The effect of umbilical cord coiling ındex measured in antenatal period on pregnancy results.

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.

To compare perinatal and infant surgical outcomes in fetuses with gastroschisis with and without gastric dilation in a single-center cohort. This was a retrospective study of all singleton pregnancies with a prenatal diagnosis of gastroschisis managed at University of Toronto perinatal centers between January 2001 and February 2010. Digital prenatal ultrasound images were reviewed to determine fetal gastric size within 2 weeks of delivery. Perinatal and surgical outcomes were compared in fetuses with and without gastric dilation including: gestational age at delivery, mode of delivery, indication for Cesarean section, meconium-stained amniotic fluid, birth weight percentile, Apgar scores at 1 and 5 min, umbilical artery pH, time to full enteral feeding, length of hospital stay, bowel atresia or necrosis and need for bowel resection. Ninety-eight fetuses with prenatally diagnosed gastroschisis managed at our center were included in the study, of which 32 (32.7%) were found to have gastric dilation. Gastric dilation predicted meconium-stained amniotic fluid at delivery (53% vs. 24%; P = 0.017), but no other adverse perinatal outcome. Surgical morbidity rates (bowel atresia, bowel necrosis, perforation diagnosed postnatally, need for bowel resection, total time to full enteral feeding and length of hospital stay) were unaffected by gastric dilation. In gastroschisis, fetal gastric dilation is associated with meconium-stained amniotic fluid at delivery, but is not predictive of any serious perinatal or postnatal complications. Fetal growth and well-being should be serially evaluated on ultrasound using biophysical and Doppler assessment to decide on the optimal timing and mode of delivery.

The umbilical coiling index in complicated pregnancy

Objectives: To measure the umbilical coiling index (UCI) postnatally and to study its association with adverse antenatal and perinatal outcome. Materials and Methods: This prospective study was carried out in the department of pediatrics at Navodaya Medical College, Raichur, Karnataka, from June to July 2016. 200 patients who were in active labor irrespective of their parities, who had singleton pregnancies with live babies who were either delivered by vaginal, instrumental, or lower segmental cesarean section were included in the study and multiple pregnancies, malpresentations, previously diagnosed intrauterine device, and elective cesarean section were excluded. UCI was calculated at the time of delivery by dividing the total number of coils by the total umbilical cord length in centimeters. Its association with various maternal and perinatal risk factors was noted. The statistical tests were the Chi-square test and assessed with EPI Info Version 12.0 software and statistically analyzed. Results: The mean UCI was 0.25±0.03. Hypocoiling or UCI <10th percentile (<0.11) was found to be significantly associated with low APGAR at 1 min and 5 min, meconium stained liquor (MSL), abruption, abnormal fetal heart rate (FHR), neonatal intensive care unit (NICU) admission, low birth weight, and intrauterine growth restriction. Hypercoiling or UCI >90th percentile (>0.37) was found to be associated withpregnancy-induced hypertension, preterm, diabetes mellitus, postpartum hemorrhage, polyhydramnios, NICU admission, abnormal FHR, MSL, and low APGAR at 1 min. Conclusion: Abnormal UCI is associated with several antenatal and perinatal adverse features.

The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. The UCI was not associated with adverse perinatal outcome in this study.

Pregnancies complicated by late-onset fetal growth restriction (FGR) are at increased risk of short- and long-term morbidities. Despite this, identification of cases at higher risk of adverse perinatal outcome, at the time of FGR diagnosis, is challenging. The aims of this study were to elucidate the strength of association between fetoplacental Doppler indices at the time of diagnosis of late-onset FGR and adverse perinatal outcome, and to determine their predictive accuracy. This was a prospective study of consecutive singleton pregnancies complicated by late-onset FGR. Late-onset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 3rd centile, or EFW or AC < 10th centile and umbilical artery (UA) pulsatility index (PI) > 95th centile or cerebroplacental ratio (CPR) < 5th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UA-PI, fetal middle cerebral artery (MCA) PI, CPR and umbilical vein blood flow normalized for fetal abdominal circumference (UVBF/AC) were recorded at the time of the diagnosis of FGR. Doppler variables were expressed as Z-scores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.10 and neonatal admission to the special care unit. Logistic regression analysis was used to elucidate the strength of association between different ultrasound parameters and composite adverse perinatal outcome, and receiver-operating-characteristics (ROC)-curve analysis was used to determine their predictive accuracy. In total, 243 consecutive singleton pregnancies complicated by late-onset FGR were included. Composite adverse perinatal outcome occurred in 32.5% (95% CI, 26.7-38.8%) of cases. In pregnancies with composite adverse perinatal outcome, compared with those without, mean uterine artery PI Z-score (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Z-scores of UVBF/AC (-1.93 ± 0.88 vs -0.89 ± 0.94, P ≤ 0.0001), MCA-PI (-1.56 ± 0.93 vs -1.22 ± 0.84, P = 0.004) and CPR (-1.89 ± 1.12 vs -1.44 ± 1.02, P = 0.002) were lower. On multivariable logistic regression analysis, Z-scores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated independently with composite adverse perinatal outcome. UVBF/AC Z-score had an area under the ROC curve (AUC) of 0.723 (95% CI, 0.64-0.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI Z-score (AUC, 0.593; 95% CI, 0.50-0.69) and CPR Z-score (AUC, 0.615; 95% CI, 0.52-0.71). A multiparametric prediction model including Z-scores of MCA-PI, uterine artery PI and UVBF/AC had an AUC of 0.745 (95% CI, 0.66-0.83) for the prediction of composite adverse perinatal outcome. While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by late-onset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

It was thought that Umbilical Cord Coiling plays an important role in protecting the umbilical cord from external pressure such as tension, pressure, stretching or entanglement. The mechanism of coiling still remains undetermined. According to several studies abnormal umbilical coiling is associated with poor perinatal outcomes. Objectives: To evaluate the sonographic accuracy in determining Umbilical Coiling Index (UCI). To correlate it with postnatal examination of umbilical coiling and its association with obstetric and perinatal outcome. Material and Methods: Prospective observational study was conducted at Saveetha Medical College Obstetrics Department. For 200 pregnant women USG umbilical coiling index was measured during routine foetal evaluation between 28 to 40 weeks. USG-Umbilical Coiling Index was correlated with postnatal umbilical coiling index and its association with obstetric& perinatal outcome was calculated. Sonologist was blinded for pregnancy outcome. Results: USG –UCI was normal in 52%, hypocoiling 12% and hypercoiling 36%.In normal coiling there was no antenatal or intranatal problems. In hypocoiling Spontaneous Preterm Delivery was 50% and Low Birth Weight was38.9%, FGR 11.1%. In hypercoiling group Oligohydramnios was 14.8%, Intrapartum fetal distress33.3%, Meconium staining of liquor 16.6 %. In normal coiling all of them delivered naturally. In hypocoiling and in hypercoiling mode of delivery either forceps 7% or LSCS 41%.NICU admission in hypocoiling was 18 % and in hypercoiling 3%. Perinatal mortality was NIL. USG-Umbilical Coiling Index Sensitivity 97.8 specificity, 62.5%, Positive predictive value 96.77% Negative predictive value 71.4%. Conclusion: In our study there is a good correlation between USG-UCI and postnatal UCI. Our study confirms that there is an adverse perinatal outcome with both hypocoiling and hyper coiling of the umbilical cord.

Re-evaluation of umbilical cord coiling index in adverse pregnancy outcome – Does it have role in obstetric management?

To estimate the relation between undercoiling and overcoiling of the umbilical cord and adverse pregnancy outcome. Umbilical cords and hospital records of 885 patients were studied in a cross-sectional study design. The umbilical coiling index was determined as the number of complete coils divided by the length of the cord in centimeters, blinded for pregnancy outcome. Obstetric history and pregnancy outcome of each patient were obtained from hospital records, blinded for the umbilical coiling index. Odds ratios and their 95% confidence intervals were calculated to evaluate associations between undercoiling and overcoiling and adverse pregnancy outcome, using multiple logistic regression. Undercoiling (umbilical coiling index below the 10th percentile, using references values from uncomplicated pregnancies) was associated with fetal death (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.48-7.63), spontaneous preterm delivery (OR 2.16, 95% CI 1.34-3.48), trisomies (OR 5.79, 95% CI 2.07-16.24), low Apgar score at 5 minutes (OR 3.14, 95% CI 1.47-6.70), velamentous cord insertion (OR 3.00, 95% CI 1.16-7.76), single umbilical artery (OR 3.68, 95% CI 1.26-10.79), and dextral coiling (OR 1.80, 95% CI 1.02-3.17). Overcoiling (umbilical coiling index above the 90th percentile) was associated with asphyxia (OR 4.16, 95% CI 1.30-13.36), umbilical arterial pH < 7.05 (OR 2.91, 95% CI 1.05-8.09), small for gestational age infants (OR 2.10, 95% CI 1.01-4.36), trisomies (OR 9.26, 95% CI 2.84-30.2), single umbilical artery (OR 8.25, 95% CI 2.60-26.12), and sinistral coiling (OR 4.30, 95% CI 1.52-12.2). Undercoiling and overcoiling of the umbilical cord are associated with increased risk for adverse perinatal outcome.

Background: The umbilical cord has pivotal role in the development, well-being, and survival of fetus and is vulnerable to kinking, torsion, and compression affecting perinatal outcome adversely. Aims and Objectives: This study was aimed to correlate the umbilical cord index measured antenatally using ultrasonography with that of the umbilical cord index measured postnatally and the association of this index with adverse fetal outcomes. Materials and Methods: This prospective cohort study was conducted on 124 antenatal cases of age group 18–35 years with term gestation with singleton pregnancy that attendant the outpatients department and indoor of Department of Obstetrics and Gynecology, Nehru Hospital B.R.D. Medical College, Gorakhpur over a period of 1 year (2019–2020). After detailed history, examination, and required antenatal care investigations, Ultrasonographic examination was done and antenatal umbilical coiling index (UCI) was calculated. The cases were followed up till delivery and postnatal UCI was also calculated and fetomaternal outcome was noted. Statistical analysis: Appropriate tests were applied where ever necessary. Results: The mean age was 25.71±4.30 years. The risk of preeclampsia, fetal growth restriction, oligohydramnios was significantly high with antenatal and postnatal hypocoiling (P&lt;0.001) whereas the risk of gestational diabetes mellitus was significantly associated with antenatal and postnatal hypercoiling. The risk of low birth weight, preterm, low APGAR, neonatal intensive care unit admission and perinatal mortality were significantly high with postnatal hypocoiling (P&lt;0.0001). Conclusion: The present study concludes that abnormal UCI was associated with adverse perinatal outcomes. Quantification of degree of abnormal coiling in antepartum period is important.

The umbilical coiling index and adverse perinatal outcome

Coiling is an important property of the umbilical cord and its vessels. The helical arrangement of the umbilical vessels makes the cord both strong and flexible, permitting it to resist external forces that otherwise might compromise blood flow. This study attempted to identify any adverse pregnancy outcomes associated with under- or overcoiling of the umbilical vessels. Coiling was examined in 565 consecutive cases with an indication for histological examination of the placenta. They represented about 10% of all deliveries during the study interval from December 1998 to May 2002. The umbilical coiling index (UCI) was determined as the number of complete coils divided by the length of the umbilical cord in centimeters, as estimated by an observer without knowledge of pregnancy outcomes. Undercoiling was a UCI less than the 10th percentile, and overcoiling, an index above the 90th percentile. Undercoiling of the umbilical cord was found in 18% of cases, and overcoiling in 13.5%. The mean UCI was 0.18, with a standard deviation of 0.12. The UCI was not associated with gestational age at delivery, infant gender maternal age or parity, smoking status, or the presence or absence of preeclampsia, gestational diabetes, or preexisting diabetes. Fetal death, chorioamnionitis, and fetal structural or chromosomal abnormalities were associated with undercoiling. The odds ratio (OR) for fetal death was 4.09, with a 95% confidence interval (CI) of 2.2-7.6. Numerous conditions were associated with overcoiling, including fetal death (OR, 3.7; 95% CI, 1.9-7.4), iatrogenic preterm delivery, an umbilical arterial pH below 7.05, fetal structural or chromosomal abnormalities, thrombosed fetal placental vessels, chronic fetal hypoxia/ischemia, and lower weight for gestational age. Both overcoiling and undercoiling of the umbilical cord vessels are associated with adverse pregnancy outcomes. The investigators propose that the UCI be a routine part of assessing the placenta after delivery. The logical next step is a prospective study to determine the significance of under- and overcoiling of the cord vessels in an unselected population.

This study aimed to determine the related antepartum and intrapartum factors of birth asphyxia among neonates born in a tertiary referral hospital. A total of 45 singleton pregnant women who delivered live births with a gestational age of ≥35 weeks and their neonates who suffered from birth asphyxia from June 2016 to June 2021 were included in this retrospective study. Data regarding maternal demographic features, maternal laboratory values, pregnancy complications, and obstetric and neonatal outcomes were collected. Significant risk factors associated with birth asphyxia were nulliparity (odds ratio [OR]=5.357, 95% confidence interval [CI]=2.169-24.950, p=0.001), placental abruption (OR=8.667, 95% CI=2.223-33.784, p=0.002), intrauterine growth restriction (OR=1.394, 95% CI=1.109-8.631, p=0.012), the prolonged second stage of labor (OR=6.121, 95% CI=2.120-17.595, p=0.001), meconium-stained amniotic fluid (OR=7.615, 95% CI=2.394-24.223, p=0.001), bloody amniotic fluid (OR=9.423, 95% CI=2.885-35.232, p=0.001), the presence of FHR category II (OR=12.083, 95% CI=7.081-48.849, p <0.001) and FHR category III before labor (OR=15.500, 95% CI=8.394-56.176, p <0.001). We identified that nulliparity, placental abruption, intrauterine growth restriction, the prolonged second stage of labor, meconium-stained or bloody amniotic fluid, and FHR tracings categories II and III were significantly associated with birth asphyxia.

Meconium-stained amniotic fluid (MSAF) affects 15-20% of term pregnancies. Recent studies have shown that MSAF has adverse effects on neonatal outcomes. There is no scientific consensus on the incidence of fetal distress in MSAF neonates, and most cesarean sections due to MSAF are unnecessary. The present study was conducted to assess umbilical artery blood pH in neonates with MSAF and to examine whether there is a relationship between MSAF and fetal distress. A clinical survey case-control was conducted on the neonates of 200 pregnant women admitted to a delivery unit of the obstetrics and Gynecology center in Amir al-Momenin Hospital, Zabol in 2014. Neonates born with MSAF made up the case group, and the control group consisted of neonates born with clear amniotic fluid. Umbilical cord arterial pH, gestational age, gender, mode of delivery, and one and five-minute Apgar scores were considered in both groups. The mean pH of the umbilical cord artery blood in the infants of the case group was 7.25, and the mean pH of the umbilical cord artery in the infants of the control group was 7.29 (P = 0.93). The mean gestational age in the case and control groups was 40.08 weeks and 38.32 weeks, respectively (P= 0.03). In this study, a cesarean delivery (P=0.001) and female gender (P= 0.016) were higher in the case group than in the control group. MSAF does not necessarily imply fetal distress, so urgent cesarean sections are unnecessary. This study showed that based on the acidity variables of the umbilical cord artery, there is no statistically significant correlation between the Apgar score at the 1st and 5th minute. While a significant difference has been observed between the type of delivery, gestational age and baby's gender.

Objective To examine the correlation between the severity of isolated oligohydramnios at term and adverse perinatal outcomes, aiming to inform clinical management strategies. Study design This retrospective cohort study conducted at a tertiary university-affiliated hospital from 2028 to 2024 included women at 37–42 weeks of gestation diagnosed with isolated oligohydramnios, defined as an amniotic fluid index (AFI) ≤ 5 cm. Exclusion criteria included maternal comorbidities, fetal anomalies, abnormal Doppler studies, multifetal pregnancies, and fetuses with growth restriction or small for gestational age. Participants were categorized into severe (AFI ≤ 2 cm) and mild (AFI 2.1–5.0 cm) oligohydramnios groups. The primary outcome was a composite measure of adverse perinatal outcomes, including cesarean or vacuum delivery for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.1, meconium-stained amniotic fluid, neonatal intensive care unit admission, or birth asphyxia. Results Among 29,759 deliveries during the study period, 432 (1.5%) involved isolated oligohydramnios, of which 66 (15%) had severe and 366 (85%) had mild oligohydramnios. The incidence of adverse perinatal outcomes was significantly higher in the severe group compared to the mild group (22.7% vs. 12.8%; p = .039). Severe oligohydramnios remained an independent predictor of adverse outcomes after adjusting for confounders, with an adjusted odds ratio of 1.96 (95% CI:1.09–3.779, p = .044). Conclusions Severe isolated oligohydramnios at term is associated with nearly double the risk of adverse perinatal outcomes compared to mild cases. These findings underscore the importance of close monitoring and timely delivery planning in severe cases of isolated oligohydramnios at term.