Aim: To study of postnatal umbilical coiling index (pUCI) and its association between maternal high-risk factors and neonatal outcome. Materials and methods: A prospective analytical study was conducted after ethical clearance over a period of 6 months among 150 women giving birth in the labor room of a tertiary care center in Mumbai, Maharashtra, India. The pUCI was determined by dividing the total number of coils by the total umbilical cord length in centimeters. Its association with maternal high-risk factors and fetal outcome was noted. The statistical test was the Chi-squared test and was assessed with a statistical package for the social sciences (SPSS), version 26; p < 0.05 was considered significant. Results: The mean pUCI was 0.257 ± 0.09. The cutoff for the tenth percentile was 0.157 and the nineteenth percentile was 0.367. Hypocoiling was significantly associated with hypertensive disorder in pregnancy (HDP), gestational diabetes mellitus (GDM), and post-term pregnancy, while anemia is associated with hypercoiling. Adverse neonatal outcomes including low birth weight (LBW), intrauterine fetal death, low appearance, pulse, grimace, activity, and respiration (APGAR) score at 1 minute, and neonatal intensive care (NICU) admission are associated with hypercoiling. Meconium-stained amniotic fluid (MSAF) is significantly associated with hypocoiling. Conclusion: Abnormal pUCI translates reliably into many maternal high-risk factors and perinatal outcomes. Antenatal assessment of umbilical coiling index (UCI) can be used as a prognostic tool to help predict and prevent adverse perinatal outcomes so as to improve maternal and fetal well-being by providing a healthy pregnancy which is the right of every birthing mother. Clinical significance: Antenatal determination of UCI can help identify high-risk pregnancies to be managed with greater vigilance and monitoring.