The association between umbilical cord coiling index and adverse perinatal outcomes at term pregnancies

Objectives: The umbilical coiling index, calculated by dividing the total coil number to the cord length, is a representative parameter for umbilical cord coiling status. Recent studies have shown that abnormal umbilical coiling index is associated with adverse perinatal outcomes. Here, we aimed to determine this association at term gestation in our population. Methods: A total of 98 singleton, term pregnant women were included in this prospective study. Demographic, obstetric features and perinatal outcomes of the patients were recorded. Patients were grouped according to the umbilical coiling index as hypocoiled, normocoiled and hypercoiled. Recorded parameters were firstly compared between normocoiled (n = 60) and abnormal coiled (n = 38) groups. Then, they were compared between normocoiled, hypocoiled (n = 20) and hypercoiled (n = 18) groups. Significantly different adverse perinatal outcomes were compared between normocoiled and other groups. Results: Abnormal coiled group had an higher incidence of low fifth minutes Apgar scores, meconium-stained amniotic fluid, intrauterine growth restriction and acute fetal distress as compared to normocoiled group. No significant adverse perinatal outcome was detected between hypocoiled and normocoiled groups. Intrauterine growth restriction (p = 0.004), low Apgar scores (p = 0.046) and fetal distress (p = 0.038) and meconium-stained amniotic fluid were found to be more common in hypercoiled group than normocoiled ones. Conclusions: Abnormal umbilical coiling is associated with adverse perinatal outcomes. Hence antenatal measurement of umbilical coiling index could be a useful parameter to determine high-risk pregnancies and can provide close monitoring for fetal well-being.

Keywords:

Adverse outcome, perinatal outcome term pregnancies, umbilical coiling index,

PDF

___

1. Jo YS, Jang DK, Lee G. The sonographic umbilical cord coiling in late second trimester of gestation and perinatal outcomes. Int J Med Sci 2011;8:594-8.
2. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol 2000;3:462-71.
3. Ercal T, Lacin S, Altunyurt S, Saygili U, Cinar O, Mumcu A. Umbilical coiling index: is it a marker for the foetus at risk? Br J Clin Pract 1996;50:254-6.
4. Strong TH, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. Am J Obstet Gynecol 1994;170:29-32.
5. Rana J, Ebert GA, Kappy KA. Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstet Gynecol 1995;85:573-7.
6. Chitra T, Sushanth YS, Raghavan S. Umbilical coiling index as a marker of perinatal outcome: an analytical study. Obstet Gynecol Int 2012;2012:213689.
7. de Laat MW, Franx A, Bots ML, Visser GH, Nikkels PG. Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol 2006;107:1049-55.
8. Kumar A, Bhat V, Kumar A. Umbilical cord coiling index at term gestation and its association with perinatal outcomes. Indian J Public Health Res Dev 2022;13:69-76.
9. Milani F, Sharami SH, Lili EK, Ebrahimi F, Heirati SFD. Association between umbilical cord coiling index and prenatal outcomes. Parity 2019;7:85-91.
10. Alsatou A. Umbilical cord coiling abnormality as a predictor of maternal and fetal outcomes. Moldovan Med J 2020;63:29-32.
11. Adesina KT, Ogunlaja OA, Olarinoye AO, Aboyeji AP, Akande HJ, Fawole AA, et al. An observation of umbilical coiling index in a low risk population in Nigeria. J Perinat Med 2018;46:341-5.
12. Ezimokhai M, Rizk DE, Thomas L. Maternal risk factors for abnormal vascular coiling of the umbilical cord. Am J Perinatol 2000;17:441-6.
13. Kashanian M, Akbariana A, Kouhpayehzadeh J. The umbilical coiling index and adverse perinatal outcome. Int J Gynecol Obst 2006;95:8-13.
14. Pergialiotis V, Kotrogianni P, Koutaki D, Christopoulos-Timogiannakis E, Papantoniou N, Daskalakis G. Umbilical cord coiling index for the prediction of adverse pregnancy outcomes: a meta-analysis and sequential analysis. J Matern Fetal Neonatal Med 2019;33:4022-9.
15. Padmanabhan LD, Mhaskar R, Mhaskar A. Umbilical vascular coiling and the perinatal outcome. J Obstet Gynecol India 2001;51:43-44.
16. Patil NS, Kulkarni SR, Ohitashwa R. Umbilical cord coiling index and perinatal outcome. J Clin Diagn Res 2013;7:1675-7.
17. Gupta S, Faridi MMA, Krishnan J. Umbilical coiling index. J Obstet Gynecol Ind 2006;56:315-9.
18. Singh S, Sharma R, Radhakrishnan G, Lakhanpal S, Lakha V. Abnormal umbilical coiling index and adverse perinatal outcome. Indian J Neonatal Med Res 2017;l5:1-4.
19. Mittal A, Nanda S, Sen J. Antenatal umbilical coiling indexas a predictor of perinatal outcome. Arch Gynecol Obstet 2015;291:763-8.
20. Ndolo JM, Vinayak S, Silaba MO, Stones W. Antenatal umbilical coiling index and newborn outcomes: cohort study. J Clin Imaging Sci 2017;7:21.
21. Degani S, Leibovich Z, Shapiro I, Gonen R, Ohel G. Early second-trimester low umbilical coiling index predicts small-for-gestational-age fetuses. J Ultrasound Med 2001;20:1183-8.
22. Predanic M, Perni SC, Chasen ST, Baergen RN, Chervenak FA. Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation in association with adverse pregnancy outcome. Am J Obstet Gynecol 2005;193:387-94.
23. Ernst LM, Minturn L, Huang MH, Curry E, Su EJ. Gross patterns of umbilical cord coiling: correlations with placental histology and stillbirth. Placenta 2013;34:583-8. 24. Devi A, Ramesh S, Naik H, Huchegowda S. Umbilical coiling index and its relation to perinatal outcome. J Clin Obstet Gynecol 2021;31:6-13.
25. Duz SA, Cengiz M, Tuncaya G, Karaer A. Comparison of umbilical coiling index in term pregnancies with and without fetal growth restriction. Ann Med Res 2022;29:683-6.
26. Sebire NJ. Pathophysiological significance of abnormal umbilical cord coiling index. Ultrasound Obstet Gynecol 2007;30:804-6.
27. Garber A, Hernandez L, Mullin C, Simon M. Pressure flow through a coiled tube. Group M5, BE 310 Spring 2004.