True knot at the time of delivery: electronic fetal monitoring characteristics and neonatal outcomes

OBJECTIVE: Determine the association between electronic fetal monitoring and neonatal outcomes in the setting of a true knot at delivery. STUDY DESIGN: This was a planned secondary analysis of a prospective cohort of 8,580 women. Patients with and without a true knot were compared and the primary outcome was repetitive late decelerations occurring with at least 50% of contractions. Confounders were adjusted for using logistic regression. RESULTS: 8,580 patients met inclusion criteria and 49 (0.57%) had a TK. There was no significant difference in the rate of repetitive late decelerations in patients with TK (aOR 1.04; 95% confidence interval [CI] 0.25–4.40),other electronic fetal monitoring parameters, or neonatal outcomes. CONCLUSION: Neonates with true knots who are delivered at term have similar electronic fetal monitoring characteristics compared to those without true knots and no detectable difference in neonatal morbidity; thus, calling into question the clinical significance of a true knot at term.