ANTEPARTUM DIAGNOSIS OF NONCOILED UMBILICAL CORDS

OBJECTIVE: The null hypothesis is that fetuses with noncoiled umbilica l cords diagnosed in the antepartum period will have outcomes no diffe rent from those with normally coiled cords. STUDY DESIGN: We prospecti vely gathered data from Jan, 1 through May 18, 1992, from all fetuses undergoing routine ultrasonographic evaluation. The outcomes of fetuse s noted to have noncoiled umbilical cords were compared with those of a control group of fetuses with normally coiled cords. The control gro up consisted of those subjects undergoing ultrasonography during the s tudy period who were ultimately transferred to our perinatal practice for the remainder of the pregnancy (i.e., the highest-risk patients). Two outcome parameters were selected for comparison: fetal anomalies a nd fetal death. RESULTS: Six hundred eighty-seven consecutive ultrason ographic examinations were performed. Twenty-five subjects (3.7%) had noncoiled umbilical cords identified ultrasonographically (mean gestat ional age at diagnosis 20.3 +/- 3.5 [SD] weeks). The control group had 197 subjects. The combined incidence of fetal anomalies or death in t he noncoiled group (16%) was significantly greater (p less than or equ al to 0.05, relative risk 4.6 [95% confidence interval 1.41 to 14.15]) than that of the control group (3.5%). The noncoiled group had two fe tal deaths (8%), whereas two deaths (1%) occurred among controls (p le ss than or equal to 0.05, relative risk 8 [95% confidence interval 1.1 6 to 50]). Two (8%) fetal anomalies (anencephaly, prune-belly syndrome ) occurred in the noncoiled group, whereas the controls (n = 197) had five fetuses (2.5%) with anomalies (not significant). CONCLUSION: The antepartum identification of noncoiled umbilical cords appears to be a risk factor for suboptimal pregnancy outcome.