True umbilical cord knot appears to be a relatively common complication that occurs in 0.3%–1.3% of all pregnancies and it is correlated with an increased incidence of SGA infants, premature birth, need for neonatal intensive care and fetal death. The aim of the article was to evaluate the incidence of the true umbilical cord knot in the University Emergency Hospital, Bucharest, for a period of 5 years and its association with premature birth, low birth weight, low Apgar score at 1 minute and the need for neonatal intensive care. By reviewing the total number of women who delivered in this unit between January 1st 2011 and December 31st 2015, the percentage of the diagnosis antepartum and intrapartum, the outcome of these pregnancies, and the reflection of this condition on the fetal status, were evaluated. During 5 years, 133 (0.71%) of 18.500 deliveries were diagnosed with true umbilical cord knot, only 16 (0.08%) cases were diagnosed by ultrasound antepartum. The mean maternal age was 34.3 years. About 30% of the studied cases (39) presented this condition at the third delivery or more. A personal history for diabetes corresponded to 27 cases (20.3%). From our database, it resulted that only 12 fetuses (10.5%) required neonatal intensive care and presented an Apgar score lower than 7 at 1 minute. Prenatal diagnosis of a true umbilical cord knot is rarely encountered and sonography skills are needed. Complementary methods such as color Doppler and 3D HD Flow are reliable for the diagnostic when true umbilical cord knots are suspected after a 2D scan. Several risk factors can guide the expectancy, such as advanced maternal age, polyhydramnios, multiparty or diabetes.