EP17.04: True knot of umbilical cord: the benefit of active management

To compare perinatal outcomes between active and routine management in true knot of umbilical cord (TKUC). A retrospective study of all singletons born beyond 226/7 weeks with TKUC. Perinatal outcomes were compared between two groups- 1) prenatally detected TKUC receiving active management and 2) postnatally detected TKUC receiving routine management. Active management included weekly fetal heart rate monitoring (FHRM) from 30 weeks, growth scan at 32 weeks and labour induction at 36-37 weeks. The rates of the following adverse perinatal outcome were compared: fetal death, Caesarean section (CS) or Instrumental delivery due to non-reassuring fetal heart rate (NRFHR), low Apgar score, cord Ph <7, neonatal asphyxia, neonatal intensive care unit (NICU) admission, etc. A composite asphyxia-related outcome composed of selected individual outcomes, was compared. The Active Management (n = 59) and Routine Management (n = 1091) groups demonstrated comparable rates of composite asphyxia-related outcome (16.9% vs 16.8%, p = 0.97). The Active Management group had higher rates of prematurity (27.1% vs 5.3%, p < 0.001), labour induction (53.5% vs 13.2%, p < 0.001), induced prematurity (22% vs 1.7%, p < 0.001), CS (37.3% vs 19.2%, p = 0.003) and NICU admissions (13.6% vs 3%, p < 0.001). Fetal death occurred exclusively under routine management (1.8% vs 0%, p = 0.6). Weekly FHRM and labour induction between 36-37 weeks in TKUC does not appear to confer a proven benefit over routine management. In its current form, active management is associated with higher rates of CS, prematurity, induced prematurity and NICU admissions. Labour induction before 37 weeks should be avoided. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.