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Objective: To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation.Design: Nationwide case series.Setting: All Dutch tertiary perinatal care centres.Population: All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014.Methods: Women were identified through computerised hospital databases. Data were collected from medical records.Main Outcome Measures: Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival).Results: We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days.Conclusions: Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling.Tweetable Abstract: Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival. [ABSTRACT FROM AUTHOR]

Objective: To determine whether women delivering preterm have unfavorable cardiovascular profiles as compared with women who deliver at term., Methods: A prospective observational cohort study enrolled 165 women with spontaneous preterm delivery (sPTD) at 24 +0 and 36 +6 gestational weeks in three perinatal care centers in The Netherlands between August 2012 and August 2014. Total cholesterol, triglycerides, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, apolipoprotein, glucose, and homocysteine were measured within 24 hours after delivery. Lipids and cardiovascular biochemical risk factors were compared between women with sPTD and an external comparison group of 30 women with term delivery via analysis of covariance., Results: Mean gestational age at delivery was 30.7 ± 3.6 weeks in the sPTD group and 40.3 ± 1.3 weeks in the reference group. Data were adjusted for body mass index, age, and center. As compared with the reference group, total cholesterol and LDL-cholesterol levels were lower and glucose levels were higher among women with sPTD., Conclusion: An association between sPTD and unfavorable lipids and cardiovascular biochemical risk factors was not established. The higher levels of glucose in the sPTD group might be due to increased insulin resistance, which is associated with a higher risk of sPTD., (© 2017 International Federation of Gynecology and Obstetrics.)

Objective: To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation., Design: Nationwide case series., Setting: All Dutch tertiary perinatal care centres., Population: All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014., Methods: Women were identified through computerised hospital databases. Data were collected from medical records., Main Outcome Measures: Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival)., Results: We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days., Conclusions: Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling., Tweetable Abstract: Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival., (© 2017 Royal College of Obstetricians and Gynaecologists.)

Objective: Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF., Methods: We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation., Results: We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome., Conclusion: The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.)

Background: It is unknown whether an unfavorable (atherogenic) lipid profile and homocysteine level, which could supersede clinical cardiovascular disease, is also associated with an increased risk of spontaneous preterm delivery (sPTD). A systematic review of studies assessing the lipid profile and homocysteine value of women with sPTD compared to women with term delivery in pre-pregnancy and during pregnancy., Methods: A systematic search of peer-reviewed articles published between January 1980 and May 2014 was performed using MEDLINE, EMBASE and the Cochrane database. We included case-control and cohort studies that examined triglycerides, high/low density lipoprotein cholesterol, total cholesterol and homocysteine in women with sPTD. Articles were subdivided in pre-pregnancy, first, second and third trimester. Of 708 articles reviewed for eligibility, 14 met our inclusion criteria., Results and Conclusion: Nine cohort studies and five case-control studies were analyzed, reporting on 1466 cases with sPTD and 11296 controls with term delivery. The studies suggest a possible elevated risk of sPTD in woman with high TG levels, no association of high and low density lipoprotein cholesterol with the risk of sPTD was found. High homocysteine levels are associated with sPTD in the second trimester. The role of triglycerides and homocysteine in sPTD should be explored further., Competing Interests: Compliance with ethical standards Funding None. Conflict of interest All authors declare to have no conflict of interest. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors.

Background: Babies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome., Methods/design: Women with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial., Intervention: random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05)., Discussion: This study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure., Trial Registration: NTR3492 Dutch Trial Register (http://www.trialregister.nl).

Objectives: To determine whether there is an association between sonographically assessed hyper- or hypocoiling of the umbilical cord and the presence of trisomy 21, to provide reference values for the antenatal umbilical coiling index (aUCI) at a gestational age of 16-21 weeks and to determine whether these measurements are reliable and reproducible., Methods: This was a prospective study of 737 pregnancies in which the aUCI was measured between 16 and 21 weeks of gestation by ultrasound at the time of amniocentesis. The aUCI was calculated as the reciprocal value of the mean length of one complete coil in centimeters. We created reference curves and studied the relationship with trisomy 21 and other chromosomal defects. In 30 pregnancies we studied the intra- and interobserver variation in measurements using Bland-Altman plots with associated 95% limits of agreement and intraclass correlation coefficients., Results: aUCI was found to be non-linearly related to gestational age at 16-21 weeks and reference curves were created for the mean aUCI and the 2.3(rd) , 10(th) , 90(th) and 97.7(th) percentiles. There was no significant difference in aUCI values between the reference group (n = 714) and cases with trisomy 21 (n = 16) or other aneuploidies (n = 7) (one-way ANOVA, P = 0.716). There was good intra- and interobserver agreement in aUCI measurements., Conclusions: The aUCI can be measured reliably and varies according to gestational age at 16-21 weeks. The aUCI was not significantly associated with trisomy 21 or other chromosomal defects., (Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.)

Preterm labor (PTL) is an important cause of preterm delivery. The trigger initiating the process toward overt labor and parturition is poorly understood and the molecular basis remains an enigma. It recently emerged that the overall occurrence of PTL in pregnant women with congenital heart disease (CHD) is increased. In this review, we present data on pregnancy in women with CHD and the opportunities this provides for research on the initiating mechanisms of inappropriately premature contractions. This may provide means for early detection of women at high risk of PTL in the general population, with models using cervical length, novel biomarkers, and maternal factors. We discuss human embryonic development of the heart and the uterus and the molecular pathways shared by the cardio- and uteromyocytes. We propose 2 hypotheses for the co-occurrence of maternal CHD and PTL; one based on a shared genetic origin and the other on a shared epigenetic origin.

Objective: To determine to what extent the recommendations to actively treat preterm infants with a gestational age of 24 weeks upwards laid down in the guidelines 'Perinatal policy in cases of extreme prematurity' have influenced policy in Dutch perinatal centres in the first year after publication, and what the health outcomes were., Design: Retrospective, descriptive study., Method: Our study population included all pregnant women who were admitted to a perinatal centre at 23 5/7 to 26 weeks gestation with a diagnosis of 'threatened preterm labour', and their preterm infants. We collected both obstetric data and data on survival and morbidity of the infants from the medical files., Results: Of a total of 192 preterm infants 185 (96%) were born alive; 92% of these infants were admitted to the neonatal intensive care unit. Survival rates were 43% and 61% at 24 weeks and 25 weeks gestation, respectively. Short-term morbidity (bronchopulmonary dysplasia, retinopathy of the newborn, severe intraventricular haemorrhage, necrotising enterocolitis and persistent ductus arteriosus) occurred in 79% and 71% of the infants born at 24 weeks and 25 weeks gestation, respectively., Conclusions: The recommendations from these guidelines have been implemented swiftly in Dutch perinatal centres, and survival of extremely preterm infants has increased. This has imposed a considerable burden on the capacity of these centres. Little is yet known about the long-term (up to school-age) health and survival of these infants.

Objectives: A prospective study was performed to compare fetal behavioral development in healthy dichorionic twins and singletons, and identify twin intra-pair associations (synchrony) of fetal movements and rest-activity cycles using different criteria to define synchrony., Subjects and Methods: Twenty pregnant women carrying dichorionic twins participated. Serial simultaneous 1-hr recordings of fetal movements were made on twins between 11 and 40 weeks' gestation (wGA) using two ultrasound machines. All twins were born healthy after 36 wGA and of appropriate weight for gestation. The incidences of fetal generalized body movements (GM) and breathing movements in twins were compared with institutional reference values for singletons. A comprehensive smoothing procedure on the raw movement data was performed to evaluate previously reported variation in twin intra-pair synchrony., Results: Twin fetuses were less active (GM) than singletons throughout pregnancy, but their breathing activity was higher in the third trimester. The incidences of fetal GM, quiescence, and breathing were fairly correlated within twin pairs. However, the temporal association or simultaneous occurrence of these activities was poor, especially after 30 weeks' gestation, coinciding with emerging rest-activity cycles. There was no evidence of a consistently more active ('dominant') twin half. Potential confounders had no effect on behavioral development in fetal twins., Conclusions: The results show differential behavioral development between normal dichorionic fetal twins and singletons. Within fetal twin-pairs, we found poor synchrony of movements and independent occurrence of rest-activity cycles. Previous research on fetal twin behavior appears to have overestimated the degree of intra-pair movement synchrony., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Previous research has shown that women with congenital heart disease (CHD) are more susceptible to cardiovascular, obstetric, and offspring events. The causative pathophysiologic mechanisms are incompletely understood. Inadequate uteroplacental circulation is an important denominator in adverse obstetric events and offspring outcome. The relation between cardiac function and uteroplacental perfusion has not been investigated in women with CHD. Moreover, the effects of physiologic changes on pregnancy-related events are unknown. In addition, long-term effects of pregnancy on cardiac function and exercise capacity are scarce., Methods: Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II, a prospective multicenter cohort study, investigates changes in and relations between cardiovascular parameters and uteroplacental Doppler flow patterns during pregnancy in women with CHD compared to matched healthy controls. The relation between cardiovascular parameters and uteroplacental Doppler flow patterns and the occurrence of cardiac, obstetric, and offspring events will be investigated. At 20 and 32 weeks of gestation, clinical, neurohumoral, and echocardiographic evaluation and fetal growth together with Doppler flow measurements in fetal and maternal circulation are performed. Maternal evaluation is repeated 1 year postpartum., Implications: By identifying the factors responsible for pregnancy-related events in women with CHD, risk stratification can be refined, which may lead to better pre-pregnancy counseling and eventually improve treatment of these women., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Although it is generally accepted that antenatal corticosteroids reduce neonatal complications after preterm labor, it is unclear at what gestational age this effect starts to occur. We conducted a systematic review of the literature to determine the effects of antenatal corticosteroids given to women at risk of preterm birth <26 weeks' gestation. Two reviewers independently searched electronic databases and the Cochrane Library for randomized controlled trials including women at imminent birth at a gestational age <26 weeks. Nine randomized trials were included. Meta-analyses and meta-regression of trials including participants with a lower gestational age revealed no significant reduction of neonatal mortality and morbidity in the corticosteroid group as compared with nonintervention, in contrast to clear evidence of beneficial effects in trials including women given corticosteroids at a later gestational age. A gestational age-dependent effect of antenatal corticosteroids on neonatal outcomes with lesser treatment benefits in patients <26 weeks' gestational age appears to exist. There is no evidence from randomized controlled trials to support or refute the recommendation of administrating antenatal corticosteroids to women at risk of preterm birth <26 weeks' gestation., (Thieme Medical Publishers.)

At the request of the State Secretary of the Dutch Ministry of Health, Welfare and Sport a national multidisciplinary workgroup developed an evidence-based practice guideline for the management of pregnant women with an imminent preterm delivery after a pregnancy of less than 26 weeks duration and for extremely preterm neonates. Active care measures are advised for neonates from a gestational age of 24 0/7 weeks onwards, unless there are serious arguments that justify a conservative management. In cases of imminent preterm delivery, intrauterine transport to a perinatological care centre is advised from a gestational age of 23 4/7 weeks onwards. In cases of imminent preterm delivery, glucocorticoids to enhance fetal lung maturity should be administered from a gestational age of 23 5/7 weeks onwards. From a gestational age of 24 0/7 weeks onwards a caesarean section may be considered if the fetal condition during spontaneous labour justifies this.

Objective: To determine if presence of the Roach muscle, a small muscle bundle lying just beside the umbilical artery, contributes to umbilical cord coiling., Methods: 251 umbilical cords were examined. The umbilical coiling index (UCI) was calculated as the number of coils divided by the cord length in cm. Cords were classified as hypocoiled (UCIp90). On microscopic examination of a cross section of the cord, absence or presence of a Roach muscle was determined. The t-test for independent samples and logistic regression were used for statistical analysis., Results: A Roach muscle was observed in 101 cords. The mean UCI was higher in cords with the muscle bundle (0.23 coils/cm) than in cords without a muscle (0.18 coils/cm). Difference in mean: 0.05 coils/cm (95% C.I. 0.01-0.09). OR for hypercoiling in presence of the muscle was 2.98 (95% C.I. 1.57-5.64). OR for hypocoiling in the presence of the muscle was 1.49 (95% C.I. 0.79-2.81)., Conclusions: Our results suggest that presence of a Roach muscle bundle contributes to umbilical cord coiling. Given the divergence in umbilical cord coiling within subgroups with or without this muscle, other factors must play a more dominant role.

Our objective was to determine whether there is an association between hypercoiling of the umbilical cord and placental maturation defect. From a database comprising 1147 cases, containing data on all placentas examined at our institution during the study period, we selected all cases with a gestational age of at least 37 weeks that exhibited hypercoiling of the umbilical cord (coiling density above the 90th percentile, n = 42); we also examined 2 matched controls for each case, one with hypocoiling and one with normocoiling. The mean number of syncytiocapillary membranes (SCM) per terminal villus was calculated. Presence of a placental maturation defect was defined as the mean number of SCM below the 10th percentile. Correlations were assessed using Spearman's rho. Relations between dichotomous variables were tested using logistic regression. Mean number of SCM per terminal villus (+/-standard deviation) was 1.25 +/- 0.65. Difference in mean between hypo- and hypercoiled cords was 0.37 (95% confidence interval [CI], 0.07 to 0.67). The correlation coefficient between mean number of SCM and umbilical coiling index (UCI, coils/cm) was -0.28 (P = 0.002). The odds ratio (OR) for placental maturation defect in presence of hypercoiling was 2.61 (95% CI, 0.75 to 9.12). The OR for fetal death was 132 (95% CI, 13.2 to 1315) in the presence of a placental maturation defect and 5.49 (95% CI, 1.02 to 29.6) in the presence of hypercoiling. The OR for indication of fetal hypoxia/ischemia was 12.3 (95% CI, 3.0 to 50.3) in the presence of a placental maturation defect and 3.2 (95% CI, 0.95 to 10.9) in the presence of hypercoiling. We found a trend toward placental maturation defect in the presence of hypercoiling and an inverse relationship between the mean number of SCM in the terminal villi and the UCI. We confirmed associations between fetal death and both a maturation defect and hypercoiling and found an association between histological indication of fetal hypoxia/ischemia and a placental maturation defect.

Objective: To evaluate umbilical cord coiling in pregnancies with adverse outcome., Study Design: Umbilical cords and hospital records of 565 consecutive cases with an indication for histological examination of the placenta were studied. The umbilical coiling index (UCI) was determined as the number of complete coils divided by the length of the cord in centimeters, by an observer blinded for pregnancy outcome. Data on obstetric history and pregnancy outcome of each case were obtained from the hospital records. We calculated odds ratios and their 95% confidence interval to evaluate the strength of associations between pregnancy outcome and abnormal cord coiling., Results: Fetal death (OR 4.09, 95% CI 2.22-7.55), chorioamnionitis (OR 1.77, 95% CI 1.09-2.88), fetal structural or chromosomal abnormalities (OR 1.78, 95% CI 1.08-2.95), and lower Apgar score at 5 min (p=0.03) were associated with undercoiling (UCI below the 10th percentile, using reference values from uncomplicated pregnancies). Fetal death (OR 3.74, 95% CI 1.89-7.40), iatrogenic preterm delivery (OR 1.91, 95% CI 1.04-3.49), umbilical arterial pH<7.05 (OR 3.63, 95% CI 1.44-9.17), fetal structural or chromosomal abnormalities (OR 1.79, 95% CI 1.01-3.16), thrombosis in fetal placental vessels (OR 2.64, 95% CI 1.37-5.06), chronic fetal hypoxia/ischemia (OR 1.82, 95% CI 1.09-3.05), and lower weight for gestational age (p=0.01) were associated with overcoiling (UCI above the 90th percentile)., Conclusions: Our findings confirm that adverse perinatal outcome is associated with both undercoiling and overcoiling of the umbilical cord.

Objectives: To evaluate whether the antenatal umbilical coiling index (aUCI) as measured by ultrasonography predicts the postnatal umbilical coiling index (pUCI) and adverse pregnancy outcome., Methods: In a prospective study in 117 pregnancies, the aUCI was measured between 28 weeks and term by ultrasonography. The aUCI was calculated as the reciprocal value of the mean pitch of one complete coil. The pUCI was calculated as the number of coils divided by the cord length in cm. The correlation between aUCI and pUCI was assessed and likelihood ratios for adverse pregnancy outcome were calculated., Results: We had complete data on 81 subjects. Mean aUCI +/- SD was 0.30 +/- 0.09 and mean pUCI +/- SD was 0.17 +/- 0.08. The correlation coefficient between aUCI and pUCI was 0.66, P < 0.001. Limits of agreement were 0-0.28 coils/cm. The positive likelihood ratio for small-for-gestational-age infants was 2.6 (95% confidence interval (CI) 0.6-11.6) for ultrasound hypocoiling, and 5.7 (95% CI 1.3-24.8) for ultrasound hypercoiling. The positive likelihood ratio for interventional delivery for non-reassuring fetal status was 1.2 (95% CI 0.2-9.0) for ultrasound hypocoiling, and 10.3 (95% CI 2.1-50.2) for ultrasound hypercoiling., Conclusions: Strong correlation coefficients comparing the aUCI and pUCI do not reflect agreement. Since the limits of agreement were almost as wide as the full range for the pUCI, the aUCI does not predict the pUCI with sufficient precision. Larger prospective studies are required to confirm the predictive potential of the aUCI for adverse pregnancy outcome., (Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To estimate the relation between undercoiling and overcoiling of the umbilical cord and adverse pregnancy outcome., Methods: Umbilical cords and hospital records of 885 patients were studied in a cross-sectional study design. The umbilical coiling index was determined as the number of complete coils divided by the length of the cord in centimeters, blinded for pregnancy outcome. Obstetric history and pregnancy outcome of each patient were obtained from hospital records, blinded for the umbilical coiling index. Odds ratios and their 95% confidence intervals were calculated to evaluate associations between undercoiling and overcoiling and adverse pregnancy outcome, using multiple logistic regression., Results: Undercoiling (umbilical coiling index below the 10th percentile, using references values from uncomplicated pregnancies) was associated with fetal death (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.48-7.63), spontaneous preterm delivery (OR 2.16, 95% CI 1.34-3.48), trisomies (OR 5.79, 95% CI 2.07-16.24), low Apgar score at 5 minutes (OR 3.14, 95% CI 1.47-6.70), velamentous cord insertion (OR 3.00, 95% CI 1.16-7.76), single umbilical artery (OR 3.68, 95% CI 1.26-10.79), and dextral coiling (OR 1.80, 95% CI 1.02-3.17). Overcoiling (umbilical coiling index above the 90th percentile) was associated with asphyxia (OR 4.16, 95% CI 1.30-13.36), umbilical arterial pH < 7.05 (OR 2.91, 95% CI 1.05-8.09), small for gestational age infants (OR 2.10, 95% CI 1.01-4.36), trisomies (OR 9.26, 95% CI 2.84-30.2), single umbilical artery (OR 8.25, 95% CI 2.60-26.12), and sinistral coiling (OR 4.30, 95% CI 1.52-12.2)., Conclusion: Undercoiling and overcoiling of the umbilical cord are associated with increased risk for adverse perinatal outcome.

Our aim was to review the literature on umbilical cord coiling. Relevant articles in English published between 1966 and 2003 were retrieved by a Medline search and cross-referencing. The normal umbilical cord coiling index (UCI) is 0.17 (+/- 0.009) spirals completed per cm. Abnormal cord coiling, i.e. UCI <10th centile (<0.07) or >90th centile (>0.30) is associated with adverse pregnancy outcome. Hypocoiling of the cord is associated with increased incidence of fetal demise, intrapartum fetal heart rate decelerations, operative delivery for fetal distress, anatomic-karyotypic abnormalities and chorio-amnionitis. Hypercoiling of the cord is associated with increased incidence of fetal growth restriction, intrapartum fetal heart rate decelerations, vascular thrombosis and cord stenosis. It is not clear whether abnormal coiling is actually a cause of pathology, or merely one of the sequelae, or both. We discuss the theories involving the cause of cord coiling, and the consequences of the degree of cord coiling on blood flow through the umbilical vessels. In the future ultrasonographic evaluation of the umbilical cord and the UCI may become an integral part of fetal assessment in high-risk pregnancies.

Objective: To provide reference values for the umbilical coiling index in uncomplicated pregnancy., Methods: Umbilical cords were collected from livebom singleton infants born after uncomplicated pregnancies. The umbilical coiling index (UCI) was calculated as the number of coils divided by the cord length in centimeters. The mean value (SD) for the UCI was calculated, and possible correlations of the UCI with maternal age, parity, gestational age at delivery, mode of delivery, sex and birth weight of the infant were examined., Results: A total of 122 umbilical cords were included. The frequency distribution of the UCI was skewed to the right. The mean (SD) UCI was 0.17 (0.009) coils/cm. There were no significant correlations of the UCI with maternal age, parity, gestational age at delivery, mode of delivery, sex or birth weight of the infant., Conclusions: This is the first study to determine the UCI in a group exclusively consisting of uncomplicated pregnancies. The mean value that we found for the UCI may serve as the standard reference, allowing proper interpretation of umbilical coiling in complicated pregnancy.