True Knot of the Umbilical Cord in Low- and Middle-Income Countries: Incidence, Risk Factors, and Clinical Outcomes from a Two-Case Series

Background: True knot of the umbilical cord (TKUC) is a relatively rare obstetric occurrence with potential for fatal outcomes. While the exact etiology remains unclear, specific maternal and fetal risk factors are significantly linked to adverse perinatal outcomes. Methods: We evaluated the total number of cases of true knot of the umbilical cord presenting at a reference center over a one-year period in Ibadan, Nigeria. Results: Two cases of TKUC were incidentally diagnosed out of 108 deliveries, yielding an incidence of 1.85%. Neither case exhibited prenatal ultrasound findings suggestive of the condition. Identified risk factors included multiparity, previous uterine surgeries, and multiple gestations. Both cases were managed with elective surgical delivery resulting in favorable neonatal outcomes without mortality or neurological sequelae. Conclusion: True knot of the umbilical cord remains an unpredictable obstetric event. Every clinician involved in peripartum care must maintain a high index of suspicion to ensure timely diagnosis and mitigate potential perinatal morbidity and mortality.