Sonographic evaluation of antenatal umbilical coiling index and its association with adverse pregnancy outcomes: A prospective cohort study.

Background: The umbilical cord coiling index (UCI) is a critical indicator of fetal well-being and pregnancy outcomes. Aberrant umbilical coiling patterns, including hypo- and hypercoiling, have been associated with adverse perinatal sequelae. This study aimed to elucidate the relationship between antenatal UCI (aUCI) and perinatal outcomes in an Indian cohort.

Material And Methods: A prospective cohort study conducted at a tertiary care center in India enrolled 1200 pregnant women between 18 and 23 weeks of gestation. Standardized ultrasound examinations were performed to assess aUCI. Participants were stratified into hypocoiled, normocoiled, and hypercoiled groups based on UCI percentiles. Multivariate logistic regression analyses, adjusted for maternal demographic and obstetric confounders, were used to evaluate associations between aUCI categories and perinatal outcomes.

Results: The study estimated a prevalence of 12.72% for hypocoiling and 10.30% for hypercoiling within the cohort. Hypocoiling demonstrated a significant association with increased risk of preterm birth (adjusted odds ratio [aOR]=2.87, 95%[CI]: 1.85-4.45) and intrauterine growth restriction (IUGR). Hypercoiling exhibited more severe associations, including profound IUGR (aOR = 14.31, 95% CI: 9.33-21.94), low birth weight (aOR = 2.28, 95% CI: 1.47-3.55), and adverse neonatal outcomes such as low APGAR scores and neonatal intensive care unit admissions.

Conclusion: This study substantiates the pivotal role of aUCI in predicting adverse perinatal outcomes within the Indian population. The distinct risk profiles associated with hypo- and hypercoiling suggest divergent pathophysiological mechanisms, underscoring the necessity for tailored clinical management strategies based on aUCI findings. These results have significant implications for antenatal surveillance and risk stratification in obstetric practice.