Umbilical Coiling Index- UCI by USG and its Postnatal Correlation

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.