Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation as a predictor of adverse pregnancy outcome

Abstract

TRIMESTER OF GESTATION AS A PREDICTOR OF ADVERSE PREGNANCY OUTCOME MLADEN PREDANIC, SRIRAM C. PERNI, STEPHEN T. CHASEN, REBECCA N. BAERGEN, FRANK A. CHERVENAK, Cornell University, Obstetrics and Gynecology, New York, New York, Weill Medical College of Cornell University, Obstetrics and Gynecology, New York, New York, Weill Medical College of Cornell University, Pathology and Laboratory Medicine, New York, New York OBJECTIVE: To evaluate the antenatal umbilical cord coiling index (aUCI) obtained during the fetal anatomical survey in the second trimester as a predictor of adverse antenatal and perinatal events. STUDY DESIGN: Four hundred and twenty-five consecutive women who had a routine fetal anatomical survey in second trimeseter were evaluated for umbilical cord coiling index. aUCI was correlated with adverse antenatal and perinatal events, such as: small for gestational age (SGA), mode of delivery (interventional vs noninterventional), presence of meconium stained amniotic fluid, presence of non-reassuring fetal status (NRFS) in labor, and low Apgar scores (6 or less) at 1 and 5 minutes. RESULTS: A total of 294 patients had adequate ultrasound images and all antenatal and labor data to meet the study inclusion criteria. The aUCI above 90%ile and below 10%ile were recognized as hyperand hypocoiled umbilical cords in 10.5% and 9.2% of cases, respectively. Abnormal coiling was significantly associated with SGA neonates at birth (P = .043) and NRFS in labor (P = .007), whereas a trend toward a higher incidence of interventional deliveries and meconium stained amniotic fluid in labor was observed, but statistically nonsignificant (Table). No statistical difference for low Apgar scores between compared groups was noted. CONCLUSION: Abnormal umbilical cord coiling, detected at the fetal ultrasound anatomical survey in the second trimester, can be potentially employed as a predictor of adverse antenatal or perinatal events.