Three-dimensional Umbilical Cord Coiling Index

Study Overview
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Brief Summary
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Previous studies have shown that abnormal coiling of the umbilical cord is associated with adverse perinatal outcome. For example, an umbilical cord that is non-coiled increases the chance of fetal morbidity and mortality, moreover, they have shown that the lack of the usual coiled umbilical cord configuration may result in an umbilical cord that is structurally less able to withstand external mechanical stress, on the other hand, studies from recent years show that hypercoiling - excessive coiling of the umbilical cord is associated with poor obstetric outcomes, such as fetal distress at birth, meconium staining, fetal acidosis, premature birth, intrauterine growth disorder and even fetal death. The studies carried out on the calculation of UCI include performing these measurements in two dimensions, including Doppler activation, but no studies were carried out in which three dimensions were used. The purpose of the study is to measure UCI using a 3D method in a random sample of 250 patients beyond 24 week of gestation, and to compare pregnancies with hypercoiling, hypocoiling or with a normal number of coils in terms of birth outcomes.

Detailed Description
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The umbilical cord connects the growing fetus to the placenta and contains 3 blood vessels, 2 arteries and a vein. The umbilical cord is protected by a layer of Wharton jelly and is characterized by being coiled. This coiling provides the umbilical cord with strength and flexibility simultaneously, and as a result lowers the risk of complications such as torsion of the umbilical cord. The reason for the formation of this coiling is unknown, but there are many hypotheses such as mobility and rotation of the fetus around the axis of the umbilical cord, a different growth pattern of the blood vessels in the umbilical cord and a special arrangement of the muscles in the walls of the arteries of the umbilical cord. Umbilical cord index (UCI) is the distance between one coil of the umbilical cord. it is calculated from the inner edge of the wall of an umbilical cord artery or vein to the outer edge of the same vessel in the next coil, the direction is from the edge of the placenta to the fetus. The final value is the average of three readings in three different segments of the umbilical cord. Previous studies have shown that abnormal coiling of the umbilical cord is associated with adverse perinatal outcome. For example, an umbilical cord that is non-coiled increases the chance of fetal morbidity and mortality, moreover, they have shown that the lack of the usual coiled umbilical cord configuration may result in an umbilical cord that is structurally less able to withstand external mechanical stress, on the other hand, studies from recent years show that hypercoiling - excessive coiling of the umbilical cord is associated with poor obstetric outcomes, such as fetal distress at birth, meconium staining, fetal acidosis, premature birth, intrauterine growth disorder and even fetal death. The studies carried out on the calculation of UCI include performing these measurements in two dimensions, including Doppler activation, but no studies were carried out in which three dimensions were used. The purpose of the study is to measure UCI using a 3D method in a random sample of 250 patients beyond 24 week of gestation, and to compare pregnancies with hypercoiling, hypocoiling or with a normal number of coils in terms of birth outcomes.

Official Title
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The Effect of Three-dimensional Umbilical Cord Coiling Index on Obstetrical and Neonatal Outcomes: a Prospective Study

Conditions
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Umbilical Cord Issue, Intrauterine Growth Restriction, Fetal Distress

Intervention / Treatment
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* Diagnostic Test: Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Singleton pregnancy Pregnancy week > or = 24.0 Exclusion Criteria: Twin pregnancy Pregnancy week<24 Single umbilical cord Insufficient prenatal care Abnormal anatomical fetal findings, abnormal results of aneuploidy screening Premature rupture of membranes Polyhydramnios or Oligohydramnios at the time of recruitment. Intrauterine growth restriction at the time of recruitment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| The study cohort (total sample)<br>All women will undergo ultrasound examination for three-dimensional umbilical cord index. | Diagnostic Test: Ultrasound<br>* The intervention is ultrasound examination with three dimensional umbilical cord index, two-dimensional umbilical cord index, and doppler examination of the umbilical cord artery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intrauterine growth restriction | The correlation between three-dimensional umbilical cord index and the rate of intrauterine growth restriction | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Two-dimensional umbilical cord index | The correlation between three-dimensional umbilical cord index and the two-dimensional umbilical cord index | 1 year | 
| Doppler index of the umbilical cord | The correlation between three-dimensional umbilical cord index and the doppler index of the umbilical cord | 1 year | 
| fetal distress during delivery | The correlation between three-dimensional umbilical cord index and the rate of fetal distress during delivery | 2 years | 
| Meconium staining | The correlation between three-dimensional umbilical cord index and meconium staining at delivery | 2 years | 
| Delivery mode | The correlation between three-dimensional umbilical cord index and the delivery mode | 2 years | 
| Cord pH | The correlation between three-dimensional umbilical cord index and Cord pH | 2 years | 
| APGAR score | The correlation between three-dimensional umbilical cord index and APGAR score | 2 years | 
| Newborn intensive care unit admission | The correlation between three-dimensional umbilical cord index and admission to NICU | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coiling index, Neonatal outcome, Intrauterine Growth Restriction, Antepartum screening