Abstract
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.
Highlights
Communication between the placenta and the foetus are through the umbilical cord which provides major foeto maternal unit
Fetal death, fetal growth restriction, fetal chromosomal or structural abnormalities, operative delivery for fetal distress, and meconium staining of amniotic fluid is associated with abnormal coiling
In3 stated in their study that Interventional deliveries and meconium-stained amniotic fluid in labor were observed high in abnormal coiling which is similar to our study
Summary
Communication between the placenta and the foetus are through the umbilical cord which provides major foeto maternal unit. Tension and torsion and provides uninterrupted blood supply to the foetus. The umbilical cord is vital to the development, well-being, and survival of the foetus, but is vulnerable to kinking, compressions, traction, and torsion which may affect the perinatal outcome. Wharton’s jelly, the amniotic fluid, and the helical patterns of coiling of the umbilical cord protect blood vessel in the umbilical cord. Various hypotheses regarding origin of umbilical cord coiling are there but the exact cause is unknown. As early as 28 days after conception coiling of the umbilical vessels develops and its helices maybe seen at 7 weeks in 95% of fetuses by ultra sonographic examination. Studies have shown that abnormal umbilical cord coiling is associated with adverse pregnancy outcome. Umbilical coiling index can be obtained both antenatally by USG and postnatally by measuring the cord
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