Abstract Background: The umbilical coiling index (UCI), defined as the ratio of vascular coils to cord length, has been proposed as an indicator of fetal well-being. Deviations from normal coiling—whether reduced (hypocoiling) or excessive (hypercoiling)—have been linked with unfavorable maternal and neonatal outcomes. However, its routine clinical use remains limited, particularly in low-resource environments. Objective: To evaluate the relationship between umbilical coiling patterns and perinatal outcomes in uncomplicated term singleton pregnancies. Methods: A cross-sectional observational study was carried out on women with term, cephalic, singleton gestations. The umbilical cord was examined immediately after delivery, and UCI was calculated based on length and number of vascular coils. Cases were grouped into hypocoiled, normocoiled, and hypercoiled categories according to percentile-based cutoffs. Maternal and fetal outcomes—including operative delivery, fetal distress, meconium-stained liquor, neonatal condition at birth, and need for NICU admission—were compared across groups. Associations with maternal comorbidities were also analyzed. Results: Cords with normal coiling formed the majority, while both under-and over-coiling patterns were associated with adverse pregnancy outcomes. Abnormal UCI correlated with higher rates of fetal compromise, low neonatal weight, increased NICU admissions, and growth restriction. Maternal complications, including hypertensive disorders and gestational diabetes, were also more frequent among abnormal coiling groups. Operative interventions, particularly cesarean deliveries, were more common in such cases. Conclusion: Umbilical coiling abnormalities serve as important predictors of perinatal risk. Incorporating UCI evaluation into obstetric assessment—postnatally and potentially during antenatal sonography—could enhance risk identification and support timely clinical decision-making, thereby improving maternal and neonatal outcomes.