A Longitudinal Analytical Study on Umbilical Cord Coiling Index as a Predictor of Pregnancy Outcome

Abstract

BackgroundThe umbilical cord coiling index (UCI) is usually measured sonographically during antenatal follow-up and can be used to determine the fetuses at risk of adverse outcomes. MethodologyUCI measured antenatally and postnatally whose correlation is studied along with the association of abnormal UCI with the adverse outcomes in terms of gestational age, intrauterine growth restriction (IUGR), intra-uterine death, birth weight, sex, neonatal intensive care unit (NICU) admission, the color of the liquor, Amniotic Fluid Index (AFI), Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at one min and five mins and mode of delivery. All parameters are tested for significant differences among UCI and a pvalue < 0.05 is considered significant. The correlation of UCI measured antenatally and postnatally is tested using the spearman correlation coefficient. ResultsA strong correlation is found between antenatal UCI and postnatal UCI with r s 0.9. The majority of the population had normo coiling. Hyper and hypo coiling are associated risks of emergency lower segment cesarean section (LSCS). Low birth weight is seen in 88.89% of hypo coiled patients with a p-value < 0.01. The coiling index among sex is found to be insignificant with a p-value of 0.81. Meconium-Stained Liquor (MSL) is seen in 78.5% of hyper coiled patients. IUGR is found to be associated with hypo coiling as seen in 59.2% of patients with significant p-value (< 0.01). Age, gestational age, and birth weight are found to be statistically significant between various coiling indexes with p-value < 0.05. ConclusionAntenatal UCI correlates with postnatal UCI and any abnormal index found can be used as a predictor of adverse perinatal outcomes and help obstetricians to monitor continuously and put the patients at risk on prophylactic measures.

Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes

“…The characteristic helical coiling of the cord helps to prevent twisting, compression, and traction, and it is also involved in regulating the blood flow to and from the placenta. The umbilical coiling index (UCI) specifies the number of coils, which normally is one coil every five centimeters [12,13]. A hypocoiled cord is defined as one coil per 10-cm segment, whereas hypercoiling presents more than three coils per 10 cm.…”

Twisting the theory on the origin of human umbilical cord coiling featuring monozygotic twins

“…Insight into the origin of the helices is important because hypercoiling is strongly associated with adverse pre- and postnatal clinical outcomes ( 5 , 6 , 7 ). In 1994, Strong et al proposed a standardized metric to quantify hUC helices, the umbilical coiling index (UCI), which is defined as the number of helices per centimeter of the hUC and is irrespective of the helix direction ( 8 , 9 , 10 , 11 ).…”

“…Numerous studies linked an abnormal hUC coiling intensity to pre- and perinatal morbidity and mortality ( 5 , 6 , 7 , 13 , 14 ). Hypercoiling is associated with fetal growth restriction and fetal distress resulting in (planned) premature delivery, a decreased Apgar score at 5 min, or even fetal demise ( 6 , 7 ).…”

“…Numerous studies linked an abnormal hUC coiling intensity to pre- and perinatal morbidity and mortality ( 5 , 6 , 7 , 13 , 14 ). Hypercoiling is associated with fetal growth restriction and fetal distress resulting in (planned) premature delivery, a decreased Apgar score at 5 min, or even fetal demise ( 6 , 7 ). Hypercoiling can also lead to umbilical vascular compression and reduced fetal blood flow, which in turn may result in parenchymal abnormalities such as fetal thrombosis in the hUC vessels, chorionic plate, and (stem) villi, creating a higher risk of prenatal and perinatal morbidity and mortality ( 15 ).…”