Combined simple and complex cord knots

Both double true knots and complex knots of the umbilical cord are rare events. This report presents a case in which the two occurrences were combined. Apart from some early decelerations in the first stage of labour, there was no evidence of fetal compromise. A mid-cavity forceps delivery performed for poor maternal effort resulted in the birth of a healthy female infant. The mechanism and consequences of umbilical cord knotting are reviewed.