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


  • Pratibha S. Sarkate Department of Obstetrics and Gynecology, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
  • Sujitkumar Hiwale Philips Research, Bangalore, Karnataka, India



India, Perinatal outcomes, UCI, Umbilical coiling index, Umbilical cord


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 the 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.


de Laat MWM, Franx A, van Alderen ED, Nikkels PGJ, Visser GHA. The umbilical coiling index, a review of the literature. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2005;17(2):93-100.

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.

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.

Sebire NJ. Pathophysiological significance of abnormal umbilical cord coiling index. Ultrasound Obstet Gynecol. 2007;30(6):804-6.

Kalish RB, Hunter T, Sharma G, Baergen RN. Clinical significance of the umbilical cord twist. Am J Obstet Gynecol. 2003;189(3):736-9.

Jessop FA, Lees CC, Pathak S, Hook CE, Sebire NJ. Umbilical cord coiling: clinical outcomes in an unselected population and systematic review. Virchows Arch Int J Pathol. 2014;464(1):105-12.

de Laat MWM, Franx A, Bots ML, Visser GHA, Nikkels PGJ. Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol. 2006;107(5):1049-55.

Chitra T, Sushanth YS, Raghavan S. Umbilical coiling index as a marker of perinatal outcome: an analytical study. Obstet Gynecol Int. 2012;2012:e213689.

Ezimokhai M, Rizk DE, Thomas L. Maternal risk factors for abnormal vascular coiling of the umbilical cord. Am J Perinatol. 1999;17(8):441-5.

Khong TY. Evidence-based pathology: umbilical cord coiling. Pathology (Phila). 2010;42(7):618-22.

Gupta S, MMA F. Umbilical coiling index. J Obstet Gynecol India. 2006;56(4):315-9.

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 Gynecol India. 2012;62(6):650-4.

Patil NS, Kulkarni SR, Lohitashwa R. Umbilical cord coiling index and perinatal outcome. J Clin Diagn Res JCDR. 2013;7(8):1675-7.

Agarwal S, Purohit R, Jani G. Umbilical cord coiling index and perinatal outcome in normal and abnormal pregnancies. Sch J Appl Med Sci. 2014;447-50.

Strong TH, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. Am J Obstet Gynecol. 1994;170(1 Pt 1):29-32.

Rana J, Ebert GA, Kappy KA. Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstet Gynecol. 1995;85(4):573-7.

Mikolajczyk RT, Zhang J, Betran AP, Souza JP, Mori R, Gülmezoglu AM, et al. A global reference for fetal-weight and birthweight percentiles. The Lancet. 2011;377(9780):1855-61.

Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. J Obstet Gynecol Neonatal Nurs JOGNN. 2008;37(5):510-5.

Yajnik CS, Fall CHD, Coyaji KJ, Hirve SS, Rao S, Barker DJP, et al. Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord J Int Assoc Obes. 2003;27(2):173-80.

Pathak S, Hook E, Hackett G, Murdoch E, Sebire NJ, Jessop F, et al. Cord coiling, umbilical cord insertion and placental shape in an unselected cohort delivering at term: Relationship with common obstetric outcomes. Placenta. 2010;31(11):963-8.

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.

Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T. Ultrasound diagnosis and management of umbilical cord abnormalities. Taiwan J Obstet Gynecol. 2009;48(1):23-7.






Original Research Articles