True Knot in Umbilical Cord

In this video, ABC Law Centers: Birth Injury Lawyers’ previous in-house nurse Andrea Shea discusses what a true knot is and how it can deprive the baby of oxygen.

At ABC Law Centers: Birth Injury Lawyers, our in-house medical professionals are a critical part of our team. Our registered nursing staff provides our legal team with valuable insight, medical knowledge, and experience for birth injury cases. As experienced medical professionals, they have the necessary knowledge to help us assess each case. Moreover, their compassion for patients translates over into their strong advocacy and care for our own clients. Meet our registered nursing staff here.

When you contact ABC Law Centers: Birth Injury Lawyers, you will be greeted by an intake professional, who will listen attentively and answer your legal questions. Our intake nurse, Lesley Atton, RN, will gather information from you and speak to one of our birth injury lawyers about your potential case. While our staff is always happy to answer questions regarding birth injury or legal questions, unfortunately, our nurses cannot provide medical advice. 

If you have medical questions or concerns about a true knot in your baby’s umbilical cord, it’s important to contact your doctor as soon as possible. As dedicated advocates for mothers and babies, we want to ensure that every patient receives proper and timely individualized care. If you have concerns about your treatment or need medical attention, speak with your care team or a hospital patient advocate.

True knots normally form between nine and twelve weeks gestation because that is the period when the amniotic fluid level in the womb is very high. There is also evidence that true knots can form during labor. These two periods of time are the most likely periods for a true knot to occur.

It’s important for physicians to properly screen their patients for risk factors. If risk factors for true knots are present, the patient will require ultrasound checks to identify a possible knot and appropriately monitor the baby. 

True knots are more likely in the instances of:

• Monoamniotic twins: Identical twins who share the same amniotic sac 
• Polyhydramnios: An excess of amniotic fluid
• A long umbilical cord
• Small size fetuses
• Multiparity: Having two or more previous pregnancies
• Advanced maternal age: A mother over age 35

Decreased fetal activity after week 37 is the most common sign of a true knot. Another sign is an abnormal or non-reassuring fetal heart rate on a fetal heart monitor. Abnormal heart rates will occur when the knot is serious enough to cause a decrease in oxygen delivered to the baby’s brain.

There is nothing a patient can do to prevent a true umbilical cord knot from forming. Doctors should monitor the baby closely if there are concerns of decreased fetal activity.

Although an abnormal or non-reassuring heart tracing can be indicative of a true knot, an ultrasound examination is the method of choice for diagnosis of a knot. When certain risk factors are present, such as the mother being pregnant with monoamniotic twins, it is the standard of care to test for knots prenatally. Specifically, four-dimensional, color Doppler and power Doppler examination are the most important modalities for assessment and diagnosis of a true knot.

During delivery, a true knot can be diagnosed by examining the placenta and umbilical cord.

Knots do not have negative effects in the majority of cases, but in a few cases they can result in injury to the baby or death.

For this reason, when a baby has risk factors for a knot, more frequent ultrasounds are required. When a true knot is diagnosed, strict monitoring of fetal well-being is required during pregnancy and delivery. Often, the physician will admit the mother to the hospital for close and continuous monitoring. True knots can tighten at any time, especially during delivery.

Due to the compression of the cord vessels when a knot tightens, true knots greatly increase the chances of death and hypoxic-ischemic encephalopathy (HIE). Proper antenatal care must be administered in order to protect the baby from suffering birth injury. A C-section delivery is often the safest way to deliver a baby when a true knot and fetal distress are present. If the baby is experiencing non-reassuring heart tones, an emergency C-section is usually necessary to deliver before the baby suffers HIE from not getting enough oxygen.

While true knots are not preventable, a birth injury from a true knot is preventable. If your child is injured from a mismanaged true knot, you may have a legal case. Doctors are required to follow standards of care as outlined on this page if a true knot or risk factors for a true knot exist. If they do not follow these standards and cause a preventable injury to their patient, it’s considered medical malpractice. 

It can be extremely upsetting to know that the team you trusted with your care made an error that harmed your family. It may also feel overwhelming or intimidating to consider filing a legal case while caring for an injured baby. Our birth injury attorneys have been working with parents like yourself for over 25 years. We have seen firsthand how overwhelming this entire process can feel, which is why our team is here to attentively listen to your story, patiently answer any questions or concerns you may have, and explain your legal options. We offer free consultations, and our clients do not pay us at all unless we win or favorably settle their case.

If your loved one suffered permanent damage from an umbilical cord complication, it’s important to work with a firm that has experience in these types of complex medical malpractice cases. Birth injury medical malpractice lawsuits can take multiple years to litigate and require input from medical, economic, and life-care planning experts. The firm you work with should have the resources and experienced staff needed to handle your case. 

ABC Law Centers: Birth Injury Lawyers was established to focus exclusively on birth injury. At our office, clients are not just a case number. Our focus on birth injury allows us to give each client the attention and care that their case deserves. Our attorneys and in-house medical staff determine the causes of our clients’ injuries and uncover where the medical negligence occurred. In every case, we consult with our network of leading medical, economic, and life-care planning experts across the country. While we’re based in Detroit, Michigan, our attorneys handle cases all over the United States.

1. Cord Knots in Pregnancy: Causes, Symptoms & Treatment
2. True Knot of Umbilical Cord
3. Ikechebelu, J., Eleje, G., & Ofojebe, C. (2014). True umbilical cord knot leading to fetal demise. Annals of medical and health sciences research, 4(Suppl 2), S155-8.