Background:The umbilical cord serves as a lifeline between the fetus and the placenta, playing a critical role in ensuring optimal fetal growth and development.This study aimed to evaluate the relationship between the Umbilical Cord Coiling Index (UCCI) and perinatal outcomes, including neonatal and maternal complications. Identifying abnormal coiling patterns may help in early risk assessment and improved perinatal care. Materials and Methods: A prospective observational study was conducted over 12 months at a tertiary care hospital, involving 100 pregnant women between 28 and 40 weeks of gestation. UCCI was measured using third-trimester ultrasound scans and categorized into hypocoiled (<0.10), normocoiled (0.10–0.30), and hypercoiled (>0.30) groups. Neonatal outcomes, including Apgar scores, birth weight, NICU admission, and umbilical cord accidents, were assessed. Maternal outcomes such as mode of delivery and labor duration were also analyzed. Statistical analysis was performed using SPSS, with significance set at p < 0.05. Results: Among the study population, 15% had hypocoiled, 65% had normocoiled, and 20% had hypercoiled cords. Hypocoiled and hypercoiled groups exhibited higher incidences of low Apgar scores, NICU admissions, and low birth weight. Hypocoiled cords were significantly associated with an increased need for neonatal resuscitation (p < 0.05), while hypercoiled cords had a higher incidence of meconium aspiration syndrome. However, there were no significant differences in maternal outcomes, including mode of delivery and postpartum hemorrhage, across UCCI groups. Conclusion: Abnormal UCCI, particularly hypocoiling and hypercoiling, is associated with adverse neonatal outcomes, such as low Apgar scores, increased NICU admissions, and low birth weight. Routine assessment of UCCI may aid in identifying high-risk pregnancies and improving perinatal management strategies. Further studies with larger sample sizes are needed to establish clinical guidelines for integrating UCCI evaluation into obstetric care.