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Expedited delivery in a patient with reduced fetal movements and abnormal Doppler findings revealed a true umbilical cord knot, resulting in a favorable neonatal outcome.
A 38 year old multigravida (gravida:4, para:2+1, live:1) with nonsevere pre-eclampsia presented at 34 weeks gestation with reduced fetal movements [RFM]. Admission cardiotocography was reactive. Obstetric ultrasound showed weight on 1st centile. Dopplers showed cerebroplacental ratio of 0.9 suggestive of brain sparing. Umbilical artery pulsatility index was at 96th centile, with forward flow in diastole. In view of the persistent complaint of RFM, it was jointly decided to expedite delivery of the fetus. Per operatively, a true knot was present around 10 cms from the umbilical end with blanching proximal to the knot. The baby was delivered active, with anApgar score of 6 and 7 at 1 and 5 minutes respectively.
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Suman Nishad (2023) studied this question.
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