E-ISSN: 2619-9467

Contents    Cover    Publication Date: 13 Apr 2021
Year 2021 - Volume 31 - Issue 1

Open Access

Peer Reviewed

ORIGINAL RESEARCH
191 Viewed68 Downloaded

Umbilical Coiling Index and Its Relation to Perinatal Outcome

  
J Clin Obstet Gynecol. 2021;31(1):6-13
DOI: 10.5336/jcog.2020-78828
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Umbilical cord is crucial to the development, well-being and survival of the fetus, but also being vulnerable to kinking, compressions, traction, and torsion which may affect the perinatal outcome. Abnormally coiled cords have been reported to be more frequent in cases with adverse perinatal outcome. It was aimed to evaluate the umbilical coiling index (UCI) postnatally and its association with perinatal morbidity and mortality. Material and Methods: We conducted a cross sectional study for over 12 months in ESIC MC & PGIMSR, Bengaluru. A total of 321 term consenting parturient mothers with singleton live pregnancy in cephalic presentation were randomly selected by a single observer admitted in labour room irrespective of their parity. After delivery, the UCI was calculated as the number of complete coils divided by the total length of the cord in centimetres, UCI was grouped as hypocoiled (<10th percentile), normocoiled (10th to 90th percentile) and hypercoiled (>90th percentile). The statistical tests used were chi-square test and Fisher exact test in SPSS v24, p value of less than 0.05 was taken as statistically significant. Results: The mean UCI was 0.18 +/- 0.096. Of the patients, 9.3% (30 out of 321) had hypocoiled (UCI<0.082) and 9.7% (31 patients) had hypercoiled (UCI>0.316). Hypercoiled is significantly associated with fetal distress [OR=13.5 (0.003-0.008)] p=0.001, neonatal intensive care unit (NICU) admission [OR=19.14 (0.01 to 0.015)] p<0.001 and meconium staining [OR=5.65 (0.024-0.030)] p=0.017. It was also found that presence of nuchal cord in hypercoiled group was significantly associated with fetal distress [OR=4.661 (0.052-0.061)] p=0.031. Conclusion: Abnormal UCI is associated with adverse perinatal outcome. Clinical significance: Antenatal detection of the coiling index can identify the fetuses at risk and thus help in timely intervention and further management.
REFERENCES:
  1. Evans MJ. Review: diabetes and pregnancy: a review of pathology. Br J Diabetes Vasc Dis. 2009;9(5):201-6. [Crossref] 
  2. Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol. 2000;3(5):462-71. [Crossref] [PubMed] 
  3. Strong TH Jr, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. Am J Obstet Gynecol. 1994;170(1 Pt 1):29-32. [Crossref] [PubMed] 
  4. Rana J, Ebert GA, Kappy KA. Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstet Gynecol. 1995;85(4):573-7. [Crossref] [PubMed] 
  5. Strong TH Jr, Elliott JP, Radin TG. Non-coiled umbilical blood vessels: a new marker for the fetus at risk. Obstet Gynecol. 1993;81(3):409-11. [PubMed] 
  6. Ezimokhai M, Rizk DE, Thomas L. Maternal risk factors for abnormal vascular coiling of the umbilical cord. Am J Perinatol. 2000;17(8):441-5. [Crossref] [PubMed] 
  7. Sebire NJ. Pathophysiological significance of abnormal umbilical cord coiling index. Ultrasound Obstet Gynecol. 2007;30(6):804-6. [Crossref] [PubMed] 
  8. de Laat MW, Franx A, van Alderen ED, Nikkels PG, Visser GH. The umbilical coiling index, a review of the literature. J Matern Fetal Neonatal Med. 2005;17(2):93-100. [Crossref] [PubMed] 
  9. Gupta S, Faridi MMA, Krishnan J. Umbilical coiling index. J Obstet Gynecol India. 2006;56(4):315-9. [Link] 
  10. Edmonds HW. The spiral twist of the normal umbilical cord in twins and in singletons. Am J Obstet Gynecol. 1954;67(1):102-20. [Crossref] [PubMed] 
  11. Chitra T, Sushanth YS, Raghavan S. Umbilical coiling index as a marker of perinatal outcome: an analytical study. Obstet Gynecol Int. 2012;2012:213689. [Crossref] [PubMed] [PMC] 
  12. Lacro RV, Jones KL, Benirschke K. The umbilical cord twist: origin, direction, and relevance. Am J Obstet Gynecol. 1987;157(4 Pt 1):833-8. [Crossref] [PubMed] 
  13. Sepulveda W. Time for a more detailed prenatal examination of the umbilical cord? Ultrasound Obstet Gynecol. 1999;13(3):157-60. [Crossref] [PubMed] 
  14. Ercal T, Lacin S, Altunyurt S, Saygili U, Cinar O, Mumcu A. Umbilical coiling index: is it a marker for the foetus at risk? Br J Clin Pract. 1996;50(5):254-6. [PubMed] 
  15. Chaurasia BD, Agarwal BM. Helical structure of the human umbilical cord. Acta Anat (Basel). 1979;103(2):226-30. [Crossref] [PubMed] 
  16. Hickey K, McKenna P. Chirality in the umbilical cord. Br J Obstet Gynaecol. 1993;100(10):971-2. [Crossref] [PubMed] 
  17. Ezimokhai M, Rizk DE, Thomas L. Abnormal vascular coiling of the umbilical cord in gestational diabetes mellitus. Arch Physiol Biochem. 2001;109(3):209-14. [Crossref] [PubMed] 
  18. van Diik CC, Franx A, de Laat MW, Bruinse HW, Visser GH, Nikkels PG. The umbilical coiling index in normal pregnancy. J Matern Fetal Neonatal Med. 2002;11(4):280-3. [Crossref] [PubMed] 
  19. Kashanian M, Akbarian A, Kouhpayehzadeh J. The umbilical coiling index and adverse perinatal outcome. Int J Gynaecol Obstet. 2006;95(1):8-13. [Crossref] [PubMed] 
  20. de Laat MW, Franx A, Bots ML, Visser GH, Nikkels PG. Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol. 2006;107(5):1049-55. [Crossref] [PubMed] 
  21. Ernst LM, Minturn L, Huang MH, Curry E, Su EJ. Gross patterns of umbilical cord coiling: correlations with placental histology and stillbirth. Placenta. 2013;34(7):583-8. [Crossref] [PubMed] 
  22. Khong TY. Evidence-based pathology: umbilical cord coiling. Pathology. 2010;42(7):618-22. [Crossref] [PubMed] 
  23. Garber A, Hernandez L, Mullin C, Simon M. Pressure flow through a coiled tube. Group M5, BE 310 Spring 2004. [Link] 
  24. Strong TH Jr, Manriquez-Gilpin MP, Gilpin BG. Umbilical vascular coiling and nuchal entanglement. J Matern Fetal Med. 1996;5(6):359-61. [Crossref] [PubMed] 
  25. Chholak D, Gupta P, Khajotia S. Study to evaluate association of umbilical coiling index and perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6(2):408-12. [Crossref] 
  26. Ek S, Andersson A, Johansson A, Kublicas M. Oligohydramnios in uncomplicated pregnancies beyond 40 completed weeks. A prospective, randomised, pilot study on maternal and neonatal outcomes. Fetal Diagn Ther. 2005;20(3):182-5. [Crossref] [PubMed] 
  27. Nakamura M, Hasegawa J, Matsuaka R, Mimura T, Ichizuka K, Sekizawa A, et al. Risk analysis for the birth of a small for gestational age (SGA) infant. The Internet Journal of Gynecology and Obstetrics. 2009;13(2):1-5. [Crossref] 
  28. Hasegawa J, Mimura T, Morimoto T, Matsuoka R, Ichizuka K, Sekizawa A, et al. Detection of umbilical venous constriction by Doppler flow measurement at midgestation. Ultrasound Obstet Gynecol. 2010;36(2):196-201. [Crossref] [PubMed] 
  29. de Laat MW, van Alderen ED, Franx A, Visser GH, Bots ML, Nikkels PG. The umbilical coiling index in complicated pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;130(1):66-72. [Crossref] [PubMed] 
  30. Razak K, Meena D, Gl M. "Coils and Kinks": a novel technique to evaluate the perinatal outcome. Gynecol Obstet. 2017;7(11):1-9. [Crossref] 
  31. Peng HQ, Levitin-Smith M, Rochelson B, Kahn E. Umbilical cord stricture and overcoiling are common causes of fetal demise. Pediatr Dev Pathol. 2006;9(1):14-9. [Crossref] [PubMed] 
  32. Jo YS, Jang DK, Lee G. The sonographic umbilical cord coiling in late second trimester of gestation and perinatal outcomes. Int J Med Sci. 2011;8(7):594-8. [Crossref] [PubMed] [PMC] 
  33. Sharma B, Bhardwaj N, Gupta S, Gupta PK, Verma A, Malviya K. Association of umbilical coiling index by colour Doppler ultrasonography at 18-22 weeks of gestation and perinatal outcome. J Obstet Gynaecol India. 2012;62(6):650-4. [Crossref] [PubMed] [PMC] 
  34. Biradar A, Kori S, Patil N, Mudanur SR. Umbilical coiling index and its association with perinatal mortality and morbidity in a low resource tertiary care hospital of northern Karnataka-a prospective observational study. The New Indian Journal of OBGYN. 2020;7(1):10-5. [Crossref] 
  35. Raio L, Ghezzi F, Di Naro E, Franchi M, Maymon E, Mueller MD, et al. Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth. Ultrasound Obstet Gynecol. 1999;13(3):176-80. [Crossref] [PubMed] 
  36. Ugurlucan FG, Yuksel A. Is complete umbilical cord scanning possible at the second-trimester ultrasound scan? J Clin Ultrasound. 2015;43(4):249-53. [Crossref] [PubMed] 
  37. Hussein MR, Mohammed RJ, Jameel AA. The umbilical coiling index in term of pregnancy as a marker of perinatal outcome. Ann Trop & Public Health. 2020;23(7):816-23. [Crossref] 
  38. Predanic M, Perni SC, Chasen ST, Baergen RN, Chervenak FA. Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation in association with adverse pregnancy outcome. Am J Obstet Gynecol. 2005;193(2):387-94. [Crossref] [PubMed]