Prevalence, associated factors, and immediate birth outcomes of abnormal umbilical cord coiling among deliveries at Fort Portal Regional Referral Hospital, Western Uganda: a cross-sectional study

Background Abnormal umbilical cord coiling pattern has been associated with adverse perinatal outcomes, but evidence from Uganda is lacking. We determined the prevalence of abnormal cord coiling, the maternal and obstetric factors associated with it, and its immediate birth outcomes among deliveries at Fort Portal Regional Referral Hospital, Western Uganda. Methods A hospital-based cross-sectional study of 288 women with singleton pregnancies of at least 26 weeks’ gestation was conducted, selected by systematic sampling between 23 April and 20 July 2026. Immediately after delivery, the whole cord was measured, and the umbilical coiling index (UCI, complete coils per centimetre) was calculated. Cords were classified as hypocoiled (UCI <0.1), normocoiled, or hypercoiled (UCI >0.3). Sociodemographic data were collected by an interviewer-administered questionnaire. Factors associated with abnormal coiling patterns were examined with logistic regression. Associations between abnormal coiling and birth outcomes were estimated as crude and adjusted odds ratios (aOR) using Firth-penalized logistic regression. Results Of 288 deliveries, 49 (17.0%; 95% CI 13.1–21.8) had abnormal coiling: 37 (12.8%) were hypercoiled and 12 (4.2%) hypocoiled. No maternal, obstetric, or lifestyle factor was significantly associated with abnormal coiling; preterm delivery had the largest aOR (2.19, 95% CI 0.69–6.93). Abnormal coiling was independently associated with meconium-stained liquor (aOR 2.31, 95% CI 1.21–4.41), a low one-minute Apgar score (aOR 3.12, 95% CI 1.18–8.26), and neonatal intensive care unit (NICU) admission (aOR 3.62, 95% CI 1.32–9.91). It was not associated with a low five-minute Apgar score (aOR 1.12, 95% CI 0.25–5.12) or low birth weight (aOR 0.78, 95% CI 0.21–2.95). Conclusions About one in six deliveries had abnormal cord coiling, and hypercoiling was about three times as common as hypocoiling. Abnormal coiling was associated with intrapartum compromise and NICU admission.