����JFIFXX�����    $.' ",#(7),01444'9=82<.342  2!!22222222222222222222222222222222222222222222222222����"��4�� ���,�PG"Z_�4�˷����kjز�Z�,F+��_z�,�© �����zh6�٨�ic�fu���#ډb���_�N�?��wQ���5-�~�I���8����TK<5o�Iv-�����k�_U_�����~b�M��d����Ӝ�U�Hh��?]��E�w��Q���k�{��_}qFW7HTՑ��Y��F�?_�'ϔ��_�Ջt��=||I ��6�έ"�����D���/[�k�9���Y�8ds|\���Ҿp6�Ҵ���]��.����6�z<�v��@]�i%��$j��~�g��J>��no����pM[me�i$[����s�o�ᘨ�˸ nɜG-�ĨU�ycP�3.DB�li�;��hj���x7Z^�N�h������N3u{�:j�x�힞��#M&��jL P@_���� P��&��o8������9�����@Sz6�t7#O�ߋ �s}Yf�T���lmr����Z)'N��k�۞p����w\�Tȯ?�8`�O��i{wﭹW�[�r�� ��Q4F�׊���3m&L�=��h3����z~��#�\�l :�F,j@�� ʱ�wQT����8�"kJO���6�֚l����}���R�>ډK���]��y����&����p�}b��;N�1�m�r$�|��7�>e�@B�TM*-iH��g�D�)� E�m�|�ؘbҗ�a��Ҿ����t4���o���G��*oCN�rP���Q��@z,|?W[0�����:�n,jWiE��W��$~/�hp\��?��{(�0���+�Y8rΟ�+����>S-S����VN;�}�s?.����� w�9��˟<���Mq4�Wv'��{)0�1mB��V����W[�����8�/<� �%���wT^�5���b��)iM� pg�N�&ݝ��VO~�q���u���9� ����!��J27����$O-���! �:�%H��� ـ����y�ΠM=t{!S�� oK8������t<����è:a������[�����ա�H���~��w��Qz`�po�^ ����Q��n� �,uu�C�$ ^���,������8�#��:�6��e�|~���!�3�3.�\0��q��o�4`.|� ����y�Q�`~;�d�ׯ,��O�Zw�������`73�v�܋�<���Ȏ�� ـ4k��5�K�a�u�=9Yd��$>x�A�&�� j0� ���vF��� Y�|�y��� ~�6�@c��1vOp�Ig����4��l�OD���L����� R���c���j�_�uX6��3?nk��Wy�f;^*B� ��@�~a�`��Eu������+���6�L��.ü>��}y���}_�O�6�͐�:�YrG�X��kG�����l^w���~㒶sy��Iu�!� W ��X��N�7BV��O��!X�2����wvG�R�f�T#�����t�/?���%8�^�W�aT��G�cL�M���I��(J����1~�8�?aT ���]����AS�E��(��*E}� 2��#I/�׍qz��^t�̔���b�Yz4x���t�){ OH��+(E��A&�N�������XT��o��"�XC��'���)}�J�z�p� ��~5�}�^����+�6����w��c��Q�|Lp�d�H��}�(�.|����k��c4^�"�����Z?ȕ ��a<�L�!039C� �Eu�C�F�Ew�ç ;�n?�*o���B�8�bʝ���'#Rqf���M}7����]����s2tcS{�\icTx;�\��7K���P���ʇ Z O-��~��c>"��?�������P��E��O�8��@�8��G��Q�g�a�Վ���󁶠�䧘��_%#r�>�1�z�a��eb��qcPѵ��n���#L��� =��׀t� L�7�`��V���A{�C:�g���e@�w1 Xp3�c3�ġ����p��M"'-�@n4���fG��B3�DJ�8[Jo�ߐ���gK)ƛ��$���� ���8�3�����+���� �����6�ʻ���� ���S�kI�*KZlT _`���?��K����QK�d����B`�s}�>���`��*�>��,*@J�d�oF*����弝��O}�k��s��]��y�ߘ��c1G�V���<=�7��7����6�q�PT��tXԀ�!9*4�4Tހ3XΛex�46���Y��D ����� �BdemDa����\�_l,��G�/���֌7���Y�](�xTt^%�GE�����4�}bT���ڹ�����;Y)���B�Q��u��>J/J �⮶.�XԄ��j�ݳ�+E��d ��r�5�_D�1 ��o�� �B�x�΢�#���<��W�����8���R6�@g�M�.��� dr�D��>(otU��@x=��~v���2� ӣ�d�oBd��3�eO�6�㣷�����ݜ6��6Y��Qz`��S��{���\P�~z m5{J/L��1������<�e�ͅPu�b�]�ϔ���'������f�b� Zpw��c`"��i���BD@:)ִ�:�]��hv�E�w���T�l��P���"Ju�}��وV J��G6��. J/�Qgl߭�e�����@�z�Zev2u�)]կ�����7x���s�M�-<ɯ�c��r�v�����@��$�ޮ}lk���a���'����>x��O\�ZFu>�����ck#��&:��`�$�ai�>2Δ����l���oF[h��lE�ܺ�Πk:)���`�� $[6�����9�����kOw�\|���8}������ބ:��񶐕��I�A1/�=�2[�,�!��.}gN#�u����b��� ~��݊��}34q����d�E��Lc��$��"�[q�U�硬g^��%B �z���r�pJ�ru%v\h1Y�ne`ǥ:g���pQM~�^�Xi� ��`S�:V29.�P���V�?B�k�� AEvw%�_�9C�Q����wKekPؠ�\�;Io d�{ ߞo�c1eP����\� `����E=���@K<�Y���eڼ�J���w����{av�F�'�M�@/J��+9p���|]�����Iw &`��8���&M�hg��[�{��Xj��%��Ӓ�$��(����ʹN���<>�I���RY���K2�NPlL�ɀ)��&e����B+ь����( � �JTx���_?EZ� }@ 6�U���뙢ط�z��dWI�n` D����噥�[��uV��"�G&Ú����2g�}&m��?ċ�"����Om#��������� ��{�ON��"S�X��Ne��ysQ���@Fn��Vg���dX�~nj�]J�<�K]:��FW��b�������62�=��5f����JKw��bf�X�55��~J �%^����:�-�QIE��P��v�nZum� z � ~ə ���� ���ة����;�f��\v���g�8�1��f24;�V���ǔ�)����9���1\��c��v�/'Ƞ�w�������$�4�R-��t���� e�6�/�ġ �̕Ecy�J���u�B���<�W�ַ~�w[B1L۲�-JS΂�{���΃������A��20�c#��@ 0!1@AP"#2Q`$3V�%45a6�FRUq��� ����^7ׅ,$n�������+��F�`��2X'��0vM��p�L=������5��8������u�p~���.�`r�����\���O��,ư�0oS ��_�M�����l���4�kv\JSd���x���SW�<��Ae�IX����������$I���w�:S���y���›R��9�Q[���,�5�;�@]�%���u�@ *ro�lbI �� ��+���%m:�͇ZV�����u�̉����θau<�fc�.����{�4Ա� �Q����*�Sm��8\ujqs]{kN���)qO�y�_*dJ�b�7���yQqI&9�ԌK!�M}�R�;������S�T���1���i[U�ɵz�]��U)V�S6���3$K{�ߊ<�(� E]Զ[ǼENg�����'�\?#)Dkf��J���o��v���'�%ƞ�&K�u�!��b�35LX�Ϸ��63$K�a�;�9>,R��W��3�3� d�JeTYE.Mϧ��-�o�j3+y��y^�c�������VO�9NV\nd�1 ��!͕_)a�v;����թ�M�lWR1��)El��P;��yوÏ�u 3�k�5Pr6<�⒲l�!˞*��u־�n�!�l:����UNW ��%��Chx8vL'��X�@��*��)���̮��ˍ��� ���D-M�+J�U�kvK����+�x8��cY������?�Ԡ��~3mo��|�u@[XeY�C�\Kp�x8�oC�C�&����N�~3-H���� ��MX�s�u<`���~"WL��$8ξ��3���a�)|:@�m�\���^�`�@ҷ)�5p+��6���p�%i)P M���ngc�����#0Aruz���RL+xSS?���ʮ}()#�t��mˇ!��0}}y����<�e� �-ή�Ԩ��X������ MF���ԙ~l L.3���}�V뽺�v�����멬��Nl�)�2����^�Iq��a��M��qG��T�����c3#������3U�Ǎ���}��לS�|qa��ڃ�+���-��2�f����/��bz��ڐ�� �ݼ[2�ç����k�X�2�* �Z�d���J�G����M*9W���s{��w���T��x��y,�in�O�v��]���n����P�$�JB@=4�OTI�n��e�22a\����q�d���%�$��(���:���: /*�K[PR�fr\nڙdN���F�n�$�4�[�� U�zƶ����� �mʋ���,�ao�u 3�z� �x��Kn����\[��VFmbE;�_U��&V�Gg�]L�۪&#n%�$ɯ�dG���D�TI=�%+AB�Ru#��b4�1�»x�cs�YzڙJG��f��Il��d�eF'T� iA��T���uC�$����Y��H?����[!G`}���ͪ� �纤Hv\������j�Ex�K���!���OiƸ�Yj�+u-<���'q����uN�*�r\��+�]���<�wOZ.fp�ێ��,-*)V?j-kÊ#�`�r��dV����(�ݽBk�����G�ƛk�QmUڗe��Z���f}|����8�8��a���i��3'J�����~G_�^���d�8w������ R�`(�~�.��u���l�s+g�bv���W���lGc}��u���afE~1�Ue������Z�0�8�=e�� f@/�jqEKQQ�J��oN��J���W5~M>$6�Lt�;$ʳ{���^��6�{����v6���ķܰg�V�cnn �~z�x�«�,2�u�?cE+Ș�H؎�%�Za�)���X>uW�Tz�Nyo����s���FQƤ��$��*�&�LLXL)�1�" L��eO��ɟ�9=���:t��Z���c��Ž���Y?�ӭV�wv�~,Y��r�ۗ�|�y��GaF�����C�����.�+� ���v1���fήJ�����]�S��T��B��n5sW}y�$��~z�'�c ��8 ��� ,! �p��VN�S��N�N�q��y8z˱�A��4��*��'������2n<�s���^ǧ˭P�Jޮɏ�U�G�L�J�*#��<�V��t7�8����TĜ>��i}K%,���)[��z�21z ?�N�i�n1?T�I�R#��m-�����������������1����lA�`��fT5+��ܐ�c�q՝��ʐ��,���3�f2U�եmab��#ŠdQ�y>\��)�SLY����w#��.���ʑ�f��� ,"+�w�~�N�'�c�O�3F�������N<���)j��&��,-� �љ���֊�_�zS���TǦ����w�>��?�������n��U仆�V���e�����0���$�C�d���rP �m�׈e�Xm�Vu� �L��.�bֹ��� �[Դaզ���*��\y�8�Է:�Ez\�0�Kq�C b��̘��cө���Q��=0Y��s�N��S.���3.���O�o:���#���v7�[#߫ ��5�܎�L���Er4���9n��COWlG�^��0k�%<���ZB���aB_���������'=��{i�v�l�$�uC���mƎҝ{�c㱼�y]���W�i ��ߧc��m�H� m�"�"�����;Y�ߝ�Z�Ǔ�����:S#��|}�y�,/k�Ld� TA�(�AI$+I3��;Y*���Z��}|��ӧO��d�v��..#:n��f>�>���ȶI�TX��� 8��y����"d�R�|�)0���=���n4��6ⲑ�+��r<�O�܂~zh�z����7ܓ�HH�Ga롏���nCo�>������a ���~]���R���̲c?�6(�q�;5%� |�uj�~z8R=X��I�V=�|{v�Gj\gc��q����z�؋%M�ߍ����1y��#��@f^���^�>N�����#x#۹��6�Y~�?�dfPO��{��P�4��V��u1E1J �*|���%���JN��`eWu�zk M6���q t[�� ��g�G���v��WIG��u_ft����5�j�"�Y�:T��ɐ���*�;� e5���4����q$C��2d�}���� _S�L#m�Yp��O�.�C�;��c����Hi#֩%+) �Ӎ��ƲV���SYź��g |���tj��3�8���r|���V��1#;.SQ�A[���S������#���`n�+���$��$I �P\[�@�s��(�ED�z���P��])8�G#��0B��[ى��X�II�q<��9�~[Z멜�Z�⊔IWU&A>�P~�#��dp<�?����7���c��'~���5 ��+$���lx@�M�dm��n<=e�dyX��?{�|Aef ,|n3�<~z�ƃ�uۧ�����P��Y,�ӥQ�*g�#먙R�\���;T��i,��[9Qi歉����c>]9�� ��"�c��P�� �Md?٥��If�ت�u��k��/����F��9�c*9��Ǎ:�ØF���z�n*�@|I�ށ9����N3{'��[�'ͬ�Ҳ4��#}��!�V� Fu��,�,mTIk���v C�7v���B�6k�T9��1�*l� '~��ƞF��lU��'�M ����][ΩũJ_�{�i�I�n��$���L�� j��O�dx�����kza۪��#�E��Cl����x˘�o�����V���ɞ�ljr��)�/,�߬h�L��#��^��L�ф�,íMƁe�̩�NB�L�����iL����q�}��(��q��6IçJ$�W�E$��:������=#����(�K�B����zђ <��K(�N�۫K�w��^O{!����)�H���>x�������lx�?>Պ�+�>�W���,Ly!_�D���Ō�l���Q�!�[ �S����J��1��Ɛ�Y}��b,+�Lo�x�ɓ)����=�y�oh�@�꥟/��I��ѭ=��P�y9��� �ۍYӘ�e+�p�Jnϱ?V\SO%�(�t� ���=?MR�[Ș�����d�/ ��n�l��B�7j� ��!�;ӥ�/�[-���A�>�dN�sLj ��,ɪv��=1c�.SQ�O3�U���ƀ�ܽ�E����������̻��9G�ϷD�7(�}��Ävӌ\�y�_0[w ���<΍>����a_��[0+�L��F.�޺��f�>oN�T����q;���y\��bՃ��y�jH�<|q-eɏ�_?_9+P���Hp$�����[ux�K w�Mw��N�ی'$Y2�=��q���KB��P��~������Yul:�[<����F1�2�O���5=d����]Y�sw:���Ϯ���E��j,_Q��X��z`H1,#II ��d�wr��P˂@�ZJV����y$�\y�{}��^~���[:N����ߌ�U�������O��d�����ؾe��${p>G��3c���Ė�lʌ�� ת��[��`ϱ�-W����dg�I��ig2��� ��}s ��ؤ(%#sS@���~���3�X�nRG�~\jc3�v��ӍL��M[JB�T��s3}��j�Nʖ��W����;7��ç?=X�F=-�=����q�ߚ���#���='�c��7���ڑW�I(O+=:uxq�������������e2�zi+�kuG�R��������0�&e�n���iT^J����~\jy���p'dtG��s����O��3����9* �b#Ɋ�� p������[Bws�T�>d4�ۧs���nv�n���U���_�~,�v����ƜJ1��s�� �QIz��)�(lv8M���U=�;����56��G���s#�K���MP�=��LvyGd��}�VwWBF�'�à �?MH�U�g2�� ����!�p�7Q��j��ڴ����=��j�u��� Jn�A s���uM������e��Ɔ�Ҕ�!)'��8Ϣ�ٔ��ޝ(��Vp���צ֖d=�IC�J�Ǡ{q������kԭ�߸���i��@K����u�|�p=..�*+����x�����z[Aqġ#s2a�Ɗ���RR�)*HRsi�~�a &f��M��P����-K�L@��Z��Xy�'x�{}��Zm+���:�)�) IJ�-i�u���� ���ܒH��'�L(7�y�GӜq���� j��� 6ߌg1�g�o���,kر���tY�?W,���p���e���f�OQS��!K�۟cҒA�|ս�j�>��=⬒��˧L[�� �߿2JaB~R��u�:��Q�] �0H~���]�7��Ƽ�I���(}��cq '�ήET���q�?f�ab���ӥvr� �)o��-Q��_'����ᴎo��K������;��V���o��%���~OK ����*��b�f:���-ťIR��`B�5!RB@���ï�� �u �̯e\�_U�_������� g�ES��3�������QT��a����x����U<~�c?�*�#]�MW,[8O�a�x��]�1bC|踤�P��lw5V%�)�{t�<��d��5���0i�XSU��m:��Z�┵�i�"��1�^B�-��P�hJ��&)O��*�D��c�W��vM��)����}���P��ܗ-q����\mmζZ-l@�}��a��E�6��F�@��&Sg@���ݚ�M����� ȹ 4����#p�\H����dYDo�H���"��\��..R�B�H�z_�/5˘����6��KhJR��P�mƶi�m���3�,#c�co��q�a)*Pt����R�m�k�7x�D�E�\Y�閣_X�<���~�)���c[[�BP����6�Yq���S��0����%_����;��Àv�~�| VS؇ ��'O0��F0��\���U�-�d@�����7�SJ*z��3n��y��P����O���������m�~�P�3|Y��ʉr#�C�<�G~�.,! ���bqx���h~0=��!ǫ�jy����l�O,�[B��~��|9��ٱ����Xly�#�i�B��g%�S��������tˋ���e���ې��\[d�t)��.+u�|1 ������#�~Oj����hS�%��i.�~X���I�H�m��0n���c�1uE�q��cF�RF�o���7� �O�ꮧ� ���ۛ{��ʛi5�rw?׌#Qn�TW��~?y$��m\�\o����%W� ?=>S�N@�� �Ʈ���R����N�)�r"C�:��:����� �����#��qb��Y�. �6[��2K����2u�Ǧ�HYR��Q�MV��� �G�$��Q+.>�����nNH��q�^��� ����q��mM��V��D�+�-�#*�U�̒ ���p욳��u:�������IB���m���PV@O���r[b= �� ��1U�E��_Nm�yKbN�O���U�}�the�`�|6֮P>�\2�P�V���I�D�i�P�O;�9�r�mAHG�W�S]��J*�_�G��+kP�2����Ka�Z���H�'K�x�W�MZ%�O�YD�Rc+o��?�q��Ghm��d�S�oh�\�D�|:W������UA�Qc yT�q������~^�H��/��#p�CZ���T�I�1�ӏT����4��"�ČZ�����}��`w�#�*,ʹ�� ��0�i��課�Om�*�da��^gJ݅{���l�e9uF#T�ֲ��̲�ٞC"�q���ߍ ոޑ�o#�XZTp����@ o�8��(jd��xw�]�,f���`~�|,s��^����f�1���t��|��m�򸄭/ctr��5s��7�9Q�4�H1꠲BB@l9@���C�����+�wp�xu�£Yc�9��?`@#�o�mH�s2��)�=��2�.�l����jg�9$�Y�S�%*L������R�Y������7Z���,*=�䷘$�������arm�o�ϰ���UW.|�r�uf����IGw�t����Zwo��~5 ��YյhO+=8fF�)�W�7�L9lM�̘·Y���֘YLf�큹�pRF���99.A �"wz��=E\Z���'a� 2��Ǚ�#;�'}�G���*��l��^"q��+2FQ� hj��kŦ��${���ޮ-�T�٭cf�|�3#~�RJ����t��$b�(R��(����r���dx� >U b�&9,>���%E\� Ά�e�$��'�q't��*�א���ެ�b��-|d���SB�O�O��$�R+�H�)�܎�K��1m`;�J�2�Y~9��O�g8=vqD`K[�F)k�[���1m޼c��n���]s�k�z$@��)!I �x՝"v��9=�ZA=`Ɠi �:�E��)`7��vI��}d�YI�_ �o�:ob���o ���3Q��&D&�2=�� �Ά��;>�h����y.*ⅥS������Ӭ�+q&����j|UƧ����}���J0��WW< ۋS�)jQR�j���Ư��rN)�Gű�4Ѷ(�S)Ǣ�8��i��W52���No˓� ۍ%�5brOn�L�;�n��\G����=�^U�dI���8$�&���h��'���+�(������cȁ߫k�l��S^���cƗjԌE�ꭔ��gF���Ȓ��@���}O���*;e�v�WV���YJ\�]X'5��ղ�k�F��b 6R�o՜m��i N�i����>J����?��lPm�U��}>_Z&�KK��q�r��I�D�Չ~�q�3fL�:S�e>���E���-G���{L�6p�e,8��������QI��h��a�Xa��U�A'���ʂ���s�+טIjP�-��y�8ۈZ?J$��W�P� ��R�s�]��|�l(�ԓ��sƊi��o(��S0��Y� 8�T97.�����WiL��c�~�dxc�E|�2!�X�K�Ƙਫ਼�$((�6�~|d9u+�qd�^3�89��Y�6L�.I�����?���iI�q���9�)O/뚅����O���X��X�V��ZF[�یgQ�L��K1���RҖr@v�#��X�l��F���Нy�S�8�7�kF!A��sM���^rkp�jP�DyS$N���q��nxҍ!U�f�!eh�i�2�m���`�Y�I�9r�6� �TF���C}/�y�^���Η���5d�'��9A-��J��>{�_l+�`��A���[�'��յ�ϛ#w:݅�%��X�}�&�PSt�Q�"�-��\縵�/����$Ɨh�Xb�*�y��BS����;W�ջ_mc�����vt?2}1�;qS�d�d~u:2k5�2�R�~�z+|HE!)�Ǟl��7`��0�<�,�2*���Hl-��x�^����'_TV�gZA�'j� ^�2Ϊ��N7t�����?w�� �x1��f��Iz�C-Ȗ��K�^q�;���-W�DvT�7��8�Z�������� hK�(P:��Q- �8�n�Z���܃e貾�<�1�YT<�,�����"�6{/ �?�͟��|1�:�#g��W�>$����d��J��d�B��=��jf[��%rE^��il:��B���x���Sּ�1հ��,�=��*�7 fcG��#q� �eh?��2�7�����,�!7x��6�n�LC�4x��},Geǝ�tC.��vS �F�43��zz\��;QYC,6����~;RYS/6���|2���5���v��T��i����������mlv��������&� �nRh^ejR�LG�f���? �ۉҬܦƩ��|��Ȱ����>3����!v��i�ʯ�>�v��オ�X3e���_1z�Kȗ\<������!�8���V��]��?b�k41�Re��T�q��mz��TiOʦ�Z��Xq���L������q"+���2ۨ��8}�&N7XU7Ap�d�X��~�׿��&4e�o�F��� �H����O���č�c�� 懴�6���͉��+)��v;j��ݷ�� �UV�� i��� j���Y9GdÒJ1��詞�����V?h��l����l�cGs�ځ�������y�Ac�����\V3�? �� ܙg�>qH�S,�E�W�[�㺨�uch�⍸�O�}���a��>�q�6�n6����N6�q������N ! 1AQaq�0@����"2BRb�#Pr���3C`��Scst���$4D���%Td�� ?���N����a��3��m���C���w��������xA�m�q�m���m������$����4n淿t'��C"w��zU=D�\R+w�p+Y�T�&�պ@��ƃ��3ޯ?�Aﶂ��aŘ���@-�����Q�=���9D��ռ�ѻ@��M�V��P��܅�G5�f�Y<�u=,EC)�<�Fy'�"�&�չ�X~f��l�KԆV��?�� �W�N����=(� �;���{�r����ٌ�Y���h{�١������jW����P���Tc�����X�K�r��}���w�R��%��?���E��m�� �Y�q|����\lEE4���r���}�lsI�Y������f�$�=�d�yO����p�����yBj8jU�o�/�S��?�U��*������ˍ�0������u�q�m [�?f����a�� )Q�>����6#������� ?����0UQ����,IX���(6ڵ[�DI�MNލ�c&���υ�j\��X�R|,4��� j������T�hA�e��^���d���b<����n�� �즇�=!���3�^�`j�h�ȓr��jẕ�c�,ٞX����-����a�ﶔ���#�$��]w�O��Ӫ�1y%��L�Y<�wg#�ǝ�̗`�x�xa�t�w��»1���o7o5��>�m뭛C���Uƃߜ}�C���y1Xνm�F8�jI���]����H���ۺиE@I�i;r�8ӭ����V�F�Շ| ��&?�3|x�B�MuS�Ge�=Ӕ�#BE5G�����Y!z��_e��q�р/W>|-�Ci߇�t�1ޯќd�R3�u��g�=0 5��[?�#͏��q�cf���H��{ ?u�=?�?ǯ���}Z��z���hmΔ�BFTW�����<�q�(v� ��!��z���iW]*�J�V�z��gX֧A�q�&��/w���u�gYӘa���; �i=����g:��?2�dž6�ى�k�4�>�Pxs����}������G�9��3 ���)gG�R<>r h�$��'nc�h�P��Bj��J�ҧH� -��N1���N��?��~��}-q!=��_2hc�M��l�vY%UE�@|�v����M2�.Y[|y�"Eï��K�ZF,�ɯ?,q�?v�M 80jx�"�;�9vk�����+ ֧�� �ȺU��?�%�vcV��mA�6��Qg^M����A}�3�nl� QRN�l8�kkn�'�����(��M�7m9و�q���%ޟ���*h$Zk"��$�9��: �?U8�Sl��,,|ɒ��xH(ѷ����Gn�/Q�4�P��G�%��Ա8�N��!� �&�7�;���eKM7�4��9R/%����l�c>�x;������>��C�:�����t��h?aKX�bhe�ᜋ^�$�Iհ �hr7%F$�E��Fd���t��5���+�(M6�t����Ü�UU|zW�=a�Ts�Tg������dqP�Q����b'�m���1{|Y����X�N��b �P~��F^F:����k6�"�j!�� �I�r�`��1&�-$�Bevk:y���#yw��I0��x��=D�4��tU���P�ZH��ڠ底taP��6����b>�xa����Q�#� WeF��ŮNj�p�J* mQ�N����*I�-*�ȩ�F�g�3 �5��V�ʊ�ɮ�a��5F���O@{���NX��?����H�]3��1�Ri_u��������ѕ�� ����0��� F��~��:60�p�͈�S��qX#a�5>���`�o&+�<2�D����: �������ڝ�$�nP���*)�N�|y�Ej�F�5ټ�e���ihy�Z �>���k�bH�a�v��h�-#���!�Po=@k̆IEN��@��}Ll?j�O������߭�ʞ���Q|A07x���wt!xf���I2?Z��<ץ�T���cU�j��]��陎Ltl �}5�ϓ��$�,��O�mˊ�;�@O��jE��j(�ا,��LX���LO���Ц�90�O �.����a��nA���7������j4 ��W��_ٓ���zW�jcB������y՗+EM�)d���N�g6�y1_x��p�$Lv:��9�"z��p���ʙ$��^��JԼ*�ϭ����o���=x�Lj�6�J��u82�A�H�3$�ٕ@�=Vv�]�'�qEz�;I˼��)��=��ɯ���x �/�W(V���p�����$ �m�������u�����񶤑Oqˎ�T����r��㠚x�sr�GC��byp�G��1ߠ�w e�8�$⿄����/�M{*}��W�]˷.�CK\�ުx���/$�WPw���r� |i���&�}�{�X� �>��$-��l���?-z���g����lΆ���(F���h�vS*���b���߲ڡn,|)mrH[���a�3�ר�[1��3o_�U�3�TC�$��(�=�)0�kgP���� ��u�^=��4 �WYCҸ:��vQ�ר�X�à��tk�m,�t*��^�,�}D*� �"(�I��9R����>`�`��[~Q]�#af��i6l��8���6�:,s�s�N6�j"�A4���IuQ��6E,�GnH��zS�HO�uk�5$�I�4��ؤ�Q9�@��C����wp�BGv[]�u�Ov���0I4���\��y�����Q�Ѹ��~>Z��8�T��a��q�ޣ;z��a���/��S��I:�ܫ_�|������>=Z����8:�S��U�I�J��"IY���8%b8���H��:�QO�6�;7�I�S��J��ҌAά3��>c���E+&jf$eC+�z�;��V����� �r���ʺ������my�e���aQ�f&��6�ND��.:��NT�vm�<- u���ǝ\MvZY�N�NT��-A�>jr!S��n�O 1�3�Ns�%�3D@���`������ܟ 1�^c<���� �a�ɽ�̲�Xë#�w�|y�cW�=�9I*H8�p�^(4���՗�k��arOcW�tO�\�ƍR��8����'�K���I�Q�����?5�>[�}��yU�ײ -h��=��% q�ThG�2�)���"ו3]�!kB��*p�FDl�A���,�eEi�H�f�Ps�����5�H:�Փ~�H�0Dت�D�I����h�F3�������c��2���E��9�H��5�zԑ�ʚ�i�X�=:m�xg�hd(�v����׊�9iS��O��d@0ڽ���:�p�5�h-��t�&���X�q�ӕ,��ie�|���7A�2���O%P��E��htj��Y1��w�Ѓ!����  ���� ࢽ��My�7�\�a�@�ţ�J �4�Ȼ�F�@o�̒?4�wx��)��]�P��~�����u�����5�����7X ��9��^ܩ�U;Iꭆ 5 �������eK2�7(�{|��Y׎ �V��\"���Z�1� Z�����}��(�Ǝ"�1S���_�vE30>���p;� ΝD��%x�W�?W?v����o�^V�i�d��r[��/&>�~`�9Wh��y�;���R��� ;;ɮT��?����r$�g1�K����A��C��c��K��l:�'��3 c�ﳯ*"t8�~l��)���m��+U,z��`(�>yJ�?����h>��]��v��ЍG*�{`��;y]��I�T� ;c��NU�fo¾h���/$���|NS���1�S�"�H��V���T���4��uhǜ�]�v;���5�͠x��'C\�SBpl���h}�N����� A�Bx���%��ޭ�l��/����T��w�ʽ]D�=����K���ž�r㻠l4�S�O?=�k �M:� ��c�C�a�#ha���)�ѐxc�s���gP�iG��{+���x���Q���I= �� z��ԫ+ �8"�k�ñ�j=|����c ��y��CF��/��*9ж�h{ �?4�o� ��k�m�Q�N�x��;�Y��4膚�a�w?�6�>e]�����Q�r�:����g�,i"�����ԩA�*M�<�G��b�if��l^M��5� �Ҩ�{����6J��ZJ�����P�*�����Y���ݛu�_4�9�I8�7���������,^ToR���m4�H��?�N�S�ѕw��/S��甍�@�9H�S�T��t�ƻ���ʒU��*{Xs�@����f�����֒Li�K{H�w^���������Ϥm�tq���s� ���ք��f:��o~s��g�r��ט� �S�ѱC�e]�x���a��) ���(b-$(�j>�7q�B?ӕ�F��hV25r[7 Y� }L�R��}����*sg+��x�r�2�U=�*'WS��ZDW]�WǞ�<��叓���{�$�9Ou4��y�90-�1�'*D`�c�^o?(�9��u���ݐ��'PI&� f�Jݮ�������:wS����jfP1F:X �H�9dԯ���˝[�_54 �}*;@�ܨ�� ð�yn�T���?�ןd�#���4rG�ͨ��H�1�|-#���Mr�S3��G�3�����)�.᧏3v�z֑��r����$G"�`j �1t��x0<Ɔ�Wh6�y�6��,œ�Ga��gA����y��b��)��h�D��ß�_�m��ü �gG;��e�v��ݝ�nQ� ��C����-�*��o���y�a��M��I�>�<���]obD��"�:���G�A��-\%LT�8���c�)��+y76���o�Q�#*{�(F�⽕�y����=���rW�\p���۩�c���A���^e6��K������ʐ�cVf5$�'->���ՉN"���F�"�UQ@�f��Gb~��#�&�M=��8�ט�JNu9��D��[̤�s�o�~������ G��9T�tW^g5y$b��Y'��س�Ǵ�=��U-2 #�MC�t(�i� �lj�@Q 5�̣i�*�O����s�x�K�f��}\��M{E�V�{�υ��Ƈ�����);�H����I��fe�Lȣr�2��>��W�I�Ȃ6������i��k�� �5�YOxȺ����>��Y�f5'��|��H+��98pj�n�.O�y�������jY��~��i�w'������l�;�s�2��Y��:'lg�ꥴ)o#'Sa�a�K��Z� �m��}�`169�n���"���x��I ��*+� }F<��cГ���F�P�������ֹ*�PqX�x۩��,� ��N�� �4<-����%����:��7����W���u�`����� $�?�I��&����o��o��`v�>��P��"��l���4��5'�Z�gE���8���?��[�X�7(��.Q�-��*���ތL@̲����v��.5���[��=�t\+�CNܛ��,g�SQnH����}*F�G16���&:�t��4ُ"A��̣��$�b �|����#rs��a�����T�� ]�<�j��BS�('$�ɻ� �wP;�/�n��?�ݜ��x�F��yUn�~mL*-�������Xf�wd^�a�}��f�,=t�׵i�.2/wpN�Ep8�OР���•��R�FJ� 55TZ��T �ɭ�<��]��/�0�r�@�f��V��V����Nz�G��^���7hZi����k��3�,kN�e|�vg�1{9]_i��X5y7� 8e]�U����'�-2,���e"����]ot�I��Y_��n�(JҼ��1�O ]bXc���Nu�No��pS���Q_���_�?i�~�x h5d'�(qw52] ��'ޤ�q��o1�R!���`ywy�A4u���h<קy���\[~�4�\ X�Wt/� 6�����n�F�a8��f���z �3$�t(���q��q�x��^�XWeN'p<-v�!�{�(>ӽDP7��ո0�y)�e$ٕv�Ih'Q�EA�m*�H��RI��=:��� ���4牢) �%_iN�ݧ�l]� �Nt���G��H�L��� ɱ�g<���1V�,�J~�ٹ�"K��Q�� 9�HS�9�?@��k����r�;we݁�]I�!{ �@�G�[�"��`���J:�n]�{�cA�E����V��ʆ���#��U9�6����j�#Y�m\��q�e4h�B�7��C�������d<�?J����1g:ٳ���=Y���D�p�ц� ׈ǔ��1�]26؜oS�'��9�V�FVu�P�h�9�xc�oq�X��p�o�5��Ա5$�9W�V(�[Ak�aY錎qf;�'�[�|���b�6�Ck��)��#a#a˙��8���=äh�4��2��C��4tm^ �n'c���]GQ$[Wҿ��i���vN�{Fu ��1�gx��1┷���N�m��{j-,��x�� Ūm�ЧS�[�s���Gna���䑴�� x�p 8<������97�Q���ϴ�v�aϚG��Rt�Һ׈�f^\r��WH�JU�7Z���y)�vg=����n��4�_)y��D'y�6�]�c�5̪�\� �PF�k����&�c;��cq�$~T�7j ���nç]�<�g ":�to�t}�159�<�/�8������m�b�K#g'I'.W�����6��I/��>v��\�MN��g���m�A�yQL�4u�Lj�j9��#44�t��l^�}L����n��R��!��t��±]��r��h6ٍ>�yҏ�N��fU�� ���� Fm@�8}�/u��jb9������he:A�y�ծw��GpΧh�5����l}�3p468��)U��d��c����;Us/�֔�YX�1�O2��uq�s��`hwg�r~�{ R��mhN��؎*q 42�*th��>�#���E����#��Hv�O����q�}�����6�e��\�,Wk�#���X��b>��p}�դ��3���T5��†��6��[��@�P�y*n��|'f�֧>�lư΂�̺����SU�'*�q�p�_S�����M�� '��c�6�����m�� ySʨ;M��r���Ƌ�m�Kxo,���Gm�P��A�G�:��i��w�9�}M(�^�V��$ǒ�ѽ�9���|���� �a����J�SQ�a���r�B;����}���ٻ֢�2�%U���c�#�g���N�a�ݕ�'�v�[�OY'��3L�3�;,p�]@�S��{ls��X�'���c�jw�k'a�.��}�}&�� �dP�*�bK=ɍ!����;3n�gΊU�ߴmt�'*{,=SzfD� A��ko~�G�aoq�_mi}#�m�������P�Xhύ����mxǍ�΂���巿zf��Q���c���|kc�����?���W��Y�$���_Lv����l߶��c���`?����l�j�ݲˏ!V��6����U�Ђ(A���4y)H���p�Z_�x��>���e��R��$�/�`^'3qˏ�-&Q�=?��CFVR �D�fV�9��{�8g�������n�h�(P"��6�[�D���< E�����~0<@�`�G�6����Hг�cc�� �c�K.5��D��d�B���`?�XQ��2��ٿyqo&+�1^� DW�0�ꊩ���G�#��Q�nL3��c���������/��x ��1�1[y�x�პCW��C�c�UĨ80�m�e�4.{�m��u���I=��f�����0QRls9���f���������9���~f�����Ǩ��a�"@�8���ȁ�Q����#c�ic������G��$���G���r/$W�(��W���V�"��m�7�[m�A�m����bo��D� j����۳� l���^�k�h׽����� ��#� iXn�v��eT�k�a�^Y�4�BN��ĕ��0 !01@Q"2AaPq3BR������?���@4�Q�����T3,���㺠�W�[=JK�Ϟ���2�r^7��vc�:�9 �E�ߴ�w�S#d���Ix��u��:��Hp��9E!�� V 2;73|F��9Y���*ʬ�F��D����u&���y؟��^EA��A��(ɩ���^��GV:ݜDy�`��Jr29ܾ�㝉��[���E;Fzx��YG��U�e�Y�C���� ����v-tx����I�sם�Ę�q��Eb�+P\ :>�i�C'�;�����k|z�رn�y]�#ǿb��Q��������w�����(�r|ӹs��[�D��2v-%��@;�8<a���[\o[ϧw��I!��*0�krs)�[�J9^��ʜ��p1)� "��/_>��o��<1����A�E�y^�C��`�x1'ܣn�p��s`l���fQ��):�l����b>�Me�jH^?�kl3(�z:���1ŠK&?Q�~�{�ٺ�h�y���/�[��V�|6��}�KbX����mn[-��7�5q�94�������dm���c^���h� X��5��<�eޘ>G���-�}�دB�ޟ� ��|�rt�M��V+�]�c?�-#ڛ��^ǂ}���Lkr���O��u�>�-D�ry� D?:ޞ�U��ǜ�7�V��?瓮�"�#���r��չģVR;�n���/_� ؉v�ݶe5d�b9��/O��009�G���5n�W����JpA�*�r9�>�1��.[t���s�F���nQ� V 77R�]�ɫ8����_0<՜�IF�u(v��4��F�k�3��E)��N:��yڮe��P�`�1}�$WS��J�SQ�N�j�ٺ��޵�#l���ј(�5=��5�lǏmoW�v-�1����v,W�mn��߀$x�<����v�j(����c]��@#��1������Ǔ���o'��u+����;G�#�޸��v-lη��/(`i⣍Pm^���ԯ̾9Z��F��������n��1��� ��]�[��)�'������:�֪�W��FC����� �B9،!?���]��V��A�Վ�M��b�w��G F>_DȬ0¤�#�QR�[V��kz���m�w�"��9ZG�7'[��=�Q����j8R?�zf�\a�=��O�U����*oB�A�|G���2�54 �p��.w7� �� ��&������ξxGHp� B%��$g�����t�Џ򤵍z���HN�u�Я�-�'4��0��;_��3 !01"@AQa2Pq#3BR������?��ʩca��en��^��8���<�u#��m*08r��y�N"�<�Ѳ0��@\�p��� �����Kv�D��J8�Fҽ� �f�Y��-m�ybX�NP����}�!*8t(�OqѢ��Q�wW�K��ZD��Δ^e��!� ��B�K��p~�����e*l}z#9ң�k���q#�Ft�o��S�R����-�w�!�S���Ӥß|M�l޶V��!eˈ�8Y���c�ЮM2��tk���� ������J�fS����Ö*i/2�����n]�k�\���|4yX�8��U�P.���Ы[���l��@"�t�<������5�lF���vU�����W��W��;�b�cД^6[#7@vU�xgZv��F�6��Q,K�v��� �+Ъ��n��Ǣ��Ft���8��0��c�@�!�Zq s�v�t�;#](B��-�nῃ~���3g������5�J�%���O������n�kB�ĺ�.r��+���#�N$?�q�/�s�6��p��a����a��J/��M�8��6�ܰ"�*������ɗud"\w���aT(����[��F��U՛����RT�b���n�*��6���O��SJ�.�ij<�v�MT��R\c��5l�sZB>F��<7�;EA��{��E���Ö��1U/�#��d1�a�n.1ě����0�ʾR�h��|�R��Ao�3�m3 ��%�� ���28Q� ��y��φ���H�To�7�lW>����#i`�q���c����a��� �m,B�-j����݋�'mR1Ήt�>��V��p���s�0IbI�C.���1R�ea�����]H�6����������4B>��o��](��$B���m�����a�!=��?�B� K�Ǿ+�Ծ"�n���K��*��+��[T#�{E�J�S����Q�����s�5�:�U�\wĐ�f�3����܆&�)����I���Ԇw��E T�lrTf6Q|R�h:��[K�� �z��c֧�G�C��%\��_�a�84��HcO�bi��ؖV��7H �)*ģK~Xhչ0��4?�0��� �E<���}3���#���u�?�� ��|g�S�6ꊤ�|�I#Hڛ� �ա��w�X��9��7���Ŀ%�SL��y6č��|�F�a 8���b��$�sק�h���b9RAu7�˨p�Č�_\*w��묦��F ����4D~�f����|(�"m���NK��i�S�>�$d7SlA��/�²����SL��|6N�}���S�˯���g��]6��; �#�.��<���q'Q�1|KQ$�����񛩶"�$r�b:���N8�w@��8$�� �AjfG|~�9F ���Y��ʺ��Bwؒ������M:I岎�G��`s�YV5����6��A �b:�W���G�q%l�����F��H���7�������Fsv7��k�� 403WebShell
403Webshell
Server IP : 172.67.215.126  /  Your IP : 172.69.130.107
Web Server : Apache/2.4.52 (Ubuntu)
System : Linux ip-172-31-19-221 6.8.0-1029-aws #31~22.04.1-Ubuntu SMP Thu Apr 24 21:16:18 UTC 2025 x86_64
User : www-data ( 33)
PHP Version : 8.1.28
Disable Function : NONE
MySQL : OFF  |  cURL : ON  |  WGET : ON  |  Perl : ON  |  Python : OFF  |  Sudo : ON  |  Pkexec : ON
Directory :  /efsdata/scitechnol.com/httpdocs/submission/uploads/

Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 

Command :


[ Back ]     

Current File : /efsdata/scitechnol.com/httpdocs/submission/uploads/0-0-Manuscript-2014-02-08.doc
��ࡱ�>��	
����	
�����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������_�	���7bjbj,E,E	4>N/N/�,��������	�	���������8D�t�f�����(�>�J��������$Q���r<�i�R�D��(�R�R�<������q��L�L�L�R�Z�����L�R��L�L��Σ|F������p�$��������J����0�\��u�J�u�$F�u��F��R�R�L�R�R�R�R�R�<�<�L�R�R�R��R�R�R�R���������������������������������������������������������������������u�R�R�R�R�R�R�R�R�R��	 �:	UMBILICAL CORD COILING INDEX IN WOMEN OF SOUTH-EASTERN NIGERIA

Running title:		Umbilical Coiling Index

1Paul A. Feyi-Waboso PA MBBS (Ib), FWACS, FMCOG, FRCOG, FICS, 2Lawrence O. Omo-Aghoja LO MBBS (Benin), FWACS, FMCOG, FICS, CGCP (London) 
1Department of Obstetrics and Gynecology, College of Medicine & Health Sciences, Uturu, Abia State University, Nigeria and 2Department of Obstetrics and Gynecology, College of Health Sciences, Delta State University, Abraka, Nigeria.





Address for Correspondence:
Prof. P. A. Feyi-Waboso
Department of Obstetrics & Gynecology,
Faculty of Clinical Medicine,
College of Medicine and Health Sciences,
Abia State University,
Aba, Nigeria.
Tel: +234 8033093178
Email:	wabosop@gmail.com


Abstract 
Introduction 
Abnormal Umbilical Cord Coiling Index (UCI) is associated with adverse pregnancy and perinatal outcome. 
Materials and methods
It was a prospective comparative study to determine the appropriate UCI values for the African population. Also determined were the clinicodemographic variables and associated pregnancy outcomes in parturients at risk of having an abnormal UCI amongst women who delivered in a Nigerian tertiary hospital.  
Results 
The mean UCI for normal pregnancies was 0.13+ 0.06. The 10th and 90th percentile UCI values were 0.06coils/cm and 0.21 respectively. The incidence of abnormal UCI (hypercoiled, hypocoiled and non-coiled) was 19.8% and majority of the parturients (80.2%) had normal UCI (normocoiled). Of the abnormal UCIs, there was preponderance of hypercoiling (7.8%) and hypocoiling (7.8%) as compared to the non-coiled cases (4.2%). Abnormal coiling index is strongly predictive of the risk of a parturient having caesarean section (OR= 4.33, 95% CI, 0.24-79.59), PROM (OR=4.09,+ 95%CI, 2.22-7.53), retained placenta (OR=3.74, 95%CI, 1.89-7.4), and PPH (OR=3.63. 95%CI, 1.+45-9.17). Other findings are associations with extremes of reproductive age <20 years (OR=2.65, 95%CI, 0.22-32.08), >35 years (OR=2.22, 95%CI, 0.26-19.40), maternal weight >90kg (OR=2.64, 95%CI, 1.37-5.06), fetal death (OR=2.35, 95%CI, 0.87-7.54) and ABD (OR=1.82, 95%CI, 0.71-4.69). GDM and hypertension�s significant association in the univariate model were attenuated on logistic regression analysis.
Conclusion	
The mean UCI parameters and the cutoffs for normality at the 10th and 90th percentile are lower than the previously reported for both normal and complicated pregnancies. Adverse pregnancy and perinatal outcome is associated with abnormal UCI.

Keywords:	Umbilical Coiling Index, Women, South-Eastern Nigeria 
Introduction 
  Available evidence indicates that the umbilical cord serves a paramount role in fetal intrauterine persistence [1]. The normal human umbilical cord contains a helix of three blood vessels: two arteries and one vein protected by Wharton�s jelly, amniotic fluid, helical patterns and coiling of vessels [2]. At term gestation, the normal umbilical cord is 50�60 cm long and its vessels complete on average 10�11 spirals or coils between the fetal and placental insertion sites [3]. Existing data shows that coiling may develop as early as the 28th day after conception and in most umbilical cords (about 95%), coiling is established by the 9th week of gestation, however in a few others development may be as late as after the 20th week [4,5].  Both right and left sided coiling has been reported with a preponderance of the left sided twist (7:1 ratio) [4]. 
 	A search of the literature reveals that the exact mechanism by which coiling occurs is uncertain [2]. However several hypotheses have been propounded and these include fetal movements [6], active and passive torsion of the embryo [5], differential umbilical vascular growth rates [4], fetal hemodynamic forces [7] and the arrangements of muscular fibers in the umbilical arterial wall [5]. Regardless of its origin, umbilical cord coiling appears to confer turgor and compression-resistant properties to the umbilical unit, producing a cord that is strong but flexible, like a telephone   cord [7,8]. The number of coils is believed to be constant throughout pregnancy [4,9]. Umbilical coiling was first quantified in 1954 by Edmonds who divided the total number of coils by the umbilical cord length in centimeters and called it �The Index of twist� assigning positive or negative scores to clockwise or anticlockwise coiling respectively [6].  Later modifications of his work resulted in the concept of �Umbilical Coiling Index (UCI)� which is calculated by dividing the total number of coils by the total length of the cord immediately after delivery [10]. It has been established that normal umbilical cord coiling is approximately 1 coil/5 cm of umbilical cord length or 0.20 to 0.24 coils/cm [10-13]. Most published studies defined UCI as hypocoiled (undercoiled) or hypercoiled (overcoiled), and these are umbilical cords with UCI values below the 10th and above the 90th percentiles, respectively [10,12,14,15].
The literature is replete with reports that indicates that a low or high UCI (hypocoiling or hypercoiling) are associated with adverse perinatal outcome such as fetal chromosomal abnormalities, fetal growth restriction, fetal death, preterm delivery, abnormal fetal heart rate tracing, low cord blood pH, meconium staining, interventional delivery for fetal distress and chorioamnionitis [8,10,11,14,15]. Also it has been suggested that the association between low or high UCI and adverse pregnancy outcome may be explained by abnormal flow or thrombosis in the umbilical cord, with subsequent asphyxia and eventually fetal death [11]. This hypothesis is in keeping with the observations that umbilical vein blood flow is correlated with the number of vascular coils and the UCI [9,16].
Current evidence suggests that it is now possible to identify the coils of the umbilical cord with reasonable accuracy using modern imaging techniques including ultrasonography, and indeed prenatal sonographic evaluation of umbilical cord coiling during the second trimester fetal anatomic survey is accurate enough to predict true coiling at birth if the antenatal UCI is obtained in an adequate and standardized manner [17].  Therefore, this may be established as a routine screening modality for abnormal coiling index to predict adverse pregnancy outcomes during the antenatal period with appropriate measures instituted to obviate them [6,9,18,19], yet there is no published work on UCI for the African population. We believe therefore that as a first step in contemplating such a screening program, it is necessary to determine appropriate postpartum UCI values for the African population, identify the clinicodemographic variables and associated pregnancy outcomes in parturients at risk of having an abnormal umbilical coiling index. This may serve as a basis to institute antenatal UCI studies in Africans to determine how this is correlated with postnatal UCI values and therefore serving as a basis for recommending its use or not in predicting pregnancy outcome in our obstetric population.   











MATERIALS AND METHODS
It was a prospective comparative study that was undertaken at the department of Obstetrics and Gynaecology of Abia State University Teaching Hospital (ABSUTH), Aba.  ABSUTH is a tertiary health care delivery facility rendering services to all cadres of patients in Aba, Abia state and neighboring south eastern states including obstetric and gynaecological cases. The obstetric unit has seventy beds and the delivery rate is approximately one thousand eight hundred per year. The staff consists of eight Consultants, twenty resident doctors and fifty nurses.
All women who presented in labour at ABSUTH during the study period, January 1st, 2010 to June 30th, 2010 constituted the study population. Consenting parturients from amongst the study population were recruited into the study. Upon recruitment each patient had a data sheet completed. The data sheet contained the sociodemographic variables, complications occurring during pregnancy, gestational age at delivery, mode of delivery, fetal outcome, cord parameters (length, number of coils and direction of coils) and post-partum complications. Maternal demographic factors and medical and obstetrical data, as well as neonatal clinical events, were extracted from the case files. Multiple pregnancies were excluded from the study due to the high confounding aspects of multiple gestation on placenta and cord abnormalities.  Also excluded were cords with indeterminate or incomplete turns and cases with incomplete maternal or neonatal data because of antenatal care elsewhere.
The sample size for the study was calculated based on an assumed average of 12% prevalence rate of abnormal UCI from published series [19-21]. This was obtained using the standard formula for minimum sample size for a prevalence study by Taylor D.W. [22]
N =     ___PQ__
           (E/1.96)2
Where N = minimal sample size 
1.96 = is a standard normal deviation (constant)
p = maximum known prevalence of the abnormality = 12% = 0.12
q = 1-p (proportion of persons free from the abnormality) = 1-0.12 =0.88
E = Error margin allowable = (0.05)
Therefore N = 0.12 x 0.88
                       (0.05/1.96)2       = 162 
However, all 525 consenting parturients who met the inclusion criteria within the study period were recruited into the study.
Ethical approval from this study was granted by the ethical committee of the ABSUTH, Aba. The study was carefully explained to the patients and their informed consent obtained before they were recruited into the study. The rights of the woman to participate or not was respected.
All women who had singleton delivery at > 28 weeks gestation during the period (n = 813) constituted the study population. Of these, 525 (90.2%) parturients that met the inclusion criteria were examined clinically and had their cords evaluated. The remaining 288 parturients could not be examined because they fell within the criteria for exclusion or were excluded from the final data analysis for incomplete data. Analysis of the data revealed that 389 of the recruited parturients had normal uncomplicated pregnancies. History and thorough clinical examination was then performed on each parturients. At delivery the fetal end of the cord was clamped and cut at 5cm from the fetal insertion taking care not to milk the cord, this end was held to prevent changes in coiling until the placenta reached the perineum. Following delivery of the placenta, the umbilical cord was cut flush with the fetal surface of placenta without stretching. The length of the cord was measured against a non-elastic measuring tape graduated in cm and 5cm was added to the length of the measured cord. The placentas were examined and the umbilical cord was evaluated for umbilical coiling by visual examination. A complete vascular coil was defined as a 360 � complete round coiling of the vasculature and the total number of these complete vascular coils was divided by the total length of the cord in centimeters in order to determine the umbilical coiling index (UCI).
Umbilical coiling index (UCI) = total number of complete vascular coiling
                                                             Total length of cord (cm) 
The direction of the umbilical cord twist was determined by a standardized approach. Specifically, the umbilical cord was held vertically for inspection. A left twist would travel from the upper left to the lower right. In other words, a left twist would reflect the left-hand limb of the letter ��V.�� Conversely, a right twist would reflect the right-hand limb. The direction of the twist was independent of orientation of the specimen and thus was constant whether the placental end or the fetal end was held superiorly. In all cases, the umbilical cord was also evaluated for vessel number and identification of any gross abnormalities. The placentas were also examined for gross abnormalities. As in previous studies, umbilical coiling index were classified as undercoiled if the coiling index was smaller than the 10th percentile, normocoiled if the umbilical coiling index was between the 10th and 90th percentile, or overcoiled if the umbilical coiling index was above the 90th percentile. [10,11,14,15] Where there are no coils it is described as non-coiled.  
All information obtained was recorded on the data sheet designed for the study. The recorded data was coded and fed into the computer using the Statistical Package for Social Sciences (SPSS Inc., Chicago Il., USA) software and this was also used for the analysis of the data. The analysis consisted of univariate and bivariate analysis, and comparison of identified relationships. Test of statistical significance were based on 95% confidence interval (p<0.05) using the X2 test with Yates or Fischer exact correction where applicable. Odds ratio and their 95% confidence interval were calculated using logistic regression analysis to evaluate the strength of associations between adverse pregnancy outcomes and under coiling or over coiling and to eliminate effects of potential confounding variables. The model used two dummy variables, using an UCI between the 10th-90 th percentile as reference.













RESULTS
The frequency distribution of coiling index was found to be normal. The mean UCI for normal pregnancies was 0.13+ 0.06. The 10th and 90th percentile UCI values were 0.06coils/cm and 0.21 respectively. Using the above established normal range, the parturients� UCI were classified into hypocoiled, normocoiled, hypercoiled and non-coiled, undercoiling (hypocoiled) was defined as UCI less than 0.06 coils/cm and overcoiling (hypercoiled) as UCI more than 0.21 coils/cm. The mean length � SD of the umbilical cord was 65.94 � 11.6 cm and the mean number of coils � SD per umbilical cord was 8.4 � 3.92. All the umbilical cords examined contained three blood vessels.
The frequency distribution of the umbilical coiling index in the study population is presented in Table 1. The incidence of abnormal UCI (hypercoiled, hypocoiled and non-coiled) was 19.8% and majority of the parturients (80.2%) had normal UCI (normocoiled). Of the abnormal UCI, there was preponderance of hypercoiling (7.8%) and hypocoiling (7.8%) as compared to the non-coiled cases (4.2%).
Table 2 describes the relationship between maternal demographics, the presence of medical disorders during pregnancy, and the umbilical coiling index. Of the 41 parturients who had hypercoiling abnormality, there was a statistically significantly higher proportion of parturients < 21 years, higher incidence of PIH and retained placenta compared to the normocoiled cases. Similarly, of the 41 parturients who had hypocoiling abnormality, there was a statistically significantly higher proportion of parturients < 21 years, obesity, higher incidence of PPH and retained placenta compared to the normocoiled cases. Among the 22 parturients with non-coiled umbilical cords, there were statistically significantly higher proportion of nulliparous individuals, obesity, gestational diabetes mellitus, PIH, PPH, retained placenta and preterm rupture of fetal membranes compared to the normocoiled cases. 
Depicted in table 3 is the relationship between neonatal outcome/delivery events and umbilical coiling index. When the parturients with hypercoiled cords were compared to those with normocoiled cords, a statistically significantly higher incidence of meconium staining of liquor at birth (P=0.000), fetal growth restriction (P=0.001), fetal anomalies (P=0.0001) and assisted breech delivery (0.001) occurred in the hypercoiled population. The incidence of preterm delivery (P=0.033) and the perinatal mortality rate was also significantly increased in this group of parturients (P=0.0001). Similarly, When the subjects with hypocoiled cords were compared with normocoiled subjects, there was a statistically significantly higher incidence of meconium staining of liquor at birth (P=0.000), fetal growth restriction (P=0.001), congenital anomalies (P=0.0001), higher perinatal mortality rate (0.001) interventional delivery by cesarean section (P=0.001), assisted breech delivery (P=0.0001) and preterm delivery (P=0.001) in the hypocoiled population. The perinatal mortality rate was also significantly higher in this group (P=0.0001). Additionally, the parturients with noncoiled cords were similarly compared to parturients with normocoiled cords and it revealed a statistically significantly higher incidence of meconium staining of liquor at birth (P=0.000), fetal growth restriction (P=0.001), fetal distress (p= 0.000), congenital anomalies (P=0.0001), interventional delivery by cesarean section for fetal distress (P=0.001) and preterm delivery (P=0.033) in the noncoiled group. The perinatal mortality rate was also significantly increased (P=0.0001) in them.
Table 4 shows the relationship between the direction of umbilical coils and the Umbilical Coiling Index. There was a preponderance of leftward twists but this preponderance of left to right twists was not statistically significant (P=0.478).
The key sociodemographic parameters of the parturients, fetal outcome, maternal morbidity, mode of delivery and the direction of the coils were further subjected to logistic regression analysis to eliminate the impact of chance and or other potential confounding variables, and the positive findings are highlighted in bold in table 5. Abnormal coiling index was positively correlated with the risk of a parturient having caesarean section (OR= 4.33, 95% CI, 0.24-79.59), PROM (OR=4.09,+ 95%CI, 2.22-7.53), retained placenta (OR=3.74, 95%CI, 1.89-7.4), and PPH (OR=3.63. 95%CI, 1.+45-9.17). Other positive findings are associations with extremes of reproductive age <20 years (OR=2.65, 95%CI, 0.22-32.08), >35 years (OR=2.22, 95%CI, 0.26-19.40), maternal weight >90kg (OR=2.64, 95%CI, 1.37-5.06), fetal death (OR=2.35, 95%CI, 0.87-7.54) and ABD (OR=1.82, 95%CI, 0.71-4.69). GDM and hypertension in the univariate model showed significant association with the risk of abnormal coiling index. However these associations were attenuated in the logistic regression model. 






Discussion
There has been continuing interest in the importance of this subject. This study is the first to provide reference values for UCI in an African population, in both normal and complicated pregnancies. The overall aim of this study was to find a relationship between UCI and various maternal and perinatal factors in Africans, as we believe that the findings are capable of engendering interventions that will help optimize fetal and maternal outcomes of pregnancy as a way of helping to achieve the targets of the safe motherhood initiative and millennium development goals of improved maternal and perinatal morbidity and mortality.  The mean UCI value (0.13+0.06) for normal pregnancies in our study population agrees with the findings of an earlier study by Gupta et al who reported from Delhi, India [23]. However this figure is lower than those (0.16-0.24) reported by other authors [5,10,13,14,23-25]. The 10th and 90th percentile (0.06 coils/cm and 0.21 coils/cm respectively) for this study on African population is lower than the values (0.065 to 0.17 coils/cm for the 10th percentile and 0.22 to 0.3 coils/cm for the 90th percentile) from previous published series [2,8,9,11,12] in the Caucasian and Arabian population. Overall, reports indicate that UCI is on the average slightly lower in normal pregnancies than in complicated pregnancies.[2] The mean  length (65.94+11.6cm) of the umbilical cords in this present study is much longer than previously reported figures (44.4+9.2cm; 52.87+13.49cm) [5,23]. However, the mean number (8.4+3.92) of coils per umbilical cord in our study is lower than that (12.59+5.8) reported by Chitra et al [5] but higher than the figure (5.8+3.8) reported by Gupta et al [23]. The differences in results between this study and those of earlier studies are most likely to be due to differences in study populations and protocols.  This study reported on clamped cords. If the cord is clamped at both sides, the umbilical coiling index is slightly overestimated as compared with the umbilical coiling index in the same, unclamped cord [25]. 
This study established associations between several parameters of the parturients including pregnancy outcome. Maternal age < 20 years was found to be statistically significantly associated with abnormal UCI and this association was confirmed on logistic regression analysis (OR=2.65; 95%CI, 0.22-32.08). In the univariate model maternal age >35 years was not significantly associated with abnormal UCI but this was confirmed otherwise on logistic regression analysis where it was shown that there was over a two-fold chance (OR=2.22; 95%CI, 0.26-19.40) that abnormal UCI is associated with maternal age > 35 years. That extremes of reproductive age is associated with abnormal UCI has previously been reported [5,15]. Maternal obesity in both the univariate and multivariate analysis was found to be associated with abnormal UCI, and similar findings have earlier been reported by Ezimokhai et al [15]. Again PIH was found to be associated with abnormal UCI (hypercoiling and noncoiling) in this study and this compares favorably with the findings of earlier studies [5,15,23]. While we are unable to explain why hypercoiling is associated with PIH, association of noncoiling is usually hypothesized to be due to the fact that coiled umbilical cord has elastic properties and therefore able to resist external forces that might compromise the umbilical vascular flow. The coiled umbilical cord acts like a semierectile organ that is more resistant to snarling torsion, stretch, and compression than the noncoiled one. PPH was another adverse obstetric outcome that was found significantly associated with abnormal UCI in this study. Only one previous study [5] has reported similar finding and their explanation for the association with PPH probably may be due to the association of PPH with multiple factors like multiple pregnancy and polyhydramnios. However we are unable to apply this rationale to our study as it was undertaken in singleton pregnant parturients. PPH in our study was also strongly correlated with the presence of abnormal UCI on logistic regression analysis with almost a four-fold chance (OR=3.63, 95%CI, 1.45-9.17) of PPH occurring in face of abnormal UCI.   
Additionally, retained placenta was found to be associated with the presence of abnormal UCI both in the univariate and multivariate models (P = 0.0001; OR = 3.74; 95%CI, 1.89-7.4). This finding seems to be unique to the African population as no available past studies in the Caucasian or Arabian population had established this. We cannot explain the reason for this association. It requires further investigation to possibly determine the impact of other potential confounding variables that may have been present. Preterm rupture of fetal membrane is strongly associated with noncoiling abnormality of UCI in both the univariate (p=0.0001) model and multivariate logistic regression analysis (OR=4.09; 95%CI, 2.22-7.53) and similarly preterm delivery is also strongly associated with all categories of UCI abnormalities from this study. Association of preterm delivery with abnormal UCI in this study compares favorably with previous reports [8,14,25,26]. Rana et al [14] and de Laat et al [26] found hypercoiled cords to be significantly associated with preterm labor and they believed that hypercoiling was an adaptive response to fetal hemodynamic changes, which initiates preterm labor on reaching a certain threshold. Meconium staining of the amniotic fluid was also found to be statistically significantly associated with abnormal umbilical coiling index in this study and this agrees with the findings of some previous studies [5,8,10,11,15], although a few other works showed no statistically significant association [3,14]. The reason for this variance in association is not yet known. Another important finding in this study was the association of fetal growth restriction (FGR) with all categories of abnormalities of UCI. This Is similar to the findings by previous authors who reported on UCI and pregnancy outcomes [5,8,11,15,24], Strong et al [8] and Machin et al [11]  whom found FGR associated with hypocoiling posited that adequate coiling prevents cord compression and that hypocoiling predispose to cord compression and in the long run, results in reduced fetoplacental circulation, thus resulting in FGR. While Ezimokhai et al [15] and de Laat et al [24] who found FGR significantly associated with hypercoiling, explains that hypercoiled cords are predisposed to kinking and torsion, again interfering with fetoplacental circulation.     
 	Similar to what has been reported in earlier studies [5,8,10,15], fetal anomalies were statistically significantly associated with abnormal UCI in this study. While Ezimokhai et al [15] and Strong et al [8] found fetal anomalies significantly associated with hypocoiling, Chitra et al [5] found fetal anomalies significantly associated with hypercoiling, and we found fetal anomalies associated with all categories of abnormalities of UCI, thus we confirmed their independent and varying findings in one study.  Also, our study undoubtedly confirms earlier reports [11,24,26] that abnormal UCI was significantly associated with increased risk of fetal demise and higher perinatal mortality. This was consistently associated in both the univariate and multivariate models of analysis. We believe that the great majority of stillbirths that are �unexplained� or of �cause unknown [27,28] may have, in fact, be caused by abnormal cord coiling and its sequelae. In this study we found significant association between fetal distress and noncoiled cords. Fetal distress has also been previously reported in association with UCI abnormalities [24]. The likely reason for association with noncoiled cords is that such cords are highly predisposed to compression and hence compromised fetoplacental circulation. 
As previously reported [5], instrumental delivery did not find any significant association with extremes of UCI in this study. However we found a significant association between increased risk for caesarean section and abnormalities of UCI as have been reported in other studies [2,8,10,14,15,29].  The significant association on univariate model (P=0.0001 and 0.001) was confirmed on the Logistic regression analysis model (OR=4.33; 95%CI, 0.24-79.59) with over a four-fold increased risk as compared to the normocoiled population. The likely explanation could be the increased risk of fetal hypoxia in this group since adequate coiling may have a beneficial effect by increasing the ability of the cord to resist vascular compression [30] or obviate kinking and or torsion [15,24].  It may then be speculated that an abnormal UCI is directly associated with fetal distress, subsequently leading to a high incidence of Cesarean sections. Similarly assisted breech delivery is found to be significantly associated with abnormalities of UCI. On logistic regression model, the chance of having an assisted breech delivery is about twice more in association with abnormal umbilical coiling index compared to the normocoiled population. The predominant direction of coils was the left to right twist and this was more associated with an abnormal umbilical coiling index compared to the normocoiled population. This is in agreement with previous reports [3,4,6,7]. The reason for this is uncertain. However, the predominance of the left to right twist is thought to be the result of more forceful paddling with the right arm of a fetus who has already established handedness [4,23], or the cord twist is the result of either active or passive rotation of the fetus [6]. The incidence of cords without any coil was 4.2% which is in agreement with findings of Lacro et al (5%) [4], Rana et al (4.9%) [14] and Gupta et al (5.6%) [23].  

CONCLUSION
This study is the first attempt at documenting UCI parameters and its impact on course and outcome of pregnancy in an African population. Overall the normal mean UCI parameters and the cutoffs for normality at the 10th and 90th percentile are lower that the previously reported for Caucasian and Arabian populations for both normal and complicated pregnancies. The study clearly shows that adverse pregnancy outcome is associated with abnormal coiling of the vessels of the umbilical cord.
We reaffirm the suggestion from previous studies 11,30 that determination of the umbilical coiling index should be a routine part of placental examination post-partum as it may explain a proportion of otherwise unexplained perinatal deaths which is important for both clinicians and parents. Furthermore, an attractive hypothesis is that antenatal detection of cord abnormalities with ultrasonography may be helpful in selecting cases in which strict fetal monitoring is warranted, antenatally as well as intrapartum. If the umbilical coiling index can be measured reliably in utero by ultrasound, then it might be a promising prognostic marker for adverse pregnancy outcome. This deserves to be tested in further studies. Also the clinical significance of the umbilical cord twist needs to be investigated in our own population.







Table 1:  Distribution of the umbilical cord index
	
  UCI			Frequency		 	%                  Mean UCI + SD

Normo-coiled	     421			80.2    	                               0.13 + 0.06
Hypercoiled	       41			  7.8		                   0.27 + 0.04
Hypocoiled 	       41			  7.8		                   0.04 + 0.01
Non-coiled 	       22			  4.2		                   0	

Total 		     525			 100	
\















Table 2:  Relationship between Maternal Demographic Factors, obstetric/medical disorders
 and the Umbilical Coiling Index
	
  UCI			Normo-coiled    ��Hypercoiled  ��� Hypocoiled      Non-coiled 
					 	N =525
Age @ Delivery (yrs)
     <20	    	               1 (0.2)                    1 (2.4)*            1 (2.4)*                 0 
 21 �35 		 367(88.9)               35(85.4)           35(85.4)	            20(90.9)
     >35 		   45 (10.9)                5(12.2)            5(12.2)	              2(9.1)
Parity 
    0		            135 (40.0)	        13 (31.7)	        16 (40.0)               6 (27.3)� 	
1 � 4		            257 (61.0)               24 (58.5)          22 (55.0)             14 (63.6) 
    >5  	                           29 (6.9)                  4 (9.8)	          2 (5.0)                 2 (9.1)
Weight @ Delivery 
(Kg)
    <50		               13 (3.2)	          2 (4.4)             2 (4.9)                  2 (9.0)   
51-90		             328 (78)	        34 (82.3)         32 (78.0)               11(51.0)  
   >90		               80(18.8)                 5 (13.3)           7 (17.1)�                  9 (40)*
Obstetric/Medical 
Disorders 	       
GDM			   16(3.8)                  3 (7.3)             1 (2.4)                      6 (27.2)*
PIH			   38 (9)                   7(17.7)*             5(12.2)                   8 (36.4)* 
PPH                                40 (0.95)              0                      10 (24.4)*               13 (59.1)*
Retained placenta           10 (0.24)              8 (19.5)*           6 (14.6)*               11 (50)* 
Preterm ROM                 44 (10.5)              8 (19.5)*           6 (14.6)*               15 (68.2)*       

* p-value 0.0001                  Values in parenthesis are percentages
� p-value 0.003
� p-value 0.001
GDM=Gestational Diabetes Mellitus
PIH=Pregnancy Induced Hypertension
PPH=Post Partum Haemorrhage
PROM= Preterm Rupture of Membranes



















Table 3:  Relationship between neonatal & delivery events and the Umbilical Coiling Index
	
  UCI			Normo-coiled        �Hypercoiled  ��� Hypocoiled      Non-coiled 

Birth weight (kg)           �3.37 � 0.470        3.33+ 0.564     3.30 +0.373      3.25 +0.381
Gestational age (wks)    �39.2 +1.54	          38.8 +1.48      38.7   +1.22      40.1 + 1.54
APGAR score (5mins)    �8.62 +1.51	         8.66 +0.99        8.44 +2.07        7.68 + 2.78
Meconium staining           2 (0.48)                22 (53.7)�       16 (39.0)�           8(36.4)�
FGR*			      0		         8 (19.5) �	2 (4.9)�           11 (50)�
Fetal anomalies 	      0                         1 (2.4)#               1(2.4)#               4 (18.2)#
Fetal distress		      2 (0.48)               0                        0                      13 (59.1)�
PNM/1000		      4 (0.95) 	         10 (24.4)#           7(17.0)#	11 (50)#	
Mode of delivery:
 SVD**		    387 (92.8)	         36 (87.8)	            37 (90.2)         19 (90.5)
 C/S 	     	   	     22 (5.3)	          1 (2.4)		 4 (9.8) #            2(9.5)�
Instrumental	                 11(1.9)	          3 (4.8)	             0	              0 
ABD***		       0	          	          2 (5.0)#	             1 (50)#              0
Preterm delivery               1(3.9)	         21 (77.8) *          5 (18.5)*          14 (63.6) *

* FGR = fetal growth restriction; **SVD = spontaneous vaginal delivery; ***ABD= assisted breech delivery PNM=Perinatal mortality; C/S = caesarean section 
Values in parenthesis are percentages.         
� P-value 0.000                      �=Mean � SD
� p-value 0.001                       C/S=Cesarean section
# p-value 0.0001                  
* P-value 0.033
Table 4:  Relationship between direction of umbilical coils & the Umbilical Coiling Index
	
  UCI			    Normo-coiled    ��Hypercoiled  ��� Hypocoiled      Non-coiled 
                                                                             N (%)

Direction of coils
Left right 		      226 (53.8)	            24 (58.5)	27 (65.9)         13 (60.0)
Right left		      195 (46.2)		17 (41.5) 	14 (34.1)          9 (40.0)
=
P-value 0.478
















Table 5:  Logistic regression to determine predictive factors of the likelihood of 
   abnormal** umbilical cord coiling index
	
  UCI			  	 	    OR **			CI (95%) 

Age @ Delivery 
(yrs) 
 <20	  				    2.65			            0.22-32.08
  21 � 35 		    		    0.83			            0.40-1.72
>35 		    		                2.22			            0.26-19.40	
Weight @ 
Delivery 
(kg)
<50		                                        0.71			            0.32-1.56	
51-90			                            0.83			            0.37-1.85
>90				                2.64			            1.37-5.06
Parity (0)
      0		     	  	                0.73			           0.27-1.97
1 � 4		      		                0.84	                                   0.33-2.10
    >5  		       	                            1.06		                      0.63-1.78	
Fetal outcomes
Meconium staining                                1.53                                   0.81-2.84
Fetal death                                            2.35                                    0.57-7.54
Fetal anomalies                                      1.59                                    0.87-2.67
Preterm delivery                                     1.68                                    0.83-3.41

Obstetric/Medical
Disorders 	     
GDM					   0.32		                          0.13-0.82
PIH					   1.11		                          0.60-2.00
PPH					   3.63		                          1.45-9.17
Retained placenta                                3.74	                                      1.89-7.4
PROM                                                  4.09	                                      2.22-7.53
Nil					   0.50		                          0.28-0.90
Mode of delivery: 
 SVD    				  0.67			              0.25-1.74 	
Caesarean section			  4.33			              0.24-79.59 
Instrumental 		   		  0.00
ABD    				  1.82			              0.71-4.69
Direction of coils
 (left right)
Left right 		      		   1.18			              0.70-1.97
Right left		      		   0.86		                           0.51-1.42

**abnormal umbilical coiling index � hypocoiled, hypercoiled, non-coiled 







References 
Predanic M, Perni SC,  Chasen ST.  The umbilical cord thickness measured at 18�23 weeks of gestational age.  The Journal of Maternal-Fetal and Neonatal Medicine, 2005; 17(2): 111�116. 
Van Diik CC, Franx A, de Laat MW, Bruinse HW, Visser GH, Nikkels PG. The umbilical coiling index in normal pregnancy.  J Matern Fetal Neonatal Med 2002; 11: 280�283.  
Bernischke K, Kaufmann P. Pathology of the Human Placenta. New York: Springer, 1995   
Lacro RV, Jones KL, Benirschke K. The umbilical cord twist: origin, direction and relevance. Am J Obstet Gynecol 1987; 157: 833�838 
Chitra Y, Sushanth YS, Raghavan S. Umbilical Coiling Index as a Marker of Perinatal Outcome: An Analytical Study. Obstetrics and Gynaecology International vol 2012; article ID 213689, 6 pages doi: 10.1155/2012/213689.
Edmonds HW. The spiral twist of the normal umbilical cord in twins and in singletons Am J Obstet. Gynecol 1954; 67: 102�120. 
Malpas P, Symonds EM. Observations on the structure of the human umbilical cord. Surg Gynecol Obstet 1966; 123: 746�750  
Strong TH, Elliot JP, Radin TG. Non-coiled umbilical vessels: a new marker for the fetus at risk. Obstet Gynecol 1993; 81: 409�411. 
Degani S, Lewinsky RM, Berger H , Spiegel D. Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics. Obstet Gynecol 1995; 86: 990�993.
Strong TH Jr, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. Am J Obstet Gynecol 1994; 67: 102�120.
Machin  GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol 2000;  3: 462�471 
Ezimokhai M, Rizk DE, Thomas L. Abnormal vascular coiling of the umbilical cord in gestational diabetes mellitus. Arch Physiol Biochem 2001; 109: 209�214  
Ercal T, Lacin S, Altunyurt S, Saygili U, Cinar O, Mumcu A. Umbilical coiling index: is it a marker for the foetus at risk? Br J Clin Pract 1996; 50: 254�256.
Rana J, Ebert GA, Kappy KA. Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstet Gynecol 1995; 85: 573�577 
Ezimokhai M, Rizk DE, Thomas L. Maternal risk factors for abnormal vascular coiling of the umbilical cord. Am J Perinatol 2000; 17: 441�445.
Di Naro E, Ghezzi F, Raio L, Franchi M,D�Addario V,Lanzillotti G,Shneider H. Umbilical vein blood flow in fetuses with normal and lean umbilical cord. Ultrasound Obstet Gynecol 2001; 17(3): 224�228.
Predanic M, Perni S, Chasen ST, Baergen R, Chervenak FA. Assessment of umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester. J Ultrasound Med 2005; 24: 185-191.  
Nakai Y, Imanaka M, Nishio J, Ogita S. Umbilical venous pulsation associated with hypercoiled cord in growth-retarded fetuses. Obstet Gynecol Invest 1997; 43: 64�67 
Nakai Y, Imanaka M, Nishio J, Ogita S. Umbilical venous pulsation and regional circulatory disturbance. Ultrasound Med Biol 1997; 23: 1165�1169. 
Qin Y, Lau TK, Rogers MS. Second-trimester ultrasonographic assessment of the umbilical coiling index. Ultrasound Obstet Gynecol 2002; 20: 458�463.  
Otsubo Y, Yoneyama Y, Suzuki S, Sawa R, Araki T. Sonographic evaluation of umbilical cord insertion with umbilical coiling index. J Clin Ultrasound 1999; 27: 341�344.
Taylor DW. The calculation of sample size and power in the planning of experiments. Department of clinical epidemiology and biostatistics Mc Master University, Hamilton, Ontario Canada (1994).
Gupta S, Faridi MMA, Krishnan J. Umbilical coiling index. J Obstet Gynaecol India, 2006, 56(4): 315-319
de Laat MW, Franx A, van Alderen ED, et al. The umbilical coiling index, a review of the literature. J Matern Fetal Neonatal Med 2005; 17: 93-100.
de ?@Mijs����������n	o	�	�	
��Ͽ�����s���d�d���dTDh�Hh�o�CJOJQJ]�aJh�Hh~�5�CJOJQJaJh�Hh~�CJOJQJaJh�Hh�HCJOJQJaJh�Hh5%�CJOJQJaJh�Hh�-CJOJQJaJh�Hh5%�CJH*OJQJaJh�Hhn(�CJOJQJaJh�Hhn(�5�CJOJQJaJh�Hh�N2CJH*OJQJaJh�Hh�!�5�CJOJQJaJh�Hh�*Q5�CJOJQJaJ?@hi��	�	�	�	�	�	�	
=
[
�
�
�
�
�
�
�
�
�
Z�������������������������
$d�a$gdn(�
$dha$gd�N2
$dha$gd�N2

 
=
f
s
�
�
�
�
�
�
�
�
�
�
�
�
�
�
�
	��˼���������������ufWfHh�HhJ�CJOJQJaJh�Hh�?CJOJQJaJh�Hh�*QCJOJQJaJh�Hh�wJ5�CJOJQJaJh�Hh�qwCJOJQJaJhn(�5�CJOJQJaJh�HCJOJQJaJh�Hh�o�CJOJQJaJh�Hh~�CJOJQJaJ"h�Hh~�CJOJQJ\�]�aJ"h�Hh�o�CJOJQJ\�]�aJh�Hh~�CJOJQJ]�aJZopy����Wcd����������
0
�
���³��ⳤ���†v�f�f�WHh�Hh�CJOJQJaJh�Hh�?�CJOJQJaJh�Hh�o�CJH*OJQJaJh�Hh�o�>*CJOJQJaJh�Hh�o�CJOJQJaJh�Hh�1�CJOJQJaJh�Hh�?CJOJQJaJh�HhJ�CJOJQJaJh�Hh�wJ5�CJOJQJaJh�HhgB�5�CJOJQJaJh�Hh�*QCJOJQJaJh�Hh4b�CJOJQJaJZp������#q��#�#�#�#�#�#�#�#�#�#�#�#������������������������$��dh`��a$gd�N2$
�_dha$gd"0�
$dha$gd�N2�
�
@O[s���������!(*\�����������������ⵥ�������v�g���ZJh�Hh�qw5�CJOJQJaJh�qw5�CJOJQJaJh�Hh4b�CJOJQJaJh�Hh�P�CJOJQJaJh�Hh�CJH*OJQJaJh�Hh"0�5�CJOJQJaJh�Hh�wJ5�CJOJQJaJh�Hh�o�CJOJQJaJh�Hh"0�CJOJQJaJh�HhJ�CJOJQJaJh�Hh�CJOJQJaJh�Hh*f�CJOJQJaJ�#%K��������QSTUD���³���zk�k�k��z���z�\Mkh�Hh3�CJOJQJaJh�Hh1#�CJOJQJaJh�Hhe{�CJOJQJaJh�
�h�
�CJOJQJaJh�
�h�)�CJOJQJaJh�
�CJOJQJaJh�Hh�)�CJOJQJaJh�Hh=Y�CJOJQJaJh�Hh�YO5�CJOJQJaJh�Hh�)�5�CJOJQJaJh�qwh�qwCJOJQJaJh�Hh�qwCJOJQJaJDFGK_cw����������	lyz{|}~�����³��ѳ���৘����೧�zk\��h�HhRn�CJOJQJaJh�
�hRn�CJOJQJaJh�
�h�
�CJOJQJaJh�
�h�CJOJQJaJh�
�h1#�CJOJQJaJh�
�CJOJQJaJh�Hh1#�CJOJQJaJh�HhJ�CJOJQJaJh�Hh��CJOJQJaJh�Hhe{�CJOJQJaJh�Hhe{�CJH*OJQJaJ ������������� 8:;<=Hfhijk����������������Ǹ���Ӌ����|���m�|�Ӌ�Ǹ�^�|�^h�Hh!CJOJQJaJh�Hh�CJOJQJaJh�
�h�CJOJQJaJh�Hh1#�CJOJQJaJh�
�hJ�CJOJQJaJh�
�h�
�CJOJQJaJh�
�h1#�CJOJQJaJh�
�CJOJQJaJh�Hhy(uCJOJQJaJh�HhJ�CJOJQJaJh�HhE2�CJOJQJaJ$������!"#$%�,./023	-s���Ǹ����ǩ��ǩ��{���{�{���{l]�h�HhG@�CJOJQJaJh�Hh��CJOJQJaJh�Hh%CJOJQJaJh�HhRn�CJH*OJQJaJh�
�h1#�CJOJQJaJh�Hh1#�CJOJQJaJh�Hh!CJOJQJaJh�
�h�
�CJOJQJaJh�
�h�CJOJQJaJh�
�CJOJQJaJh�Hh�CJOJQJaJ s�������%EGbcdgnoq���������
���Ǹ��������{Ǹl�l�l���{�{Ǹ]h�Hh��CJOJQJaJh�Hh�#�CJOJQJaJh�
�hGS�CJOJQJaJh�
�h1#�CJOJQJaJh�Hh1#�CJH*OJQJaJh�Hh��CJOJQJaJh�Hh1#�CJOJQJaJh�
�h�
�CJOJQJaJh�
�h�CJOJQJaJh�
�CJOJQJaJh�HhRn�CJOJQJaJ
���������\{}�����4	 ( * , - �������∵y��j���j[�L�h�
�hG`
CJOJQJaJh�HhG`
CJOJQJaJh�Hh�#�CJOJQJaJh�
�hGS�CJOJQJaJh�HhGS�CJOJQJaJh�
�h�
�CJOJQJaJh�
�h1#�CJOJQJaJh�
�CJOJQJaJh�HhRn�CJOJQJaJ"h�Hh1#�6�CJOJQJ]�aJh�Hh1#�CJOJQJaJh�Hh��CJOJQJaJ- . / 0 9 C V X � !!!
!!!
!!!!0!?!S!n!�!�!���³����zk\k\k\M�>��ѳ�h�Hh�o�CJOJQJaJh�
�h�
�CJOJQJaJh�
�hG`
CJOJQJaJh�
�h1#�CJOJQJaJh�
�CJOJQJaJh�Hh�~�CJOJQJaJh�Hh�1CJOJQJaJh�HhAICJOJQJaJh�HhNdCCJOJQJaJh�Hh�a�CJOJQJaJh�Hh��CJOJQJaJh�Hh�#�CJOJQJaJh�Hh�a�5�CJOJQJaJ�!�!�!�!�!�!�!�!""""<"="G"P"^"}"�"�"�"�"�#�#�#�#�#�#�#�����ӵ��Ӧ�������yj[L�h�Hh4b�CJOJQJaJh�Hh�2CJOJQJaJh�HhbN=CJOJQJaJh�Hh�)�CJOJQJaJh�Hh�L�CJOJQJaJh�Hh�a�CJOJQJaJh�HhAICJOJQJaJh�Hh�~�CJOJQJaJh�HhV%CJOJQJaJh�Hh�CJOJQJaJh�HhNdCCJOJQJaJh�Hh1#�CJOJQJaJ�#�#�#�#�#�#�#�#k$�$�$�%�%3&<&>&?&@&O&P&Q&R&S&X&x&y&�&�&)'E'S']'(
(������Д���vfУvfV�v�vЅvЅЅУh�HhJl�CJH*OJQJaJh�Hh�YOCJH*OJQJaJh�HhJl�CJOJQJaJh�HhV8�CJOJQJaJh�Hh�	CJOJQJaJh�Hh�l~CJOJQJaJh�Hh�~gCJOJQJaJh�Hh�!�CJOJQJaJh�Hh�YOCJOJQJaJh�Hh�YO5�CJOJQJaJh�HhGpp5�CJOJQJaJ!�#�#�%�)�*�*�*+3+p+�+�+�+(,�,�-l3�34<8�;��������������������$dh�7$8$H$a$gd�N2$
��dha$gd�N2$��dh�7$8$H$`��a$gd�N2$��dh`��a$gd�N2
$dha$gd�N2
(�(&)3)8)?)�)�)�)�)�)*D*E*F*G*H*I*J*K*L*M*��������ӵө��wg�wWGh�Hh�y�CJOJQJ\�aJh�
�h�
�CJOJQJ\�aJh�
�h7�CJOJQJ\�aJh�
�hG`
CJOJQJ\�aJh�
�h�y�CJOJQJ\�aJ"h�
�h�
�5�CJOJQJ\�aJh�
�CJOJQJaJh�Hh�YOCJOJQJaJh�HhU<�CJOJQJaJh�HhV8�CJOJQJaJh�Hh�l~CJOJQJaJh�Hhan�CJOJQJaJM*N*�*�*�*�*�*�*�*�*�*�*�*�+�+,,&,',(,1,����qa�Q�a�Q�B�Bh�HhJl�CJOJQJaJh�Hh�YOCJH*OJQJaJh�Hh�YO>*CJOJQJaJh�Hh�y�>*CJOJQJaJh�Hh�y�CJOJQJaJ%h�Hh�YO5�CJH*OJQJ\�aJh�
�h�
�CJOJQJ\�aJh�
�hG`
CJOJQJ\�aJh�
�CJOJQJaJh�Hh�YOCJOJQJaJh�Hh�YOCJOJQJ\�aJ"h�Hh�y�5�CJOJQJ\�aJ1,5,6,7,8,�,�,�,�,-B-f-�-�-�-�-�-�-�-...7.C.L.N.O.R.V.W.Y.Z.q.�.�.��������ĵ�ĵ��񵄵ufW�W�f�fWf�fh�Hh�<CJOJQJaJh�Hh�ICJOJQJaJh�Hh�!�CJOJQJaJ"h�Hh�YO6�CJOJQJ]�aJh�Hh�k�>*CJOJQJaJh�HhwICJOJQJaJh�Hh�YOCJOJQJaJh�Hh�y�CJOJQJaJh�HhJl�CJOJQJaJh�Hh�:CJOJQJaJh�Hh�k�CJOJQJaJ"�.�.�.�.�./#/H/\/^/s/|/�/�/�/�/�/�/�/�/000000%0&0*0D0�0�0�0�01k1�1�1
2222����������������������񦗦����y��j�jh�Hh#7�CJOJQJaJh�Hh%'aCJOJQJaJh�Hh�x�CJOJQJaJh�HhCJOJQJaJh�Hh�[CJOJQJaJh�Hh�y�CJOJQJaJh�Hh��CJOJQJaJh�Hh�ICJOJQJaJh�Hh�<CJOJQJaJh�Hh�YOCJOJQJaJ)2`2f2g2h2m3�3�3W5x5�5�5�6�6�7�7�788
88;8�8���������{l]N�?��h�HhU�CJOJQJaJh�
�h�
�CJOJQJaJh�
�hG`
CJOJQJaJh�
�h�YOCJOJQJaJh�
�CJOJQJaJh�Hh�t�CJOJQJaJh�Hh�tCJOJQJaJh�Hh�YO>*CJOJQJaJh�Hh�:�CJOJQJaJh�HhCJOJQJaJh�Hh�~�CJOJQJaJh�Hh�CJOJQJaJh�Hh�YOCJOJQJaJ�8�8�899
999(9-949\9::4:S:l:m:�:�:�:�:;%;_;c;�;�;�;�;�;�;�;�;�;�;�;�����������������������������ⳣ��sch�Hh!
{5�CJOJQJaJh�Hh#7�5�CJOJQJaJh�Hh�15�CJOJQJaJh�Hh#�5�CJOJQJaJh�Hh�~�5�CJOJQJaJh�Hh:�5�CJOJQJaJh�HhR�CJOJQJaJh�Hh�YOCJH*OJQJaJh�Hh�YOCJOJQJaJh�Hh{�CJOJQJaJ$�;�;�;�;�;�;�;�;�;�;�;�;�;�;�;n>�?{CJ�JO O!O"O#O������������������������$��dh`��a$gd�N2
$dha$gd�N2dhgd�N2
$dha$gd�N2�;<E<F<M<S<U<\<^<�<�<�<�<%=&=3=@={=�=�=>&>,>->m>n>{>�>�>�>�>�>�?�@����óó��񕤆�����w�w�h�hYh��h�Hh�~�CJOJQJaJh�Hh�/�CJOJQJaJh�Hhy	CJOJQJaJh�Hh�=�CJOJQJaJh�HhAssCJOJQJaJh�Hh+X~CJOJQJaJh�Hh�(7CJH*OJQJaJh�Hh�(7CJOJQJaJh�Hh�6�>*CJOJQJaJh�Hh�6�CJOJQJaJh�Hh!
{CJOJQJaJ!�@�@�@�@�@FBbB�B�B�B�BzC{C�C�C�C�C�C�C�C�C�CDD&DCDFDTD�D�D�D�D�D�D�D�D�D�D�DEE��������ӵ⦗������yj�y�y�y�j�j�j�j�j�jyh�Hh�
�CJOJQJaJh�HhrQ�CJOJQJaJh�Hh!
{CJOJQJaJh�Hh�xCJOJQJaJh�Hh:�CJOJQJaJh�Hh�SqCJOJQJaJh�Hh�^LCJOJQJaJh�Hh[y�CJOJQJaJh�Hh�Y�CJOJQJaJh�Hh=@�CJOJQJaJ(E
E0E1E2E�E�E�E�E3GXG�G�GHH-H8HDHEHJH[HkHnH|H�H�H�H�H�H�H
III#IdInI�I�I�I�I�I�I�I�I�I�����ĵ���⦵Ӧӗӗӗӗӈӈӈy�ӈӈӵӗӵӵ�h�Hh�CJOJQJaJh�HhtL�CJOJQJaJh�Hh
QbCJOJQJaJh�Hh�5�CJOJQJaJh�Hh�S�CJOJQJaJh�Hh�
�CJOJQJaJh�Hh!
{CJOJQJaJh�HhrQ�CJOJQJaJh�Hh�6CJOJQJaJ,�I�I�J�J�J�J�J�J}K�K�K�KL6LALRLrLsLxL�L�LMM6M7M@M
NN6NFN�����ⵦ�������y�y�j���j��[�[h�Hh�9SCJOJQJaJh�Hh�?�CJOJQJaJh�Hh�.�CJOJQJaJh�Hh�CJOJQJaJh�Hh�qfCJOJQJaJh�Hh18CJOJQJaJh�Hh�JvCJOJQJaJh�Hh�CJOJQJaJh�Hh��CJOJQJaJh�Hh!
{CJOJQJaJh�Hh�J�CJOJQJaJFNYNZN\N�N�NO"O#O$O%O0O{O�O�O�OQ�Q�Q�Q�Q������ĵ���xiZiKZKi<h�Hh�m�CJOJQJaJh�HhTI�CJOJQJaJh�Hh#g�CJOJQJaJh�Hh�CJOJQJaJh�Hh/I&CJOJQJaJh�Hh�5�CJOJQJaJh�Hh4b�CJOJQJaJh�Hh�z�CJOJQJaJh�Hh�
�CJOJQJaJh�Hh!
{CJOJQJaJh�Hh�w�CJOJQJaJh�Hh�9SCJOJQJaJh�Hh��CJOJQJaJ#O$O%O0OSW�_i2n�u�u�u�w�z�z�z�z�z�z�z������������������$a$gd�$dh�7$8$H$a$gd�N2$��dh�7$8$H$`��a$gd�
f$��dh`��a$gd�N2$��dh`��a$gd4b�dhgd�N2
$dha$gd�N2�Q�QRRTRVRWRXR�R�R�R�R�R�R�R�R�R�R�R�RSESgSiS�S���Ǹ⩚���Ǹ{l\l\lM�=�h�Hh�iCJH*OJQJaJh�Hh�SCJOJQJaJh�Hh�;�CJH*OJQJaJh�Hh�;�CJOJQJaJh�Hh�;�5�CJOJQJaJh�Hh�k	CJOJQJaJh�Hh�iCJOJQJaJh�Hh�{(CJOJQJaJh�h�h�h�CJOJQJaJh�h�h�i�CJOJQJaJh�h�CJOJQJaJh�Hh�m�CJOJQJaJh�HhG<�CJOJQJaJ�S�S�S�S�S�S�S�S�S�S�STTT
TT&T*TSTvTwTxTyTzT���Ŷ��јщz�z�k\k�M�>�h�h�h�CJOJQJaJh�Hh�2CJOJQJaJh�Hh84CJOJQJaJh�Hh�CJOJQJaJh�HhG<�CJOJQJaJh�Hh|}CJOJQJaJh�Hh�XCJOJQJaJh�h�h�h�CJOJQJaJh�h�h��CJOJQJaJh�h�CJOJQJaJh�Hh�SCJOJQJaJh�Hh�iCJOJQJaJh�Hh�iCJH*OJQJaJzT{T|T�T�T�T�T�T�T�T�T�T�T�T
UUUUUUU9U:U{U�U�U�U�U�U���²���ѣ£�����xi£��ZJZ�Zh�HhX�>*CJOJQJaJh�HhX�CJOJQJaJh�h�h�h�CJOJQJaJh�h�h��CJOJQJaJh�h�CJOJQJaJh�Hhz7>*CJOJQJaJh�Hhz7CJOJQJaJh�Hh84>*CJOJQJaJh�Hh84CJOJQJaJh�Hh|}CJOJQJaJh�Hh�CJOJQJaJh�Hh/_�CJH*OJQJaJ�U�U�U�U�U�U�U�U�U�U�U�U�U�U�U,WKWMWNWOWPWQWRWSW���ǵ�����Ǧ�x��iLJYIh�Hh�s�5�CJOJQJaJh�Hh�5�CJOJQJaJh�h�hLedCJOJQJaJh�Hh��CJOJQJaJh�Hh�CJOJQJaJh�HhX�>*CJOJQJaJh�HhX�CJOJQJaJ"h�Hhz75�CJH*OJQJaJh�h�h�h�CJOJQJaJh�h�h��CJOJQJaJh�h�CJOJQJaJh�Hhz7CJOJQJaJSWiWjWeXjXnXsXuXvX�X�X�XY'YNYPY_YiYoYpY|Y�Y�Y�Y�Y�YZZZ Z!Z���������ӗӈ��y�y�y�y�ym^O�h�h�h�h�CJOJQJaJh�h�hnW%CJOJQJaJh�h�CJOJQJaJh�HhVUCJOJQJaJh�Hh(CJOJQJaJh�Hh��CJOJQJaJh�HhC�CJOJQJaJh�HhrJ�CJOJQJaJh�Hh�Y?CJOJQJaJh�Hh�D�CJOJQJaJh�Hh�CJOJQJaJh�Hh<O�CJOJQJaJ!Z"Z+Z2Z3Z�Z�Z�Z�Z�Z�Z�Z�Z~[�[�[�[�[�[�[B]�]�]�]�]�������ĸ��Ӌ���|m^mO���h�Hh-.CJOJQJaJh�HhC�CJOJQJaJh�Hh�hCJOJQJaJh�Hh�DCJOJQJaJh�HhhVCJOJQJaJh�h�h�h�CJOJQJaJh�h�hnW%CJOJQJaJh�h�CJOJQJaJh�Hh0�CJOJQJaJh�HhMBJCJOJQJaJh�Hh��CJOJQJaJh�Hh�CJOJQJaJ�]�]�]^ ^!^*^�^_�_�_�_�_�_�_�_J`m`w`y`~`�`�`�`�`�`�`&aza�a�a�b�b�b�b�b��������ĵĵ�񦗵����������yjy����[h�HhLD'CJOJQJaJh�Hh�B�CJOJQJaJh�Hh�.�CJOJQJaJh�Hh#�CJOJQJaJh�Hh=�CJOJQJaJh�HhhVCJOJQJaJh�Hh�Y?CJOJQJaJh�Hh�u�CJOJQJaJh�Hh�3CJOJQJaJh�Hh-.CJOJQJaJh�Hhj�CJOJQJaJ#�b�b8cXcmcvc�c�c�c�c�c�c�c�c�c�c�c�c�c�c�c3d������Ǹ����{��o`QB��h�e�h�e�CJOJQJaJh�e�hLedCJOJQJaJh�e�h��CJOJQJaJh�e�CJOJQJaJh�h�hnW%CJOJQJaJh�HhP�CJOJQJaJh�HhP�5�CJOJQJaJh�h�h�h�CJOJQJaJh�h�hLedCJOJQJaJh�h�CJOJQJaJh�Hh:	�CJOJQJaJh�HhLD'CJOJQJaJh�Hh�HCJOJQJaJ3d6d�d�d�d�d�d�d�d�d�d
e0e>eGeRebeheqexeze�e�e�e�e�e�e�e�e����ó�������������vfV���vfVh�e�h�e�CJOJQJ\�aJh�e�h��CJOJQJ\�aJh�e�CJOJQJ\�aJh�Hh��CJOJQJ\�aJh�HhNMCJOJQJ\�aJh�Hh�CJOJQJ\�aJh�Hh�@�CJOJQJ\�aJh�HhNM5�CJOJQJaJh�Hh�^zCJOJQJaJh�HhP�CJOJQJaJh�HhNMCJOJQJaJ�e�e�ef�f�fgggg g"g#g$g)g5g7g9g:g�g�g�g3hBhDhFhGh��Ͽ�����r������b��R�R��b�h�Hhk"CJOJQJ\�aJh�e�h?+CJOJQJ\�aJh�Hh��CJOJQJ\�aJh�e�h�e�CJOJQJ\�aJh�e�h��CJOJQJ\�aJh�e�CJOJQJ\�aJh�Hh?+CJOJQJ\�aJh�Hh9,�CJOJQJ\�aJh�Hh#|�CJOJQJ\�aJh�HhNMCJOJQJ\�aJh�Hh�2CJOJQJ\�aJGhHhLhYh[h]h^h_hiiiii"i>iNiPi������ޑpapRC7h�e�CJOJQJaJh�Hh�cjCJOJQJaJh�Hh$sCJOJQJaJh�Hh-!CJOJQJaJh�HhN�CJOJQJaJ"h�Hh�5�CJOJQJ\�aJh�Hh9,�CJOJQJ\�aJh�e�h�e�CJOJQJ\�aJh�e�h?+CJOJQJ\�aJh�e�CJOJQJ\�aJh�Hh?+CJOJQJ\�aJh�Hhk"CJOJQJ\�aJ"h�Hh?+CJH*OJQJ\�aJPiSiYiZi�i�i�i�i�i�i�i�i�i�i�ij(j6j8j9j:jZj{j|jkkkNkPkRkXk���ĵĵ��ӵ��ӵ����ӵ���|m��^Oh�e�hLedCJOJQJaJh�e�h�
CJOJQJaJh�Hh�CJOJQJaJh�Hh9,�CJOJQJaJh�Hh�fCJOJQJaJh�Hh"�CJOJQJaJh�e�CJOJQJaJh�Hh$sCJOJQJaJh�HhN�CJOJQJaJh�e�h�e�CJOJQJaJh�e�h�|
CJOJQJaJh�e�h�cjCJOJQJaJXkYk�k*l6lPlzl�l�l�l�l�l�l�l�l�l�l�l�m�m�m�m1n5nHnJnKnLn�n�n���ĵĦ��|��j�ĵĵ�|�Ħ�|�[Lh�Hh�C~CJOJQJaJh�Hh,ziCJOJQJaJ"h�Hh-!5�CJH*OJQJaJh�e�h�=CJOJQJaJh�e�hLedCJOJQJaJh�e�CJOJQJaJh�Hh�=CJOJQJaJh�Hh-!CJOJQJaJh�Hh�CJOJQJaJh�Hh�
CJOJQJaJh�Hh�fCJOJQJaJh�e�h�e�CJOJQJaJ�n�no/oHoJoLoMoNoQoSoVoWoYoZo[o]o�o�oGp�p�p�pqqqqq8q:q�����ǸǸǸ����|�l\|M|M֚�|M�h�Hh�XCJOJQJaJh�Hh,ziCJOJQJ\�aJh�Hh�CJOJQJ\�aJh�Hh�CJOJQJaJh�e�h�e�CJOJQJaJh�e�hLedCJOJQJaJh�e�h�CJOJQJaJh�e�h�=CJOJQJaJh�e�h�jfCJOJQJaJh�e�CJOJQJaJh�Hh�C~CJOJQJaJh�Hh,ziCJOJQJaJ:q?q@qAqBqJqOq�q�q�q�qr#r�r�rss%s&s*s���������ueUuUEu3E"h�HhLL�5�CJOJQJ\�aJh�HhLL�CJOJQJ\�aJh�HhF	FCJOJQJ\�aJh�Hh�r	CJOJQJ\�aJh�Hh�CJOJQJ\�aJh�Hh�r	CJOJQJaJh�Hh"�CJOJQJaJh�Hh:	�CJOJQJaJh�Hh�CJOJQJaJh�Hh�XCJOJQJaJh�e�h�XCJOJQJaJh�e�h�e�CJOJQJ\�aJh�e�h�O�CJOJQJ\�aJ*sBsJsKsTs�s�s�s�s�s�s�s�s=t?t�t�t�t�t�������²���sdsUI:h{O-h�O�CJOJQJaJh{O-CJOJQJaJh�Hh�O�CJOJQJaJh�Hh"�CJOJQJaJh�HhLL�CJOJQJaJh�HhLL�5�CJOJQJaJh{O-hLL�5�CJOJQJaJh{O-h{O-CJOJQJ\�aJh{O-h�O�CJOJQJ\�aJh{O-h�CJOJQJ\�aJh{O-CJOJQJ\�aJh�HhLL�CJOJQJ\�aJh�Hh�CJOJQJ\�aJ�t�t�tuuuu`uu�u�u�u�u�u�u�u�u�u�u�u�u�u�u�u�u�u:v���Ǹ�өǚ��ǚ��ǚ���{k\Mh�HhJ1[CJOJQJaJh�Hh�jfCJOJQJaJh�Hh�5�CJOJQJaJh�Hh�
fCJOJQJ\�aJh�Hh�
fCJOJQJaJh{O-h��CJOJQJaJh�Hh��CJOJQJaJh{O-h"�CJOJQJaJh{O-CJOJQJaJh�Hh�yQCJOJQJaJh�HhLL�CJOJQJaJh{O-h{O-CJOJQJaJ:v=vdviv�v�v�v�vw.w0w9w:wHw�w�w�w�w�w�w�w�w�w8xZxqx�x�x�x
y,y-yEy�z�z�z�z){�����������ⴥ��Ӗ����������������wgh�Hh:�5�CJOJQJaJh�Hh4b�CJOJQJaJh�HhLedCJH*OJQJaJh�Hh^:CJOJQJaJh�Hh�CJOJQJaJh�Hh�jfCJOJQJaJh�HhJ1[CJH*OJQJaJh�Hh�?MCJOJQJaJh�HhJ1[CJOJQJaJh�Hh"�CJOJQJaJ%�z�z){,{b{d{�{�{,|a|c||||�|�|�|�|�|�|�|�|�|�|�|�|�|�|��������������������������$a$gd�l~$a$gd:�$a$gd.F�){*{]{^{b{c{�{�{�{�{�{%|&|a|b|c|{|||}||�|�|�|�|�|�|�|}	}R}S}_}`}������ȹ������ة�؝��scSc���عh�Hh2+�5�CJOJQJaJh�Hh:�5�CJOJQJaJh�Hh�GCJOJQJaJh�Hh-e%CJOJQJaJh-e%CJOJQJaJh:�CJOJQJaJh�Hh:�6�CJOJQJaJh�Hh2+�CJOJQJaJh�Hh:�>*CJOJQJaJh�Hh:�CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHu �|�|�|}}R}a}v}�}2~�~�~�~M���8�������{�ׁL���&�(����������������������������$��`��a$gd2+�$a$gd:�`}a}v}{}�}�}�}�}�}�}�}�}(~)~2~7~;~@~a~l~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~�~=BDEQRdq�������������������������������������������������������������������������h�Hh:�>*CJOJQJaJh�Hh:�CJH*OJQJaJh�Hh"�CJOJQJaJh�Hh�GCJOJQJaJh�Hh:�5�CJOJQJaJh�Hh:�CJOJQJaJ@�����������
����$�-�.�/�?�L�\�]�_�`�n�o�q�r�w�~���������€ʀՀր׀܀݀ހ���������������������������������ђ���������ђ��������h�Hh:�CJH*OJQJaJh�HhU.�CJOJQJaJh�HhU.�6�CJOJQJaJh�HhyOW6�CJOJQJaJh�Hh:�6�CJOJQJaJh�HhyOWCJOJQJaJh�Hh:�CJOJQJaJh�Hh:�5�CJOJQJaJ1�'�?�@�A�B�Q�S�c�o�q�{�������������́�(�4�=�@�A�g�h�|����Ђ������&�'�(��������������������������������������������⫛�w�w�"h�Hhn(�6�CJOJQJ]�aJ"h�Hh:�6�CJOJQJ]�aJh�Hh:�6�CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHuh�Hh�!�CJOJQJaJh�Hh"�CJOJQJaJh�Hh:�CJOJQJaJh�Hh]}4CJOJQJaJ,(�q�������փ������������ �!�"�#�$�%�&�'�(���������������������������������$a$gd:�� �#�(���������τЄф�����������
����(�)�H�I�N�O�X�\�c�d�n�u�v��������ҹ�񪹪��x�����f���f�f�x�f���f��f��"h�Hh:�>*CJOJQJ]�aJ"h�Hh:�CJH*OJQJ]�aJh�Hh2,CJOJQJ]�aJh�Hh:�CJOJQJ]�aJh�Hh:�CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHuh�Hh:�5�CJOJQJaJh�Hh�QzCJOJQJaJh�Hh2,CJOJQJaJ&��τф/��������[�����
����Z�����݌�v���܎�����i�k�����������������������������$a$gd:���������������������…ʅυЅ��.�8�J�L�Z�l�n���������ƆȆچ܆<�B��������������9�Y�Z�g�j�{�~���������������ˆĈՈֈ׈���޺ު޺ު޺޺ު�̪����ުު��ު������ުުޘުު�̪����ުު�"h�Hh�6CJH*OJQJ]�aJh�Hh2,CJOJQJ]�aJ"h�Hh:�>*CJOJQJ]�aJ"h�Hh:�CJH*OJQJ]�aJh�Hh:�CJOJQJ]�aJ"h�Hh2,>*CJOJQJ]�aJ<׈؈������!�2�C�D�E���N�������ЊҊ6�:�Z�z����������������������������ͻ߻������߻������߫��ߒ�p"h�Hh:�6�CJOJQJ]�aJh�Hh:�6�CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHuh�HhKk(CJOJQJ]�aJ"h�Hh:�CJH*OJQJ]�aJ"h�Hh:�CJH*OJQJ]�aJh�Hh:�CJOJQJ]�aJh�Hh2,CJOJQJ]�aJ%����݌ߌ���Žڎ܎���������b�i�j�k�}�~����������%�-���;;;��͆;͕�v�fvfv�V͆h�Hh:�6�CJOJQJaJh�Hh��CJOJQJ]�aJh�Hh:�CJOJQJ]�aJh�Hh��CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHuh�Hh:�5�CJOJQJaJh�HhKk(CJOJQJaJh�Hh:�CJOJQJaJ"h�Hh:�6�CJOJQJ]�aJ"h�HhIis6�CJOJQJ]�aJk�~�ΐ��$�%�&�'�(�)�*�+�,�-�.�/�0�1�2�3�4�������ّۑ����������������������������$��`��a$gd�4g$a$gd:�-�1�4�G�R�r���������ّڑۑ�R�������ɒӒ2�q�����Ɠ͓�����&�.�A�J�U�d�}��������©���š‡w��š���w���g�h�Hh��5�CJOJQJaJh�Hh:�>*CJOJQJaJ%h�Hh:�5�6�CJOJQJ]�aJh�Hh:�CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHuh�Hh:�5�CJOJQJaJh�Hh�4g5�CJOJQJaJh�Hh��CJOJQJaJh�Hhsp�CJOJQJaJ$���R����������2�f�q����U�d�Ɣ/��������!�V�����%���ŗ����������������������������$a$gd:�}�������Ɣ���#�$�%�/�\�d�������˕��������!�+�,�`�a�������Ԗ����?�[�g���������óó������������ã����óÄ�t�t�t�h�Hh�;�5�CJOJQJaJh�Hh�P�5�CJOJQJaJh�Hh�>�CJOJQJaJh�Hh��5�CJOJQJaJh�Hh�>�5�CJOJQJaJh�Hh:�5�CJOJQJaJh�Hh��CJOJQJaJh�Hh:�CJOJQJaJh�HhKk(CJOJQJaJ'������ŗؗ������/�2�>�Y�e�x�{�����ϘҘ������ �!�m�q����ͽ��ͫ������{��rcTh�Hhsp�CJOJQJaJh�Hh:�CJOJQJaJh�Hh:�6�CJOJQJaJ0jh�Hh�p@CJOJQJUaJmHnHuh�Hh�I�CJOJQJ]�aJ"h�Hh�;�5�CJOJQJ]�aJh�Hh�;�CJOJQJ]�aJ"h�Hh:�5�CJOJQJ]�aJh�Hh�>�CJOJQJ]�aJh�Hh:�CJOJQJ]�aJŗؗ�>�Y�������ݘ�!�k�l�m�n�o�p�q�r�~�7�ߚ6����������������������������������$
&Fdha$gd4b�$a$gd�l~$a$gd:�q�r�~����������	� �-�4�`����ʚԚ�����������_�k�z��������	�d�w�������������������������ҁ�q�_��_��_�"h�Hh�c$6�CJOJQJ]�aJh�Hh�c$5�CJOJQJaJh�Hh��CJOJQJaJh�Hh�c$CJOJQJaJ"h�HhGS�6�CJOJQJ]�aJ"h�HhBN�6�CJOJQJ]�aJh�HhGS�CJOJQJaJh�HhKk(CJOJQJaJh�HhBN�5�CJOJQJaJh�HhBN�CJOJQJaJ%������������������Ş�$�6���şϟH�^�i�j����
��������%�Ţ֢עߢ��������������񯠑���������p�����h�Hh_,CJOJQJaJ"h�Hh*M6�CJOJQJ]�aJh�Hh*MCJOJQJaJh�Hh|�CJOJQJaJ"h�Hh�	N6�CJOJQJ]�aJh�Hh��CJOJQJaJ"h�Hh�c$6�CJOJQJ]�aJh�Hh�c$CJOJQJaJh�Hh�	NCJOJQJaJ&���ƞ8�؟t����.���ǣm�����<���e����4K5�5Z67�7�7�7�������������������������$a$gd�l~$�hd�^�ha$gd�$
&Fdha$gd4b���� ���������ƣF�[�a�b�դ�f�������)�;�<�G����;�Y�Z�[�e�h�������4q4�4�4������������������u�suau"h�Hh_,6�CJOJQJ]�aJUh�Hh_,CJOJQJaJh�Hh?+CJOJQJaJh�Hh*MCJOJQJaJh�Hh��CJOJQJaJ"h�Hh�Q�6�CJOJQJ]�aJh�Hh�X>6�CJOJQJaJh�Hh�X>CJOJQJaJh�HhGS�CJOJQJaJh�Hh�Q�CJOJQJaJ%Laat MW, Franx A, Bots ML, Visser GH, Nikkels PG. Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol 2006; 107: 1049�1055.
de Laat MW,  van Alderen ED, Franx A, Visser GH, Bots ML, Nikkel PG. �The umbilical coiling index in complicated pregnancy�. Eur J Obstet Gynecol Reprod Biol 2006, 70 (12): 93-100.
Wigglesworth JS. In: Wigglesworth JS, Singer DB, eds. Textbook of Fetal and Perinatal Pathology, 2nd ed. Malden, MA: Blackwell, 1998; 84�85.
 Incerpi MH, Miller DA, Samadi R, et al. Stillbirth evaluation: what tests are needed? Am J Obstet Gynecol 1998; 178: 1121�1125. 
Del Valle GO, Santerini K, Sanchez-Ramos L, Gaudier FL, Delke I. The straight umbilical cord: significance and prenatal implications [abstract]. Am J Obstet Gynecol 1995; 172: 286.
Strong TH, Finberg HJ, Mattox JH. Antepartum diagnosis of noncoiled umbilical cords. Am J Obstet Gynecol 1994; 170(1): 729�733.










 PAGE   \* MERGEFORMAT 13




�4�4545J55�5�5/6B6�6�67777d7x7}7�7�7�7�7�7�7�7�7���࿭����������}�n�_PHDHDh�p�jh�p�Uh�HhBN�CJOJQJaJh�Hh�*CJOJQJaJh�Hh,XCJOJQJaJ"h�Hh�=6�CJOJQJ]�aJh�Hh�=CJOJQJaJh�Hh��CJOJQJaJ"h�HhS76�CJOJQJ]�aJh�HhS7CJOJQJaJ"h�Hh�ZO6�CJOJQJ]�aJh�Hh_,CJOJQJaJh�Hh_,CJOJQJ\�aJ�7�7�7�7�7�7�7�7�7�7�7�7�7�7�������������$a$gd�l~$a$	d��gdNdC
�7�7�7�7�7�7�7�7�7�7�7�7�7�7�����������h�HhBN�CJOJQJaJhKP�jh�p@UmHnHuh�qwmHnHuhNdCjh�p@Uh�p�jh�p�U
21�h:p�l~��/ ��=!�8"�8#�8$�8%�������j���������666666666vvvvvvvvv666666>666666666666666666666666666�6666666666�666666666666hH66666666666666666666666666666666666666666666666666666666666666666�62���� 0@P`p������2(�� 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p��8X�V~ OJPJQJ_HmH	nH	sH	tH	J`�J�o�Normald��CJ_HaJmH	sH	tH	DA �D
Default Paragraph FontRi�R0Table Normal�4�
l4�a�(k �(
0No ListH�`��H�2
No SpacingCJ_HaJmH	sH	tH	B'`�B	�10Comment ReferenceCJaJB@B	�10Comment Textd�CJaJB�o�!B�10Comment Text CharCJaJ@j@@	�10Comment Subject5\N�o�AN�10Comment Subject Char5�CJ\�aJR�@RR	�10Balloon Textd��CJOJQJ^JaJN�o�aN�10Balloon Text CharCJOJQJ^JaJ6U`�q60�0	Hyperlink>*B*ph�@�@�@BN� List Paragraph	^��m$d�o�d�c$Default1$7$8$H$-B*CJOJPJQJ_HaJmH	phsH	tH	>�>NdC0Headerd���H�$.���.NdC0Header Char> @�>NdC0Footerd���H�$.���.NdC0Footer CharPK!����[Content_Types].xml���N�0E�H���-J��@%�ǎǢ|�ș$�ز�U��L�TB� l,�3��;�r��Ø��J��B+$�G]��7O٭V��<a���(7��I��R�{�pgL�=��r���8�5v&����uQ�뉑8��C����X=��$␴�?6N�JC������F�B.ʹ'�.�+���Y�T���^e5�5�� ��ð�_�g -�;�����Yl�ݎ��|6^�N��`�?���[��PK!�֧�6_rels/.rels���j�0���}Q��%v/��C/�}�(h"���O�
����=������ ����C?�h�v=��Ʌ��%[xp��{۵_�Pѣ<�1�H�0���O�R�Bd���JE�4b$��q_����6L�R�7`������0̞O��,�En7�Li�b��/�S���e��е�����PK!ky���theme/theme/themeManager.xml�M
� @�}�w��7c�(Eb�ˮ��C�AǠҟ����7��՛K
Y,�
�e�.���|,���H�,l����xɴ��I�sQ}#Ր���� ֵ+�!�,�^�$j=�GW��)�E�+&
8���PK!0�C)��theme/theme/theme1.xml�YOo�6��w toc'vu�ر�-M�n�i���P�@�I}��úa��m�a[�إ�4�:lЯ�GR��X^�6؊�>$�������!)O�^�r�C$�y@�����/�yH*��񄴽)�޵��߻��UDb�`}"�qۋ�Jח���X^�)I`n�E���p)���li�V[]�1M<������O�P��6r�=���z�gb�Ig��u��S�eb��O������R�D۫����qu	�g��Z����o~ٺlAp�lx�pT0���+[}`j���zA��V�2�F���i�@�q�v�֬5\|��ʜ̭N��le�X�ds���jcs���7���f����
��W��+�Ն�7����`���g�Ș��J���j|��h(�K��D-����
dX��iJ�؇(��x$(��:��;�˹!�I_�T��S1�����?E��?�����?ZBΪm���U/������?�~����xY���'���y5�g&΋/����ɋ�>���G�M�Ge���D�����3Vq%'#q�����$�8��K�����)f�w9:ĵ��
x}r�x����w���r�:\TZaG�*�y8I�j�bR��c|XŻ�ǿ�I
u3KG�nD1�NIB�s���
��R��u���K>V�.EL+M2�#'�f��i~�V��vl�{u8��z��H�
�*���:�(W�☕
~��J�T�e\O*�tHG��HY��}KN�P�*ݾ˦���TѼ�9/#��A7�qZ��$*c?���qU��n��w�N��%��O��i�4=3��N���)cbJ
u�V�4����(Tn���
7��_?���m-ٛ�{U���B�w�<w���_���$�#��[Ի�8{���(�/�$Ϫ0h݋�F۴��®{L�)#7�i�%�=A�:s�$�),��Qg20pp��f
\}DU4�p
M{��DB��%J������+{�l�C���]��=��5
2F��hsF+��Y��\Ɉ�n�ì��:3���E�[��6�9����`��&45Z!��*��5k8�`Fmw��-��"�d>�z��n���ʜ"Z��x��J�Z��p;�������{/�<�P;��,)''K�Q�k5���q��pN��8�K�Gb�e���
�S��d�̛�\17	�p�a�>��SR!���

3��K4'+�r�zQ
TT��I����Ivt]K�c⫲�K#�v�5+�|��D������~��O@%\w���_�nN[�L��9K���q��g�V�h��n
R!�y+��U�n�;�*&�/H�r��T�	�>��>\
�t��=.Tġ
���S; Z�~�!����P��9gi���C�ڧ!�#	B��,��;�X=ۻ,I�2UW�V�9$l�k���=A��j���;�{�A�P79�|s*Y�����;�̠�[�MC�ۿ�hf��]o��{oY=1k�yV��V���5E8�Vk+֜���\8���0X4D)�!!��?*|f�v�
u���"�x��A�@T_������q��6�4)kڬu�V�7��t�'��%;���i�9s�9�x���,��ڎ-45x�d���8?�ǘ�d�/Y|t��&LIL�J`�& �-G�t�/��PK!
ѐ��'theme/theme/_rels/themeManager.xml.rels��M
�0���wooӺ�&݈Э���5
6?$Q��
�,.�a��i����c2�1h�:�q��m��@RN��;d�`��o7�g�K(M&$R(.1�r'J��ЊT���8��V�"��AȻ�H�u}��|�$�b{��P����8�g/]�QAsم(����#��L�[������PK-!����[Content_Types].xmlPK-!�֧�60_rels/.relsPK-!ky���theme/theme/themeManager.xmlPK-!0�C)���theme/theme/theme1.xmlPK-!
ѐ��'�	theme/theme/_rels/themeManager.xml.relsPK]�
<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<a:clrMap xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main" bg1="lt1" tx1="dk1" bg2="lt2" tx2="dk2" accent1="accent1" accent2="accent2" accent3="accent3" accent4="accent4" accent5="accent5" accent6="accent6" hlink="hlink" folHlink="folHlink"/>�>����	+++.
�
�D��s
- �!�#
(M*1,�.2�8�;�@E�IFN�Q�SzT�USW!Z�]�b3d�eGhPiXk�n:q*s�t:v){`}�����׈��-�}���q����4�7�7TVWYZ[\]^_`abdefghiklmnoqrstuvwxyz{|}~�������������������Z�#�;#O�z�|(���k��ŗ���7�7UXcjp���������$'.!�����L�#����@���������Eq���p�(	�
��B
�
3�>�Ԕ��,�Straight Connector 15#"��Â?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!.:T�9drs/e2oDoc.xml�S��� �W�? �Y�Y'���*;�e�F�`'���H�n/UU���{����Kt��	�J�ݥqE5�-��d���D1"��%>s��V?,S��d�"Q�L�;�M�$�v�'�N� �h�S�&̒�{�L�t��2c5��j}I�U�oN���q�#Yb���h�c�Z����t�^i�`����TM<A+��������Q�'�i��&K�U���Ǚ�L�үǭE��w3����D��G�V
�A��+�@��6�JOjg�5���UGT�#㗳�,�H�	g��E3�C^G�N��$�Nѝ��~���l��)�H�\B����G!(�*G
r|v>!Ÿ%,+�RF�BC��@���R�����+iё���_,��6��E����ƞy��v��|�ѥA~>����z�O��|=�Ӻ�|�T�d��f�}]Uu�+P���q؍͚���gsi�[��tHޢG��������K'�5;o�h2�g�|}K���C��ů~��PK!D"��drs/downrev.xmlL��N�0��H�Cd$n,݀���B��5�)$N�d[��1�G���s���WJy�l`��@�ю<x}y��A�l�G&��aӝ����x�g:lˠ��s�\)S�u�̋8K�S�"c�Mx�����:��r��D�����>x�Z�<U�M����߿��S6�l��Uh.��/�Љ�.��f�
�#E���u����k�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!.:T�9.drs/e2oDoc.xmlPK-!D"��vdrs/downrev.xmlPK�y���B
�
3�>�Ԕ��,�Straight Connector 16#"��Â?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK! �M�9drs/e2oDoc.xml�S��� �W�? ��7���*;�e�F�`'���H�n/UU���{����Kt��	�J�MS����	Ֆ���f���y��Z����O����)�LwZ2n�(W�ĝ��HG;�7Ն+H6���Զ	�d�^&�4�'���XM�s�Z_�x�S��i�H���8�8�Ø���h-1��W�X�D(��UO��?�zA�v��S��D7��<��d�jv1<��8s��?X����H0�n��"=x�󖈶��J���"H�R�q��ֆZ�I�̳�?R��jyd�r6���ɛ#a�ܷ�h{��(۩�}�A�)�s���OQX����C
&�1��b<h���QJ,�
‘���DH1n	�Jo���|��P�E�!�,d�Ķ�JZt$���z���b�ㄭ��'B^b�]����kti�����z�^�|6_O�'�6U>�o�������:��ey�	Ƹ
��f��k�볹�٭]o:$oѣ`@v�G����ߥ����v4�3n����^�!~��W���PK!�8t�drs/downrev.xmlL��N�0��H�Cd$n,�@S)M'��
�=�ט��8U�m��Lj������f^)�1���E�G;�``��xU��٢�L>)æ;?k����/tܖAI	�
�R�F��;
�q"��-��E�4h��$��UU�u���É��C0�t��}����k�Q��٧l���|��\���G_ԡ�}<����G�е�KZ�+�_��V�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-! �M�9.drs/e2oDoc.xmlPK-!�8t�vdrs/downrev.xmlPK�y���B
�
3�>�Ԕ��,�Straight Connector 14#"��Ã?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!�s9drs/e2oDoc.xml�S��� �W�? ��7���*;�e�F�`'���H�n/UU���{����Kt��	�J�MS����	Ֆ���f���y��Z����O����)�LwZ2n�(W�ĝ��HG;�7Ն+H6���Զ	�d�^&�4�'���XM�s�Z_�x�S��i�H���8�8�Ø���h-1��W�X�D(��UO��?�zA�v��S��D7��<��d�jv1<��8s��?X����H0�.�H�<�yKD�yTi�@Am$A���TjkC��v�Y�)]uD�<2~9@�‰�͑0q��_4�=��u����>@� ��9���'�(,����!�KH14��\�(%�B�HA���"���e�7B�h�Th(��"�rZ
�qb�}%-:��?�e��f�A���q����!/1�.U��Z��5�4����q�X/�I>��'yZדO�*��7��}}WWU��
Բ��c\vc�f��5��\��֮7���Q0 ;�#�hf���	{��[;��7_�Rx���~����PK!��drs/downrev.xmlL��N�0��H�Cd$n,݊P�N�{�1MG�TM��#p�[�?7�9xu�)
�
,(�.ځ{����
T��}d2�I	6��E���g~��6�JJ8�h��<�Z��Q���#�d�q
�e�zm'<Ky�zUw:�r��H�����1x�]޿ڍee=��W�������֠2�o~�EZq��#ۤ�y$-KP�V�J������o��PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!�s9.drs/e2oDoc.xmlPK-!��vdrs/downrev.xmlPK�z���B
�
3�>�Ԕ��,�Straight Connector 13#"��Ã?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!2vg69drs/e2oDoc.xml�S��� �W�? �Yۉ7���*;�e�F�`'���H�n/UU���{����Kt��	�J�ݥqE5�-��d���D1"��%>s��V?,S��d�"Q�L�;�M�$�v�'�N� �h�S�&̒�{�L�t��2c5��j}I�U�oN���q�#Yb���h�c�Z����t�^i�`����TM<A+��������Q�'�i��&K�U���Ǚ�L�үǭE��w3����D��G�V
�A��+�@��6�JOjg�5���UGT�#㗳�,�H�	g��E3�C^G�N��$�Nѝ��~���<MR0�����Ac���u�BPb)T���| B�qKXVz#���K���@���R�����+iё���_,��6��E����ƞy��v��|�ѥA~>����z�O��|=�Ӻ�|�T�d����Y]Uu�+P���q؍͚���gsi�[��tHޢG��������K'�5;o�h2�g�|}K���C��ů~��PK!��drs/downrev.xmlL��N�0��H�Cd$n,݊P�N�{�1MG�TM��#p�[�?7�9xu�)
�
,(�.ځ{����
T��}d2�I	6��E���g~��6�JJ8�h��<�Z��Q���#�d�q
�e�zm'<Ky�zUw:�r��H�����1x�]޿ڍee=��W�������֠2�o~�EZq��#ۤ�y$-KP�V�J������o��PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!2vg69.drs/e2oDoc.xmlPK-!��vdrs/downrev.xmlPK�z���	B
�

3�>�Ԕ��,�Straight Connector 11#"��Ç?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!�OY�9drs/e2oDoc.xml�SM�� �W�@�gmg�٬gU�I/�n�ll�b�U���G��RU�3<޼7̟�"{a�]&�]��p��2����<՜*ТL��%ϋ���)�:P\X� ��)��{S��c�詻#4�=���m�-�W�8˦��L8���)�,"~��_��	OT� 7G�m�Ŝ�����L����J��^�j�)�Y�T/���cЧ�4��XV�g�U���Ǚ�L����%��wyB4�ѣ��T��'h�
�%D��
<P�
���ޘ`_�PuT�"2~;D�'қ#a�޷>���e;4��(9Dw�Ww����,{��Dv����4��z&e���т�_�G�zI	�VR�h��d(��Y��!�@I�qa�m�,���?�B �M������/�sO�:�1_逇� ���� ߞ���l9��&��r4��z�aUMF�U��P��UU���|Rt�s��K�擿k��9�ٵ]�:���D${�G����ߩ���k��b���[
��u���?��PK!x��drs/downrev.xmlL��N�0D�H���Hܨ��4�S!$np���x�S�u�m��Y��3��y�l��Չ�4D6�\���h�
��>�T�RF��#��OJ�m//�m<��v�WR©F.��:u��E�%{�S�,r굝�,��UQ��˂Ñu�c0�T.�υv�me=��W��������7�2��~�Za��#ۤ�y$(�%(I�j%���m������PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!�OY�9.drs/e2oDoc.xmlPK-!x��ydrs/downrev.xmlPK�~���B
�
3�>�Ԕ��,�Straight Connector 12#"��Â?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!��@�9drs/e2oDoc.xml�S��� �W�? ��7���*;�e�F�`'���H�n/UU���{����Kt��	�J�MS����	Ֆ���f���y��Z����O����)�LwZ2n�(W�ĝ��HG;�7Ն+H6���Զ	�d�^&�4�'���XM�s�Z_�x�S��i�H���8�8�Ø���h-1��W�X�D(��UO��?�zA�v��S��D7��<��d�jv1<��8s��?X����H0�n��"=x�󖈶��J���"H�R�q��ֆZ�I�̳�?R��jyd�r6���ɛ#a�ܷ�h{��(۩�}�A�)�s���OQX����C
&�1��b<h���QJ,�
‘���DH1n	�Jo���|��P�E�!�,d�Ķ�JZt$���z���b�ㄭ��'B^b�]����kti�����z�^�|6_O�'�6U>�o�������:��ey�	Ƹ
��f��k�볹�٭]o:$oѣ`@v�G����ߥ����v4�3n����^�!~��W���PK!�8t�drs/downrev.xmlL��N�0��H�Cd$n,�@S)M'��
�=�ט��8U�m��Lj������f^)�1���E�G;�``��xU��٢�L>)æ;?k����/tܖAI	�
�R�F��;
�q"��-��E�4h��$��UU�u���É��C0�t��}����k�Q��٧l���|��\���G_ԡ�}<����G�е�KZ�+�_��V�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!��@�9.drs/e2oDoc.xmlPK-!�8t�vdrs/downrev.xmlPK�y���B
�
3�>�Ԕ��,�Straight Connector 10#"��Ã?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!<�~g9drs/e2oDoc.xml�SMo�0��|Ol�i�q��Nv��~�"ɶ0Y$%N0쿏R>�v�a�2)JO������+r�I�e����̀Kݖ���h���T�er.yZ~��L!&Ё��ѮL�tޛ"M�DO���l��ԣk۔[: z��I���,7�pw�s0YF���k'<Qe��|\m\waM�Z���N�
�,z*5>z����do�P�d4~̠O�i$1�&��e��1Ǚ�L�����%�c�PM{���[*�Γ
�F��R�q^��Ɔ\�Qo�3��h�:�[�����F��Jp���v��x��=Dَ��$
B��:�[u������,{Ȑ%��RZ\/�g=	F�(��p���g�Z\��m
k�T,��d(��y��!�@I�ѱ�R�h�Ŵ����<�u����T����+�0�s��
��1{\�W��h:��FӬ�G���t4[���]]Uu�+P˧E'9:��6k>��f��͹�n�z�!}�C��$��w����^���_f)�k����
��PK!��drs/downrev.xmlL��N�0��H�Cd$n,݊P�N�{�1MG�TM��#p�[�?7�9xu�)
�
,(�.ځ{����
T��}d2�I	6��E���g~��6�JJ8�h��<�Z��Q���#�d�q
�e�zm'<Ky�zUw:�r��H�����1x�]޿ڍee=��W�������֠2�o~�EZq��#ۤ�y$-KP�V�J������o��PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!<�~g9.drs/e2oDoc.xmlPK-!��vdrs/downrev.xmlPK�z���B
�

3�<�Ԕ��*�Straight Connector 8#"��Á?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!_XG�7drs/e2oDoc.xml�S��� �W�? ��7���*;�e�F�`'���H�n/UU�3<���O�^�#�NhU�l�b��L����_6�F�ňԊ���~Z}��L�g�Ӓq�D�b0%�7E�8�񞸩6\A�Ѷ'\�&̒�{���t��2c5��n}	�U�oN���q�#Yb���j�k�Z����t�^i�`����TM<A+�������O���4��XT����u��X4Ǚ[����_�[�+1�H�%��<��R�@m�"�i0���Jmm�����<k��!�����G�/g Y8��9g��E3�!�c�N��$���6�6����y�>� !c	)ƃ�:�����R��6R���)Ɣ���FH��

%�[dBNK�B4:��WҢ#	��Xֻ4��E����ڞy��v��|��e<~>����z�O��|=�Ӻ�|�T�d���뻺���W���E'�*�G5�n���2d�a��!y�d�$��]&a��ykG�a:c�%������~��PK!D"��drs/downrev.xmlL��N�0��H�Cd$n,݀���B��5�)$N�d[��1�G���s���WJy�l`��@�ю<x}y��A�l�G&��aӝ����x�g:lˠ��s�\)S�u�̋8K�S�"c�Mx�����:��r��D�����>x�Z�<U�M����߿��S6�l��Uh.��/�Љ�.��f�
�#E���u����k�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!_XG�7.drs/e2oDoc.xmlPK-!D"��udrs/downrev.xmlPK�x���B
�
3�<�Ԕ��*�Straight Connector 9#"��Á?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!��v�7drs/e2oDoc.xml�S��� �W�? �Y�Yo6��*;�e�F�`'���H�n/UU�3<��<�O�^�#�NhU��.ň+��Pm���l&s��'��/�;����a9��Ou�%��r�`J�yo�$q��=qw�p�F۞xpm�0K@�e2M�Y2hˌՔ;��%�W�i8�ߚ�q�d�������>��jI���	z�A��EO��KoP5�����j�Gu������,}Wͮ#��Z�9����,�z�Z$X�)�Èv��vUZ)h��h�4W@z��6TJOjg�5���UGT�#ߗ��,�H�	�3p�~��䐃ױi��ځNq6��l��#
��4}La�t�%��g�{�K�B�HA���"�S¶�!e�Th(�<�rZ
�ѱ�IPO�bY�Ҭ>(�:N�j{"�ņۥ
xP�Zy�\���|=�'�t���i]O>m�|2�d��}]Uu�+P���q؍R����\Dv��[��0 ;�#�8�0������v2�3&__R��k���}���PK!�8t�drs/downrev.xmlL��N�0��H�Cd$n,�@S)M'��
�=�ט��8U�m��Lj������f^)�1���E�G;�``��xU��٢�L>)æ;?k����/tܖAI	�
�R�F��;
�q"��-��E�4h��$��UU�u���É��C0�t��}����k�Q��٧l���|��\���G_ԡ�}<����G�е�KZ�+�_��V�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!��v�7.drs/e2oDoc.xmlPK-!�8t�udrs/downrev.xmlPK�x���B
�	
3�<�Ԕ��*�Straight Connector 7#"��Â?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!i���7drs/e2oDoc.xml�S��� �W�? �Y�Yo���*;�e�F�`'���H�n/UU�3<��<�O�^�#�NhU��.ň+��Pm���l&��'��/�;����a9��Ou�%��r�`J�yo�$q��=qw�p�F۞xpm�0K@�e2M�Y2hˌՔ;��%�W�i8�ߚ�q�d�������>��jI���	z�A��EO��KoP5�����j�Gu������,}Wͮ#��Z�9����,�z�Z$X��)�Èv��vUZ)h��h�4W@z��6TJOjg�5���UGT�#ߗ��,�H�	�3p�~��䐃ױi��ځNq6��l��#
��4��0B:�R��u�3�=
F��P�m� �g�R�)a[鍐2�^*4��~�t9-���v_I��$�'~��wiV�h'l}�=�b��R<��\��<~>����z�O��l=�Ӻ�|�T�d����}]Uu�+P���q؍R����\Dv��[��0 ;�#�8�0������v2�3&__R��k���}���PK!��drs/downrev.xmlL��N�0��H�Cd$n,݊P�N�{�1MG�TM��#p�[�?7�9xu�)
�
,(�.ځ{����
T��}d2�I	6��E���g~��6�JJ8�h��<�Z��Q���#�d�q
�e�zm'<Ky�zUw:�r��H�����1x�]޿ڍee=��W�������֠2�o~�EZq��#ۤ�y$-KP�V�J������o��PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!i���7.drs/e2oDoc.xmlPK-!��udrs/downrev.xmlPK�y�	��B
�
3�<�Ԕ��*�Straight Connector 5#"��Á?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!�g�'7drs/e2oDoc.xml�S��� �W�? �Y�Y'���*;�e�F�`'���H�n/UU�3<��<�O�^�#�NhU��.ň+��Pm���l&��'��/�;����a9��Ou�%��r�`J�yo�$q��=qw�p�F۞xpm�0K@�e2M�y2hˌՔ;��%�W�i8�ߚ�q�d�������>��jI���	z�A��EO��KoP5�����j�Gu������,}Wͮ#��Z�9����,�z�Z$X�g)�Èv��vUZ)h��h�4W@z��6TJOjg�5���UGT�#ߗ��,�H�	�3p�~��䐃ױi��ځNq6��l��#
��y�>�0B:�R��u�3�=
F��P�m� �g�R�)a[鍐2�^*4��~�t9-���v_I��$�'~��wiV�h'l}�=�b��R<��\��<~>����z�O��|=�Ӻ�|�T�d��f�}]Uu�+P���q؍R����\Dv��[��0 ;�#�8�0������v2�3&__R��k���}���PK!-�d�drs/downrev.xmlL�AN�0E�H�$v�i@UH�T�,(=�4�{�n8=X>��o���:є����q�����M*ed�>2�������3��i�{%%�j4�rk�S�(`ZđX��8̂S��g)^�E����#=:�>��`�ny�Rh7�V֣>|u�Oɘ�a
*Ӝ���G_ԡ�}<�M��G��rJª*�����F��o���PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!�g�'7.drs/e2oDoc.xmlPK-!-�d�udrs/downrev.xmlPK�x���B
�
3�<�Ԕ��*�Straight Connector 6#"��Â?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!�Q��7drs/e2oDoc.xml�SM�� �W�@��Y�7k�YUv�˶��� �mTH����@>���TU}�3��x3�X<��:�U��i�WT3��
YO�9O#R+^�w�i���b4%��^K�-���T��ޔI�h���p�Vہxpm�0KF@d2K�"�e�jʝ����ˈ߶��om�G������u�d� eg���� ��b B��7��x��V�5j�ӭ�R=$�m��&K�U���h�3�6��K�6	V�#E��["�ޣZ+
��O�q%��jcC���Y�)]�Du<�}9�‰�͑�8���/�A�{�vl� ��gs�͆=��y_��C
#��XB��Ac�����Qa)Th)���@��ה���ZHG/+|7�:�����htl���E��Xֻ4���E����؞y��v��|.�Y?���|5�'��XM�i&��u>)���}s��u��
Բ��c\vW�f��I��h�"���և�-zl���#�8�0��v��6�:dPgL��� ��>د��7��PK!�8t�drs/downrev.xmlL��N�0��H�Cd$n,�@S)M'��
�=�ט��8U�m��Lj������f^)�1���E�G;�``��xU��٢�L>)æ;?k����/tܖAI	�
�R�F��;
�q"��-��E�4h��$��UU�u���É��C0�t��}����k�Q��٧l���|��\���G_ԡ�}<����G�е�KZ�+�_��V�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!�Q��7.drs/e2oDoc.xmlPK-!�8t�vdrs/downrev.xmlPK�y�
��B
�
3�<�Ԕ��*�Straight Connector 4#"��Â?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!X��M7drs/e2oDoc.xml�S��� �W�? ��7���*;�e�F�`'���H�n/UU�3<��<�O�^�#�NhU�l�b��L����_6�F�ňԊ���~Z}��L�g�Ӓq�D�b0%�7E�8�񞸩6\A�Ѷ'\�&̒�{���t��2c5��n}	�U�oN���q�#Yb���j�k�Z����t�^i�`����TM<A+�������O���4��XT����u��X4Ǚ[����_�[�+q��"=�h�-m�Q���j��Ч���+���RzR;�����:�Z���
�d�D��Hp����� ���M;5���t��9�f�OQؼ���C
#�c,!�x�X�?sݣ`�X
�F
r|v>!Ř���)��BC��@���R���m����H�z��z�f�A���q��W�!/6�.U��Z��պ���c��^��$��ד<��ɧM�O��ι����~jY^t�1��Q�Y�wR�>���nb��!y�d�$��wQ�^��֎Cu���K
�����~��PK!��drs/downrev.xmlL��N�0��H�Cd$n,݊P�N�{�1MG�TM��#p�[�?7�9xu�)
�
,(�.ځ{����
T��}d2�I	6��E���g~��6�JJ8�h��<�Z��Q���#�d�q
�e�zm'<Ky�zUw:�r��H�����1x�]޿ڍee=��W�������֠2�o~�EZq��#ۤ�y$-KP�V�J������o��PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!X��M7.drs/e2oDoc.xmlPK-!��udrs/downrev.xmlPK�y���B
�
3�<�Ԕ��*�Straight Connector 2#"��Á?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!{�I�7drs/e2oDoc.xml�S��� �W�? ��7���*;�e�F�`'���H�n/UU�3<��<�O�^�#�NhU�l�b��L����_6�F�ňԊ���~Z}��L�g�Ӓq�D�b0%�7E�8�񞸩6\A�Ѷ'\�&̒�{���t��2c5��n}	�U�oN���q�#Yb���j�k�Z����t�^i�`����TM<A+�������O���4��XT����u��X4Ǚ[����_�[�+�#Ez��["�ΣJ+
��B��
H��ֆJ�I�̳�?R��jy�r6��ɛ#�qn�_4�r�:6���>@B;�)��|�
?yDa�~��)������Ac���u��Qb)Th)���@�cJ�Vz#����

%�[dBNK�B4:��WҢ#	�_,�]���"Z�	[_mO���p�Tj>W�"�����z�^�|6_O�'�6U>�o�������:��ey�	Ƹ
�F�f��I�h."���և�-zl���tf��E	{��[;���/)�����
��PK!D"��drs/downrev.xmlL��N�0��H�Cd$n,݀���B��5�)$N�d[��1�G���s���WJy�l`��@�ю<x}y��A�l�G&��aӝ����x�g:lˠ��s�\)S�u�̋8K�S�"c�Mx�����:��r��D�����>x�Z�<U�M����߿��S6�l��Uh.��/�Љ�.��f�
�#E���u����k�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!{�I�7.drs/e2oDoc.xmlPK-!D"��udrs/downrev.xmlPK�x���B
�
3�<�Ԕ��*�Straight Connector 3#"��Á?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!�
x�7drs/e2oDoc.xml�S��� �W�? �Yۉ7���*;�e�F�`'���H�n/UU�3<��<�O�^�#�NhU��.ň+��Pm���l&��'��/�;����a9��Ou�%��r�`J�yo�$q��=qw�p�F۞xpm�0K@�e2M�y2hˌՔ;��%�W�i8�ߚ�q�d�������>��jI���	z�A��EO��KoP5�����j�Gu������,}Wͮ#��Z�9����,�z�Z$X�g)�Èv��vUZ)h��h�4W@z��6TJOjg�5���UGT�#ߗ��,�H�	�3p�~��䐃ױi��ځNq6��l��#
���4}Ha�t�%��g�{�K�B�HA���"�S¶�!e�Th��@���R���m����H�z��z�f�A���q��W�!/6�.U��Z��պ���c��^��$��ד<��ɧM�O��ᾞ�UUg��,/:�W��(�,�;)\�Ed7����E�
��?����(a��yk�!�:c�%����~��W���PK!�8t�drs/downrev.xmlL��N�0��H�Cd$n,�@S)M'��
�=�ט��8U�m��Lj������f^)�1���E�G;�``��xU��٢�L>)æ;?k����/tܖAI	�
�R�F��;
�q"��-��E�4h��$��UU�u���É��C0�t��}����k�Q��٧l���|��\���G_ԡ�}<����G�е�KZ�+�_��V�����PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!�
x�7.drs/e2oDoc.xmlPK-!�8t�udrs/downrev.xmlPK�x�
��B
�
3�<�Ԕ��*�Straight Connector 1#"��Ä?PK!��8���[Content_Types].xml��AN�0E�H��%N�@%邴K@�`dO�dlyLho���D�X�3��'���AL�:��*/�@��X�*���eRp208�J�妾�)�G�,R���}��Q)�=����HiҺ0BL��)�:T뢸W�QD�Y�;d]6������O&���8�*	�VCL�j"󃒝	yJ.;�[�wIC�_	��:�{IO�A�
!>Ø4�	�p���;fɑ3׶Vc��.��ӵn�(����&��p�����o��PK!8�!���_rels/.rels���j�0���}q���N/��k��؊c[F2��3��2z�Q����L�Z�%R6��zP����������T��](��
�LJ�[ۑ̱�j�,�Z˫��fLV:*��f"N����.�]m@=���7Lu���P�[i�?���T;GI�4Ew��=}�3��b9`5�Y�CƵkρ����ؖ9�#ۄo�~�e?z��r���PK!J�T7drs/e2oDoc.xml�SM�� �W�@�gmg�٬gU�I/�n�ll�b�U���G��RU�3<޼7̟�"{a�]&�]��p��2����<՜*ТL��%ϋ���)�:P\X� ��)��{S��c�詻#4�=���m�-�W�8˦��L8���)�,"~��_��	OT� 7G�m�Ŝ�����L����J��^�j�)�Y�T/���cЧ�4��XV�g�U���Ǚ�L����%��w	ѴG�6�R�v�T�5
��A����+���Rv���#���VD�oG� �Dzs$,��۶�'�Cw�h��� �����8x�p�a�e�Z�.�����:�Q@O¤L��A6Z���HS/)a[�J*�W�er?�:�(�C4.l���%{�'~AD�I���<�u���y�T�9�+��s�����S���-g��d<]�&Y]�>���h�����{��O�Nr.t`wi�|�w�p~4�&�6�U��=��d/�H:��;u��qm��W�Θ|~I��]Ǭ��}���PK!��drs/downrev.xmlL��N�0��H�Cd$n,݊P�N�{�1MG�TM��#p�[�?7�9xu�)
�
,(�.ځ{����
T��}d2�I	6��E���g~��6�JJ8�h��<�Z��Q���#�d�q
�e�zm'<Ky�zUw:�r��H�����1x�]޿ڍee=��W�������֠2�o~�EZq��#ۤ�y$-KP�V�J������o��PK-!��8���[Content_Types].xmlPK-!8�!���/_rels/.relsPK-!J�T7.drs/e2oDoc.xmlPK-!��wdrs/downrev.xmlPK�{���B
�S����	?�)sbsat|tuRu&{�|�|g�-�΃x��>�����t"�t�t"�t�t"�t�t"�t�t"�t
�t"�t�t"�t�t"�t
�t"�t	�t"�t�t"�tt"t�t"�t�t"�t�t"�t�t"�t��_GoBacku��u������DIKO����)-1��#�"�"�3�3�M�M�R�R�[�[�[�[)_/_3`<`O`S`�a�a*b0bomtm�m�mdsisuu�|�|<�A����������������������ōʍЍՍ܍��D�N�������������� �&�*�2�7�?�����������\�c�x�~�ɐ͐ΐՐ֐ܐ�
�T�Z�[�b�w�}�	����5�7�9�?�{�������������Ē��#�)�=�F�J�N�������Óٓޓ������������E�K�Z�^�_�d�x�|�������������v��������������������Õĕѕҕܕ5�;�<�C�Z�b�f�k�o�u�z�������,�1�5�<�@�F�J�O���������җחۗ������I�M�֘ܘݘ��������~���k�q���������͚њ֚ۚ��1�7�`�d�i�n�{�������ћכ؛ߛ���������"�0�6�s�v�y��������������9�@�P�V���������ȝѝ���P�V�W�^�ɞϞОמ�������������������V����� "}�~�� !�/0�3�3MCQC�D�D�J�JRR�S�S�[�[QaYaRcXc�d�dKgYg�k�k�t�t�v�v�x�xs{z{�{�{$~&~u~w~�~�~XZ��V�X�݀߀e�f����Q�T��	�����������v�x�����������ʚ̚����P�V�����ĝƝK�M������������������33333333333333333333333333333333333333333333333333���	
Y`[`]`^`NaPaYaZa�a�a�a�a�a�a�a�a6b8b9b:bNcPcXcYc�d�d�d�d�e�e�e�eHfJfKfLfHgJgYgZgiiii8i:i?i@i�k�k�k�k�l�l�l�lmmmmm�m�m�m�m�m�m�m�m�m�m�m�r�r�t�t��������|'�E�����������`�3��6���������TX��6���������qEY��6�����������m��6����������8~��6��������������^��`���.������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���.������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���.������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���.������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���.������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�8~��|'�`�3��mTXqEY����������������������������������������������������������������																																													)��	��*M�_�f�s^:�?(�$y	h	�k	�r	G`
�|
�[�x��XF�D�-�<�h��t!Z%�:wI�
��6fw�+�3�6-!k"�c$3%V%nW%-e%/I&LD'Kk(�{(�*?+2,_,0F,AO-{O-u--.�.�1�N2�284]}4�(7S7z718�=pM=bN=�X>�Y?�p@�|BNdCF	F�G�HAI�I57J^>JMBJ�wJ�VK�^LNM�?M�	N�YO�ZO�*Q�yQ�~Q�S�9S�[TVUhVyOW,X�X]MX�@ZJ1[Y\%'a
Qb�\bLed�
f�jf�qf�4g�~g�i,zi�cj�
k�m�moGpp�Sq$sIisAssy2ty(u�Jv�qw�z�Qz�^z {!
{|}�C~+X~�b~�l~��N�U<��@�LL��o��W��_�V8�[y�TI���U.�7k�an�#��!�#|�:	�Jl�5%��z�0��Q�J��e�7�jg��s��~��*f��;��D�`:�/_��d�"0��������B��I��3��R�E2�#g�{��y�J�2+�:�PW����m����;��x���.�|��a��J�"��w����.�rQ�9,�G@�gB��N��S�fo����P�aL��h��=��P�.F����u���{�BN����Y�
b��p��.��?�#7�=@�4b��t���tL�GS��p�wN��q�sp�G<�Rn�U��~����O�=Y�C�R���
�=��i��?��L�P�j��#��>��k��
��5��:�GE��6���1#�X�rJ��p�n(�3��
��P��-�e{��)����!�#�<O�KP�0��1�8d����/�	[����@�"
"
"
"
d~W�W�e�e�`���@���@���@��� @�h@��Unknown������������G��*�Ax�	�Times New Roman5��Symbol3.��*�Cx�	�Arial7.���@	�Calibri5.��.�[`�)�TahomaA���$B�Cambria Math"q���h2�ǥ@"�*�9�Q� �9�Q !�88����20����?�Q���HP	�	$P�����������������������YO2!xx����Dr. Omo-Aghoja LawDr. Omo-Aghoja Law$����Oh��+'��0p�������	
,8
DPX`h�Dr. Omo-Aghoja LawNormal.dotmDr. Omo-Aghoja Law6Microsoft Office Word@|	�@�#l�Y�@n���$��9�����՜.��+,��0�hp|�������
���HP Q��Title	

 !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������Root Entry��������	�FPՙ��$��1Table�����������WordDocument��������4>SummaryInformation(�����DocumentSummaryInformation8������������CompObj������������r������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
����	�F Microsoft Word 97-2003 Document
MSWordDocWord.Document.8�9�q

Youez - 2016 - github.com/yon3zu
LinuXploit