Umbilical Coiling Research Articles

Hypercoiling of the umbilical cord in uncomplicated singleton pregnancies.

The umbilical coiling index (UCI) is a measure of the number of coils in the umbilical cord in relation to its length. Hypercoiled cords with a UCI of >0.3 coils/cm have been associated with adverse fetal and neonatal outcomes. The primary aim is to determine the accuracy of UCI measured on second trimester ultrasound in predicting UCI at birth. The secondary outcome is to investigate the association between hypercoiling of the umbilical cord on prenatal ultrasound and adverse maternal, fetal and neonatal outcomes. This was a prospective cohort study of uncomplicated singleton pregnancies. Seventy two patients were included in the study. UCI was measured in the second trimester ultrasound, and compared to UCI measured postnatally. Outcomes of patients with hypercoiled cords on ultrasound were compared to outcomes of patients with normocoiled cords. Our results failed to show a strong correlation between the UCI determined with ultrasound, and the UCI determined with examination of the umbilical cord after delivery. We also did not demonstrate that measurement of the UCI on second trimester ultrasound is able to predict adverse maternal, fetal or neonatal outcomes. This study suggests that measurement of the umbilical coiling index should not be part of routine second trimester sonography in patients with uncomplicated singleton pregnancies, with no other medical or surgical comorbidities.

Hemodynamic analysis of blood flow in umbilical artery using computational modeling

The umbilical cord is the crucial pathway for blood flow between the fetus and the placenta. Umbilical coiling and length have been separately linked to adverse clinical outcomes; however, the effects of variations of these parameters on umbilical arterial blood flow are not well understood. Using 3D computational model, we studied the individual and combined effects of umbilical coiling index, cord length and arterial diameter on umbilical artery hemodynamics. We found that specific combinations of umbilical coiling index, cord length and arterial diameter yielded pressure and flow drops incompatible with fetal life. Such models are useful as hypothesis-developing tools.

Antenatal Umbilical Coiling Index and Newborn Outcomes: Cohort Study.

Objectives:We aimed to test the predictive value of antenatal umbilical coiling index (aUCI) among a prospectively recruited cohort of antenatal women.Methods:Women with singleton pregnancies were recruited at their second-trimester scan. Images of the umbilical cord were used to calculate the aUCI. Pregnancy and birth outcomes were recorded and statistical associations between aUCI and small for gestational age (SGA) using international standard birth weight centiles and preterm birth were investigated (n = 430).Results:aUCI results were consistent with the literature and showed good reproducibility between observers. Abnormal aUCI was not associated with SGA, but there was a statistical association with preterm birth (odds ratio 3.3 (95% confidence interval 1.4–7.7, P = 0.003). The sensitivity, specificity, and positive and negative predictive values for preterm birth were 47.6%, 76.9%, 9.6%, and 96.6%, respectively.Conclusions:The coiling index is unlikely to be useful in clinical practice as a screening tool for preterm birth owing to limited predictive value. We exclude a statistically or clinically significant association between abnormal coiling and SGA.

Umbilical coiling index as a marker of perinatal outcome: An analytical study at Navodaya Medical College, Raichur

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.

Umbilical Coiling Index and Perinatal Outcome

<strong>Objective(s):</strong> To study the association of umbilical coiling index and perinatal outcome. <strong>Method(s):</strong> One hundred and eighty five umbilical cords were examined. A coil is defined as a complete 360 degree spiral course of umbilical vessels around the Wharton's jelly. UCI was calculated by dividing the total number of coils by the umbilical cord length in centimeters. The outcomes measured were in terms of IUGR, fetal heart rate abnormalities during labor, meconium stained amniotic fluid, number of assisted deliveries was required, NICU admission, FSB, birth weight, ponderal index, various maternal medical illnesses. Hypocoiling was considered with UCI less than the 10th percentile and hypercoiling was considered UCI greater than the 90th percentile. Statistical analysis was done by Chi-square test, Fischer's exact test and the t-test where ever applicable. <strong>Results:</strong> The mean UCI in our study was found to be 0.19 + 0.08. 82.7% of the cords were normocoiled whereas 8.6% cords were hypocoiled as well as hypercoiled each. UCI below 0.09 was hypocoiling and above 0.26 was hypercoiling. In this study we found that PIH, IUGR, intrapartum FHR abnormalities, MSAF, increased instrumental deliveries, low APGAR scores, NICU admission, low birth weight and ponderal index were significantly associated with hypocoiling (P<0.05). IUGR and NICU admission were significantly associated with hypercoiling too (P<0.05). <strong>Conclusion:</strong> Our study thus shows that abnormal umbilical coiling index is associated with adverse perinatal outcome.

Perinatal outcomes of abnormal umbilical coiling according to a modified umbilical coiling index.

The aim of this study was to determine the relation between perinatal outcomes and umbilical cord coiling as evaluated by a modified umbilical coiling index. In this retrospective study, 200 consecutive umbilical cords were examined. An umbilical venous and arterial coiling index was calculated by dividing the total number of umbilical venous and arterial coils by the length of cord individually. Umbilical cords with umbilical venous coiling indices in the lowest decile, the highest decile, and the remaining deciles were defined as hypocoiled, hypercoiled, and normocoiled, respectively. The perinatal outcomes of the subjects with hypocoiled and hypercoiled umbilical cords were compared with those with normocoiled umbilical cords. In 69.5% of subjects, a difference in the degree of coiling was detected between the umbilical veins and arteries. While all umbilical venous twisting demonstrated the same direction, the direction of the arterial twisting reversed at a certain point along the umbilical cord in 19.0% of the subjects. The arteriovenous coiling difference was small in the hypercoiled group and large in the hypocoiled group. A hypocoiled umbilical cord evaluated by umbilical venous coiling index was found to be associated with prolonged deceleration (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.54-11.38), operative delivery (OR, 2.67; 95%CI, 1.01-7.09), and nuchal cord entanglement (OR, 3.21; 95%CI, 1.23-8.33). Umbilical coiling abnormalities were investigated using a novel umbilical venous coiling index. A hypocoiled umbilical cord evaluated by umbilical venous coiling index was found to be associated with fetal heart rate abnormalities, operative delivery, and nuchal cord entanglement.

EVALUATION OF UMBILICAL CORD THICKNESS, CROSS-SECTIONAL AREA AND COILING INDEX DURING LABOUR AND FETAL OUTCOME.

EVALUATION OF UMBILICAL CORD THICKNESS, CROSS-SECTIONAL AREA AND COILING INDEX DURING LABOUR AND FETAL OUTCOME.

Umbilical Coiling Index as a Marker of Perinatal Outcome

Umbilical Coiling Index as a Marker of Perinatal Outcome

“A Correlational Study to Assess the Umbilical Cord Coiling Index and Perinatal Outcomes in Selected Hospitals at Bijapur.

Umbilical cord, a narrow cord of tissue that connects a developing foetus with the placenta. Umbilical cord abnormalities are numerous, ranging from false knots to vasa pravia, which often leads to foetal death. An abnormal umbilical cord coiling index includes both hypo coiled cords (cords with an umbilical cord coiling index which is 90th percentile). As per many researchers, an abnormal umbilical coiling index has been reported to be related to adverse perinatal outcomes. The study was conducted in BLDEA’s hospital and research centre, Bijapur. The sample consisted of 40 intranatal mothers who are admitted in labour ward and they were selected by Non random purposive sampling technique. An observational checklist was used to assess perinatal outcomes such as amniotic fluid, weighing machine to weigh the newborn APGAR score sheet to find the APGAR score of newborn. BALLARD score sheet to assess maturity of the baby in relation to Umbilical cord coiling Index Umbilical cord coiling was calculated among 40 intranatal mothers. The result were Hyper coil 12 (30%), Normo coil 16 (40%), Hypo coil 12 (30%) and perinatal outcomes such as LBW, Meconium stained amniotic fluid, Low Apgar score and IUGR were found. The study reveals that there is a significant correlation between Umbilical cord coiling index and perinatal outcomes.

Evaluation of Umbilical Cord Coiling Index in late second trimester and its association with Perinatal Outcome

Background: Umbilical cord plays a major role for foetal persistence during the intrauterine period. Reports had shown that abnormal umbilical cord coiling in the form of hypo or hypercoiling are associated with abnormal foetal outcome in the form of chromosomal disorders, intra-uterine deaths, growth retardation, meconium stained liquor, abnormal foetal heart rate and chorioamnionitis. Aim: To evaluate the association between umbilical cord coiling index in the 2nd trimester and the perinatal outcome among the registered antenatal mothers. Methodology: A prospective longitudinal study was conducted at the Institute of Obstetrics and Gynecology, Egmore Chennai for a period of one year between June 2012 to May 2013. A total of 385 women were recruited for the study. A semi-structured questionnaire was used for collecting the demographic details. The coiling index was measured using 3.5 MHz transabdominal transducer. Longitudinal images of the umbilical cord were taken, part of the cord which was freely floating in the amniotic fluid was taken, and the coiling index was calculated. Coiling index of less than the 10th percentile was considered as hypocoiled and above 90th percentile was considered as hypercoiled. Results: The increase in the age of the mothers had shown a strong association in the development of abnormal umbilical coiling and the majority of the mothers with hypocoiled umbilical cord had delivered in less than 37 weeks of gestational age. The incidence of pregnancy induced hypertension and gestational diabetes mellitus had shown a statistically strong association with hypocoiled umbilical cord (p

Umbilical Cord Coiling and Zygosity: Is there a Link?

Introduction: The aim of this study was to analyze abnormalities of umbilical coiling index (UCI) in twin gestation to test whether the coiling is genetically influenced by zygosity.Methods: Data retrieved comprised gestational age (GA), chorionicity, fetal gender, and UCI. Results: The mean UCI of hypercoiled cords in monochorionic placentas was 0.55 coils/cm and 0.49 coils/cm in dichorionic placentas with discordant fetal gender (P = 0.2629).Discussion: In conclusion, no significant statistical difference between UCI in monochorionic and dichorionic twin placentas with discordant fetal gender was identified, suggesting that zygosity does not play a role in umbilical coiling induction.

Ultrasound Assessment of Umbilical Cord Morphology in the First Trimester: A Feasibility Study

Objective: The aim of this study was to determine whether morphology and measurement of the umbilical cord could be accurately assessed at the time of the 11- to 13⁺⁶-week scan. Methods: We conducted a prospective study of 100 consecutive women with singleton pregnancies at 11-13⁺⁶ weeks' gestation who were seen for routine aneuploidy screening. Transabdominal ultrasound scans were performed, and the distance between two adjacent coils of the umbilical artery was measured in a free loop of umbilical cord. The antenatal umbilical coiling index (aUCI) was calculated as the inverse of this measurement (aUCI = 1/intercoil distance in cm). The maximum diameter of the umbilical vein was measured. Umbilical venous blood flow velocity was obtained using standard Doppler technique. Interobserver variability was assessed. A subjective assessment of the cord was performed using the Sepulveda system of classification to compare the reproducibility of the observations between two observers. Results: The intended measurements could be obtained in all cases. The aUCI was found to decrease with advancing gestation, while the umbilical venous diameter increased with gestation. The umbilical venous blood flow velocity also increased with gestation. Interobserver consistency in the objective measurement of the aUCI was poor (kappa 0.146). However, the Sepulveda classification system was found to be applicable and reproducible at this period of gestation (kappa 0.601). Conclusions: Umbilical cord morphology can be consistently studied in the first trimester. A subjective method of evaluation of the morphology may be a more reproducible technique until measurement strategies are refined and operator experience developed.

Umbilical Hypercoiling in 2nd- and 3rd-Trimester Intrauterine Fetal Death

Cases of unexplained intrauterine fetal death (IUFD) can be reduced by full placental examination, with or without autopsy. Determination of the umbilical coiling index (UCI) is considered to be a part of full placental examination. Umbilical hypercoiling (UCI above 0.30 coils/cm) is associated with IUFD. In a large retrospective study, we found an incidence of 18% umbilical hypercoiling in IUFD. We explored the association between umbilical hypercoiling and 2nd- and 3rd-trimester IUFD in 77 cases. There was a significant negative correlation between the UCI and gestational age of IUFD (P<0.001). More severe cases of hypercoiling were observed in the categories of IUFD at a younger age and with a longer duration. Signs of fetal thrombosis were significantly more present in IUFDs with umbilical hypercoiling. An umbilical cord stricture and hypercoiling seem to be significantly more common in IUFD. The severity of hypercoiling was of no influence on the presence or absence of an umbilical cord stricture. Furthermore, there was no significant difference in signs of cardiac failure between the groups of IUFD with and without umbilical hypercoiling. Our findings may be explained by the theory that hypercoiling leads to a disturbed fetal-placental circulation. Therefore, determination of the UCI should be part of the routine placental examination of cases of IUFD.

194: Hypercoiling of the umbilical cord–is it clinically relevant?

Hypercoiling of the umbilical cord (HCUC) has been recognised since the 17th century. Many have considered it as an accentuation of normal coiling, but clinicians have been slow to give it credibility as a significant diagnosis. Recent studies, however, have linked fetal distress with hypercoiling, and have introduced an umbilical coiling index by which the degree of coiling may be judged. This study aims to determine the significance of HCUC as a risk factor for intrapartum adverse events.

Evaluation of antenatal umbilical coiling index at 16-21 weeks of gestation as a predictor of trisomy 21 and other chromosomal defects

To determine whether there is an association between sonographically assessed hyper- or hypocoiling of the umbilical cord and the presence of trisomy 21, to provide reference values for the antenatal umbilical coiling index (aUCI) at a gestational age of 16-21 weeks and to determine whether these measurements are reliable and reproducible. This was a prospective study of 737 pregnancies in which the aUCI was measured between 16 and 21 weeks of gestation by ultrasound at the time of amniocentesis. The aUCI was calculated as the reciprocal value of the mean length of one complete coil in centimeters. We created reference curves and studied the relationship with trisomy 21 and other chromosomal defects. In 30 pregnancies we studied the intra- and interobserver variation in measurements using Bland-Altman plots with associated 95% limits of agreement and intraclass correlation coefficients. aUCI was found to be non-linearly related to gestational age at 16-21 weeks and reference curves were created for the mean aUCI and the 2.3(rd) , 10(th) , 90(th) and 97.7(th) percentiles. There was no significant difference in aUCI values between the reference group (n = 714) and cases with trisomy 21 (n = 16) or other aneuploidies (n = 7) (one-way ANOVA, P = 0.716). There was good intra- and interobserver agreement in aUCI measurements. The aUCI can be measured reliably and varies according to gestational age at 16-21 weeks. The aUCI was not significantly associated with trisomy 21 or other chromosomal defects.

P05.04: Ultrasound assessment of umbilical cord morphology in the first trimester: a feasibility study

Objective: The aim of this study was to determine whether morphology and measurement of the umbilical cord could be accurately assessed at the time of the 11- to 13 +6 -week scan. Methods: We conducted a prospective study of 100 consecutive women with singleton pregnancies at 11–13 +6 weeks’ gestation who were seen for routine aneuploidy screening. Transabdominal ultrasound scans were performed, and the distance between two adjacent coils of the umbilical artery was measured in a free loop of umbilical cord. The antenatal umbilical coiling index (aUCI) was calculated as the inverse of this measurement (aUCI = 1/intercoil distance in cm). The maximum diameter of the umbilical vein was measured. Umbilical venous blood flow velocity was obtained using standard Doppler technique. Interobserver variability was assessed. A subjective assessment of the cord was performed using the Sepulveda system of classification to compare the reproducibility of the observations between two observers. Results: The intended measurements could be obtained in all cases. The aUCI was found to decrease with advancing gestation, while the umbilical venous diameter increased with gestation. The umbilical venous blood flow

Relationship between the umbilical cord coiling index and the umbilical blood flow at 11–13 weeks of gestation

The aim of this study was to clarify the effects of umbilical cord coiling on the umbilical blood flow at 11-13 weeks of gestation. A cross-sectional study was conducted among consecutive pregnant females at 11-13 weeks of gestation. Transabdominal ultrasound examinations were performed to obtain the umbilical coiling index (CI), the maximum umbilical arterial peak velocity at the free loop, the venous velocities at the free loop and the umbilical ring, and the umbilical arterial and venous flow volumes. After every measurement was standardized according to the crown-rump length (CRL), correlations between the CI and these measurements were analyzed. A total of 364 subjects were enrolled. The CI significantly decreased in association with advancing gestation. There were significant correlations between the CRLs and the umbilical arterial peak velocities, the venous velocities at the free loop and the umbilical ring, and the umbilical arterial and venous flow volumes. The z-scores of the umbilical arterial and venous velocimetries exhibited no significant correlations with the CI. The umbilical arterial and venous flow volumes were also not found to correlate with the CI. The CI does not affect either the umbilical arterial or venous blood flow at 11-13 weeks of gestation.

Gross patterns of umbilical cord coiling: Correlations with placental histology and stillbirth

IntroductionThe purpose of this study was to define gross patterns of umbilical cord hypercoiling and determine correlations with histological features in the placenta and/or perinatal outcomes such as stillbirth. MethodsGross images of placentas with hypercoiled umbilical cords (>3 coils/10 cm) were assigned a major umbilical coiling pattern and the direction (right or left) of the coiling. Definitions of 4 gross coiling patterns were established: undulating, rope, segmented, and linked, each with progressively deeper indentations in cord diameter. Outcome variables obtained from placental pathology reports and maternal medical records included histological abnormalities indicative of significant chronic fetal vascular obstruction, such as fetal vascular thrombi, avascular villi, villous stromal-vascular karyorrhexis, and fetal thrombotic vasculopathy, and stillbirth. Results318 placentas/umbilical cords met inclusion criteria. The rope pattern was the most common (52%), followed by the undulating (26%), segmented (19%) and linked (3%) patterns. The segmented and linked gross coiling patterns were significantly correlated with histologic evidence of chronic fetal vascular obstruction and stillbirth, when compared with the ropeand undulating patterns. Cords with right twists were also significantly correlated with histologic evidence of chronic fetal vascular obstruction and stillbirth when compared with cords with left twists. The number of cord coils per 10 cm did not correlate with any of the outcome variables. ConclusionsAmong hypercoiled umbilical cords, specific gross patterns of coiling can be recognized, and patterns with the most significant indentation or pinching of the cord diameter are associated with histological evidence of chronic fetal vascular obstruction and stillbirth.

Atypical hemodynamic pattern in fetuses with hypercoiled umbilical cord and growth restriction

Objectives: To describe fetal and uterine hemodynamics in intrauterine growth restriction (IUGR) fetuses with hypercoiled umbilical cord. Methods: 102 pregnant women with IUGR fetuses were enrolled in the study. In these cases, hemodynamic indices and Doppler waveform profiles were evaluated. Results: In seven of the enrolled cases of IUGR, we found an anomalous umbilical coiling. They showed normal impedance to flow in utero-placental district and abnormal venous umbilical cord pulsatility with flow velocity higher than the umbilical artery. The ductus venosus showed a reduction of the forward flow and/or a reverse flow during atrial contractions. Two of these seven patients had early onset IUGR and a particular deteriorating hemodynamic profile with “brain sparing”, severe reverse flow in the ductus venosus, increased reverse flow in the inferior vena cava during atrial contraction and absent flow during the diastole in the umbilical arteries. Five patients had late onset of IUGR and three of these did not demonstrate these worsening hemodynamic alterations until term. Conclusions: In patients with fetal IUGR and hypercoiling without signs of placental insufficiency, we observed an “atypical” feto-maternal hemodynamic pattern. These IUGR fetuses with hypercoiling and fetal venous system hemodynamic alteration can be at high hypoxic risk.

Association of Umbilical Coiling Index by Colour Doppler Ultrasonography at 18–22 Weeks of Gestation and Perinatal Outcome

To study the association between antenatal umbilical coiling index (aUCI) and perinatal outcome. 600 primigravidas with uncomplicated singleton pregnancies had an ultrasonography between 18 and 22weeks of gestation for aUCI by colour Doppler. The aUCI was calculated as the reciprocal of the distance between a pair of coils. It was then correlated with the following pregnancy outcomes: birth weight, mode of delivery, meconium staining of liquor, Apgar scores and gestational age. The results were statistically analysed by χ(2)-test. The mean aUCI was 0.41. Undercoiling was associated with spontaneous preterm delivery (47.87%), low Apgar score (52.13%), LBW (52.59%), FGR (21.28%) and NICU admission (76.34%). Overcoiling was associated with preterm deliveries (65.38%), increased caesarean sections (61.54%), meconium staining of liquor (67.31%), low Apgar score (63.46%) and NICU admission (72.55%). There was a positive strong correlation between aUCI and birth weight (r=+0.426). Abnormal coiling is strongly correlated with low birth weight.