umbilical cord was relatively long and tightly knotted. To the best of our knowledge, this was the first case report of the true knotting of the umbilical cord in Liberia. Obstetricians and general practitioners should take caution that it remains an unseen cause of sudden intra-uterine fetal death during the antenatal period.