Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation in association with adverse pregnancy outcome


      The purpose of this study was to evaluate the antenatal umbilical cord coiling index obtained during the fetal anatomic survey in the second trimester as a predictor of adverse pregnancy outcome.

      Study design

      Four hundred twenty-five consecutive women who had a fetal anatomic survey between 18 to 23 weeks of gestation were evaluated for umbilical cord coiling. The antenatal umbilical cord coiling index was calculated as a reciprocal value of the distance between a pair of coils (antenatal umbilical cord coiling index = 1/distance in cm) and was correlated with the following adverse pregnancy outcomes: (1) small for gestational age, (2) mode of delivery, (3) presence of meconium-stained amniotic fluid, (4) presence of nonreassuring fetal status in labor, and (5) Apgar scores at 1 and 5 minutes.


      A total of 294 patients had adequate ultrasound images and all antenatal and labor data to meet the study inclusion criteria. Abnormal coiling was associated significantly with small for gestational age neonates at birth (P = .043) and nonreassuring fetal status in labor (P = .007). Nine of 58 neonates (15.5%) with abnormal umbilical coiling were small for gestational age infants compared with 15 of 236 small for gestational age neonates (6.4%) who had normal cord coiling. A nonreassuring fetal status in labor was observed in 25.7% of fetuses (15/58 fetuses) with abnormal umbilical coiling compared with 11.0% of fetuses (26/236 fetuses) with normal cord coiling. In contrast, no statistical difference for Apgar scores at 1 and 5 minutes or higher prevalence of interventional deliveries and meconium-stained amniotic fluid in labor between the groups with normal and abnormal umbilical cord coiling was observed.


      Abnormal umbilical cord coiling that is detected at the fetal ultrasound anatomic survey in the second trimester is associated with a higher prevalence of small for gestational age neonates and nonreassuring fetal status in labor. This observation can be used potentially as a predictor of adverse antenatal or perinatal events in future studies.

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        • Machin G.A.
        • Ackerman J.
        • Gilbert-Barness E.
        Abnormal umbilical cord coiling is associated with adverse perinatal outcomes.
        Pediatr Dev Pathol. 2000; 3: 462-471
        • Ezimokhai M.
        • Rizk D.E.
        • Thomas L.
        Abnormal vascular coiling of the umbilical cord in gestational diabetes mellitus.
        Arch Physiol Biochem. 2001; 109: 209-214
        • Strong Jr., T.H.
        • Jarles D.L.
        • Vega J.S.
        • Feldman D.B.
        The umbilical coiling index.
        Am J Obstet Gynecol. 1994; 170: 29-32
        • Rana J.
        • Ebert G.A.
        • Kappy K.A.
        Adverse perinatal outcome in patients with an abnormal umbilical coiling index.
        Obstet Gynecol. 1995; 85: 573-577
        • Ezimokhai M.
        • Rizk D.E.
        • Thomas L.
        Maternal risk factors for abnormal vascular coiling of the umbilical cord.
        Am J Perinatol. 2000; 17: 441-445
        • 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: 254-256
        • Degani S.
        • Leibovich Z.
        • Shapiro I.
        • Gonen R.
        • Ohel G.
        Early second-trimester low umbilical coiling index predicts small-for-gestational-age fetuses.
        J Ultrasound Med. 2001; 20: 1183-1188
        • Degani S.
        • Lewingsky R.M.
        • Berger H.
        • Spiegel D.
        Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics.
        Obstet Gynecol. 1995; 86: 990-993
        • Qin Y.
        • Lau T.K.
        • Rogers M.S.
        Second-trimester ultrasonographic assessment of the umbilical coiling index.
        Ultrasound Obstet Gynecol. 2002; 20: 458-463
        • Predanic M.
        • Perni S.C.
        • Chasen S.T.
        • Baergen R.
        • Chervenak F.A.
        An assessment of the umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester.
        J Ultrasound Med. 2005; 24: 185-191
        • Doubilet P.M.
        • Benson C.B.
        • Nadel A.S.
        • Ringer S.A.
        Improved birth weight table for neonates developed from gestations dated by early ultrasonography.
        J Ultrasound Med. 1997; 16: 241-249
        • Finberg H.J.
        Avoiding ambiguity in the sonographic determination of the direction of umbilical cord twist.
        J Ultrasound Med. 1992; 11: 185-189
        • Chaurasia B.D.
        • Agarwal B.M.
        Helical structure of the human umbilical cord.
        Acta Anat. 1979; 103: 226-230
        • van Diik C.C.
        • Franx A.
        • de Laat M.W.
        • Bruinse H.W.
        • Visser G.H.
        • Nikkels P.G.
        The umbilical coiling index in normal pregnancy.
        J Matern Fetal Neonatal Med. 2002; 11: 280-283
        • Georgiu H.M.
        • Rice G.E.
        • Walker S.P.
        • Wein P.
        • Gude N.M.
        • Pemezel M.
        The effect of vascular coiling on venous perfusion during experimental umbilical cord encirclement.
        Am J Obstet Gynecol. 2001; 184: 673-678
        • Dado G.M.
        • Dobrin P.B.
        • Mrkvicka R.S.
        Venous flow through coiled and non-coiled umbilical cords: effects of external compression, twisting and longitudinal stretching.
        J Reprod Med. 1997; 42: 576-580
        • Otsubo Y.
        • Yoneyama Y.
        • Suzuki S.
        • Sawa R.
        • Araki T.
        Sonographic evaluation of umbilical cord insertion with umbilical coiling index.
        J Clin Ultrasound. 1999; 27: 341-344