Successful Vaginal Delivery Despite a Double True Umbilical Cord Knot: A Case Report and Literature Review

True umbilical cord knots are uncommon findings, occurring in approximately 0.3–2% of pregnancies, while double true knots are exceedingly rare, with an estimated incidence below 0.1%. These anomalies can lead to umbilical vessel compression, resulting in fetal hypoxia or stillbirth, though outcomes largely depend on the tightness of the knot and timely management. We report the case of a 31-year-old gravida 3 para 3 woman who delivered vaginally at 39 weeks of gestation. Her pregnancy was uneventful, and routine ultrasounds revealed no cord abnormalities. During labor, continuous fetal heart rate monitoring detected a sudden deceleration to 60 beats per minute at full dilation, prompting immediate delivery. A male newborn weighing 3200 g was delivered with Apgar scores of 6 and 9 at one and five minutes, respectively. Post-delivery examination revealed a double true umbilical cord knot approximately 30 cm and 40 cm from the placental insertion. Both mother and infant recovered well. This case emphasizes the potential risks of double true knots and highlights the crucial role of continuous intrapartum monitoring and prompt obstetric intervention in achieving favorable neonatal outcomes, even in unexpected high-risk cord anomalies.