Outcome of pregnancies with true umbilical cord knot

Pravi čvor pupkovine je jedna od abnormalnosti pupkovine koja može utjecati na ishod trudnoće. Postojanje pravog čvora pupkovine povezano je s povećanom učestalošću fetalnog morbiditeta i mortaliteta. Iako je moguće slikovno prikazati pravi čvor pupkovine, za sada se dijagnoza prenatalno postavlja isključivo slučajnim nalazom. Cilj ovog istraživanja bio je utvrditi učestalost pravog čvora pupkovine i prikazati ishode trudnoća s pravim čvorom pupkovine koje su dovršene na Klinici za ginekologiju i porodništvo KB „Sveti Duh“ u razdoblju od početka 2005. do kraja 2017. godine. Ispitanici su bili rodilje i novorođenčad kod kojih je postnatalno postavljena dijagnoza pravog čvora pupkovine (n=267). Kontrolna skupina obuhvatila je sve rodilje koje su u navedenom razdoblju rodile jedno dijete (n=39345). Istraživani su podaci o mrtvorođenosti, načinu dovršetka trudnoće – carski rez ili vaginalni porođaj, intrapartalnoj fetalnoj patnji te spolu djeteta. Podaci su prikupljeni iz knjige porođaja i iz bolničkog informatičkog sustava. Provedena je statistička obrada podataka. Ovim istraživanjem dobivena je učestalost pravog čvora pupkovine od 0,67%. Usporedbom istraživane i kontrolne skupine nije utvrđena statistički značajna razlika unačinu dovršetka poroda (p=0,067), prisutnosti znakova intrapartalne fetalne patnje (p=0,95). Utvrđena je statistički značajna razlika u spolu novorođenčeta (p< 0,0001)i mrtvorođenosti (p< 0,0001) između istraživane i kontrolne skupine. Rizik intrauterine fetalne smrti je 15 puta veći kada je prisutan pravi čvor pupkovine. Samo postojanje čvora ne ometa protok krvi kroz pupkovinu s obzirom na to da nije uočena veća učestalost intrapartalne fetalne patnje kada je prisutan pravi čvor pupkovine. Ipak, impresionira činjenica da je rizik intrauterine smrti (prema ovom istraživanju) čak 15 puta veći uz prisutnost pravog čvora pupkovine. Kada i kako pravi čvor postaje prijetnja za život djeteta još nije utvrđeno, a zbog rizika od fetalne smrti nameće se logično pitanje: Što učiniti ako se prenatalno metodom slikovnog prikaza utvrdi postojanje pravog čvora pupkovine?True umbilical cord knot is one of the umbilical cord abnormalities that can affect the pregnancy outcome. The existence of a true umbilical cord knot is associated with an increased incidence of fetal morbidity and mortality. Although it is possible to view the umbilical cord knot by imaging methods, for now prenatal diagnosis of a true knot is a random finding.The aim of this study was to determine the frequency of umbilical cord knot and to present the outcome of pregnancies with true umbilical cord knot. The analysis was performed retrospectively at the Department of Obstetrics and Gynecology of the University Hospital ˝Sveti Duh˝. The subjects were mothers who gave birth in the period from the beginning of 2005 to the end of 2017. Their newborns were also included in the study. In the researched group there were 267 mothers and newborns with the diagnosis of true umbilical cord knot. The control group included all mothers who had given birth to one child in the given period of time (n=39345). Stillbirth, mode of delivery – cesarian section or vaginal delivery, fetal asphyxia, and newborn's sex were analyzed for both groups. The data were collected from thehospital birth records and informatic system. The incidence of true umbilical cord knot was 0.67%. Comparison of the researched and control group did not establish a statistically significant difference in the mode of delivery (p=0.067), presence of fetal asphyxia (p=0.95). There was a statistically significant differencein the newborn's sex (p< 0.0001), and in the mortality (p< 0.0001) between the investigated and control group. The risk of intrauterine death is 15 times higher when a true knot is present. The existence of a true knot itself does not interfere with the blood flowthrough the umbilicalcord since there is no greater frequency of intrapartal fetal asphyxia when a true knot is present. However, the fact that there is a 15 times higher chance of intrauterine fetal death with a knotted cord is impressive. When and how a true umbilical cord knot becomes a threat to the life of the child is not yet established, and because of the higher risk of fetal death the only logical question is what to do if prenatal imaging methods determine the existence of a true knot