ASSOCIATION BETWEEN UMBILICAL COILING INDEX AND ADVERSE PERINATAL OUTCOME

INTRODUCTION: The coiling of component blood vessels is one of the most mysterious characteristics of the human umbilical cord. Umbilical coiling index (UCI) is dened as the total number of coils divided by the total length of the cord in centimeters. Most of the published studies categorize umbilical cords as hypocoiled, normocoiled and hypercoiled. The presence of hypocoiling and hypercoiling in cords has been associated with adverse perinatal outcomes. (i) To study association AIM AND OBJECTIVES: of UCI with perinatal outcome in normal as well as high risk pregnancies like PIH, GDM, eclampsia, previous LSCS and elderly mothers. (ii) To study association of UCI with mode of delivery, birth weight, Apgar score at 1 minute and 5 minutes, meconium staining, intrauterine growth restriction and neonatal intensive care unit admission. Observational study w METHODS: as carried out in the Department of Obstetrics and Gynaecology and the Department of Pediatrics, AIMSR, Bathinda. Patients were selected consecutively as and when they presented to hospital applying inclusion and exclusion criteria. Out of 200 cases, normocoiling was seen RESULTS: in 135 patients (67.50%), hypocoiling in 42 patients (21%) and hypercoiling in 23 patients (11.50%). The mean UCI in our study was 0.164 ± 0.135. Hypocoiling is signicantly associated with preeclampsia, low Apgar score at 1 minute and 5 minute, meconium stained liquor and increased NICU admissions while hypercoiling is associated with diabetes mellitus, increased LSCS and assisted vaginal deliveries, low Apgar score at 1 minute, meconium stained liquor, intrauterine growth restriction and increased NICU admissions. Both hypocoiling and hyperc CONCLUSION: oiling has signicant association with adverse fetal outcome. Therefore, detection of coiling index postnatally or antenatally can identify babies at risk and thus helps in further management.

Umbilical Coiling Index, A Predictor of Perinatal Outcome

Umbilical cord (UC) represents the “life source”, or the “entry and exit” point of humans which is the only source of energy. It is essential for the development, well-being, and survival of the nourishing baby. The characteristic of the coiling of the umbilical cord makes the cord a structure that is both flexible and strong and provides resistance to external forces which could compromise the blood flow to the foetus. UC is vulnerable to kinking, compressions, traction, and torsion, which may affect the intrauterine life and perinatal outcome due to coiling. One complete spiral of 360º of the umbilical vessels around each other is defined as Umbilical Coil. Abnormal coiling is defined as UCI less than the 10th percentile (i.e., Hypocoiled cord), UCI more than the 90th percentile (i.e., Hypercoiled cord), and the UCI between 10th and 90th percentile is Normocoiled cord. According to the literature studies, hypercoiled cords are usually associated with intrapartum foetal acidosis and asphyxia, foetal growth restriction, vascular thrombosis, and cord stenosis while the increased incidence of foetal demise, intrapartum FHR deceleration, low APGAR scores, preterm delivery, chorioamnionitis, structural and chromosomal abnormalities, and operative delivery have been associated more with hypocoiled cords. Hence, if the umbilical coiling index can be measured reliably in utero by ultrasound antenatally, then in future, it might become a promising prognostic marker for a better pregnancy and adverse foetal outcome.

Study of umbilical coiling index and perinatal outcome

Background: Study was to evaluate the relationship between umbilical coiling index (UCI) and hypo-and hyper coiling of the umbilical cord and parity, neonatal weight, Ponderal Index (PI), APGAR (Appearance, pulse, grimace, activity, and respiration) score, meconium staining of the amniotic fluid, Intrauterine growth restriction (IUGR), hypertensive disorders of pregnancy and delivery interventions.Method: A prospective analytical study was performed from January 2017 to December 2018. Total of 300 patients giving birth at labour room of SCB Medical College, Cuttack were taken into study. Immediately following delivery, the umbilical cord was clamped at the foetal end and cut with scissors. UCI, mode of delivery and perinatal outcome was followed up.Results: There were 149 lower segment caesarean sections accounting to 49.7% and 151 vaginal deliveries including instrumental deliveries which was accounting to 50.3%. Minimum number of coils observed was 2. The maximum number of coils observed was 50. Caesarean section was more in hypo coiling group. APGAR score at 5 min was calculated and there was a total of 109 neonates who had APGAR <7 at 5 minutes (36.33%) out of which there were 17 neonates with hypo coiling (2.33%), 77 neonates with normo-coiling (25.66%) and 15 neonates with hyper coiling (5%). Meconium staining and instrumental delivery was more associated with hyper coiling.Conclusion: Both hyper-coiling and hypo-coiling had significant correlation with adverse perinatal outcome. If the UCI can be measured reliably in utero by ultrasound, then it might be a promising prognostic marker for adverse pregnancy outcome.

Relationship of umbilical coiling index and cord twist direction with adverse perinatal outcomes

Background: The main objectives of this study were to examine - (1) relationship of pregnancy-related factors (maternal age, gestational diabetes mellitus, pregnancy-induced hypertension, oligohydramnios, small for gestational age (GA), and fetal gender) and postnatally measured umbilical coiling index (UCI); (2) association of UCI and cord twist directions with the following adverse perinatal outcomes, meconium staining of amniotic fluid, non-reassuring FHR on CTG, low Apgar score (<7) at one and five minutes, low birth weight, and NICU admission.Methods: The inclusion criteria were singleton live-birth pregnancy with GA > 34 weeks. The cases were categorized in hypocoiled (UCI <10th percentile), hypercoiled (UCI >90th percentile) and normocoiled groups. To study relationship of pregnancy-related factors and UCI, multivariate logistic regression was used; whereas bivariate analysis was used to study impact of UCI on various adverse perinatal outcomes. UCI was measured by a single observer.Results: In total, 100 subjects were enrolled. The mean UCI was 0.268 (SD = 0.13; 10th percentile = 0.139; 90th percentile = 0.410) coils/cm. Pregnancy-related factors had non-significant relationship with UCI. For adverse perinatal outcomes, only the non-reassuring/abnormal FHR patterns were significantly associated with hypercoiled groups (OR = 4.5; CI =1.15 - 17.58). Both cord directions had almost equal distribution without any significant difference in outcomes; however, anticlockwise twisted cords were found to have significantly high UCI.Conclusions: No significant relationship was observed with pregnancy-related factors and UCI. However, it was observed that hypercoiled cords had significant association with non-reassuring/abnormal FHR patterns on CTG.

Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition

This study focused to investigate a possible association of extensive umbilical hypercoiling (displaying an umbilical coiling index [UCI] of at least 1.0 coils/cm), clinical outcome, and associated pathoanatomical placental lesions. Of the 771 singleton placentas from the second and third trimesters submitted for pathoanatomical evaluation, 15 cases (2%) displayed extensive hypercoiling. There was an association of excessive hypercoiling with hypotrophy of fetuses and children (11 cases) and fetal demise (12 cases). Thin cord syndrome and umbilical stricture were observed in 9 cases and 4 cases, respectively. Seven of the 15 cases with excessive umbilical hypercoiling showed increased placental fibrin deposition (47% of the cases with hypercoiling), in 4 cases sufficient for rendering the diagnosis of massive perivillous fibrin deposition. Signs of maternal vascular malperfusion (n = 6) and chorangiosis (n = 2) were also detected in cases with hypercoiling. Recurrence of excessive umbilical hypercoiling was observed in 2 families, suggesting a genetic predisposition for the development of this lesion. Extensive hypercoiling could be a hitherto underrecognized pathogenetic factor for the development of massive perivillous fibrin deposition. A high UCI measured in the second trimester by ultrasound may be predictive of fetal hypotrophy, and intensified fetal monitoring is warranted, particularly if there is a history of hypercoiling and adverse fetal outcome.