Women on the Other Side of War and Poverty : Its Effect on the Health of Reproduction

The umbilical cord is a communicative bridge between the fetus and placenta, through which the fetus receives food, oxygen, and fluids essential for life from the placenta. The umbilical cord contains two arteries and one vein covered by Wharton’s jelly, the external layer of which is surrounded by amnion fluid with a length of about 5060 cm at the term time. Any damage or disruption in the cord could lead to perinatal complications. Many features of human umbilical cord have remained unknown (14). However, in recent years, interest has increased in examining the umbilical cord coils and its role. On average, the umbilical cord has 11 loops or turns along its length between the fetus and placenta. The umbilical coil index (UCI) is measured by dividing the number of complete vascular coils by the cord length in cm. The average is about 0.2 ± 0.1 of the full circle in cm (5), that is, one coil per 5 cm. The UCI is considered hypocoil if it is below the 10th percentile. However, it is referred to as either hypercoil or normocoil in case it is above the 90th percentile or between 10 and 90 percentiles (6). There is a strong association between UCI and adverse perinatal outcomes including intrauterine growth restriction (IUGR), stillbirth, low Apgar score, and the like which can suggest that the umbilical cord coils may have clinical relevance (5-10). It seems that increasing the ability of cord coiling can compensate for the adverse effect of external forces such as tension, pressure, stretching, or entanglement without disruption in the flexibility. Approximately 5% of embryos are without vascular coiling (6,11). The possible mechanism for the relationship between abnormal umbilical cord coil and adverse clinical outcomes is unclear, but the hypothesis supports the issue that the correlation between fetal secondary hypoxia and increased vulnerability of the umbilical cord is due to pressure or entanglement (5). Various studies demonstrated that the hypercoil and hypocoil abnormal cord coiling indexes were associated with the adverse perinatal outcomes (8). It seems that the embryos with no coiled or smooth cord are at an increased risk of perinatal adverse complications. The rate of stillbirth was noted about 8%-10% in cases Abstract Objectives: This study aimed to measure the umbilical cord indices (UCIs) after birth and to determine its relationship with prenatal complications. Materials and Methods: The present analytical cross-sectional study was conducted on all the pregnant women admitted to AlZahra hospital of Rasht. After birth, the umbilical cord was measured in terms of the appearance, number of vascular coils, and umbilical cord length. In addition, the umbilical cord vascular coils index was calculated. Further, maternal and neonatal variables were evaluated. Results: The mean number of umbilical cord coils, umbilical cord length, and the umbilical cord coiling index for 397 umbilical cords were obtained as 16.02 ± 4.48, 51.6 ± 12.0 and 0.31 ± 0.05 cm, respectively. In evaluating the state of the coil, 9.8% were found as hypocoil while the remaining were either hypercoil (10.3%) or normocoil (79.85%). Furthermore, a significant difference was observed between the umbilical cord coiling index, as well as gestational hypertension and abnormal fetal heart rate (HR) (P < 0.05). In the final logistic regression model, the umbilical cord length was recognized as a predictor variable for neonatal complications. Moreover, in multiple analyses regarding the effects of umbilical cord coiling index on neonatal complications by controlling the interferences, variables such as maternal age and parity in addition to the coil length were considered as predictors of neonatal complications. Conclusions: Generally, the abnormal umbilical cord coiling index was associated with pregnancy blood pressure (BP) and abnormal fetus HR. Therefore, diagnosing antenatal umbilical cord coiling index can be helpful in recognition of embryos at risk through a faster treatment process.