Analysis of Ultrasound Clinical Early Warning System in Hyper-Coiling Umbilical Cord

Abstract Background： Umbilical coiling index（UCI）can not be used to predict pregnancy outcomes. Whether there are other abnormal ultrasound indicators in the hyper-coiling cord (HC) that can give early warning of adverse pregnancy still needs to be further explored.Objective: To establish an ultrasonic early warning system for clinical intervention in patients with the hyper-coiling umbilical cord.Study Design: Retrospectively analyzed 29 patients’ characteristics with hyper-coiling cord (HC) diagnosed by ultrasound in our hospital from January 2019 to March 2021. According to whether the following high-risk factors were combined ①High resistance of umbilical arteries beside the bladder, ②fetal growth restriction (FGR), ③increased diastolic peak blood flow of middle cerebral artery, ④oligohydramnios, ⑤enhanced echo of the cerebral parenchyma, ⑥reversed A wave of the venous catheter ( VC). It could be divided into two types: simple type and complex type, and then divided into three groups according to the delivery situation of patients, as terminated pregnancy group, intervention group, and non-intervention group. At last, according to the distribution of high-risk factors in each group, established an ultrasonic early warning system which affected the clinical intervention and pregnancy outcome of complex HC patients.Results: compared with 9 cases in the simple HC group and 20 cases in the complex HC group, the intervention ratio of complex HC patients was higher (p=0.027), the average delivery gestational weeks was smaller (p=0.034), the abnormal rate of fetal heart monitoring was higher (p=0.027), and there were statistical differences in above. Compared in the three groups (terminated pregnancy group, intervention group, and the non-intervention group), there were statistical differences in the number of high-risk factors (P=0.000) and the distribution proportion of six high-risk factors (P = 0.012, 0.011, 0.000, 0.026, 0.028, 0.000).Conclusion: the monitoring of six high-risk factors by ultrasound could establish an ultrasound early warning system for HC to influence the clinical intervention and pregnancy outcome. In this early warning system, the monitoring of fetal intrauterine safety was often needed for complex HC patients. High resistance of umbilical arteries beside the bladder and FGR were the earliest warning signs. Once timely clinical intervention was carried out, the prognosis of pregnancy could be improved.