Intrapartum ultrasound for the diagnosis of cephalic malpositions and malpresentations

Gimovsky, Alexis C.

doi:10.1016/j.ajogmf.2021.100438

Cited by 11 publications

(19 citation statements)

References 51 publications

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“…Asynclitism diagnosis has always been a challenge in the past because of several reasons. First, there is a lack of a specific characterization of this entity, which often led to it simply being labeled as fetal head malposition, without giving any further or useful information to the decision-making process [ 29 , 31 ]. In addiction, asynclitism diagnosis in the pre-ultrasound era was exclusively achieved via digital examination, with the fetal sagittal suture as the only landmark.…”

Section: Digital Examination Versus Intrapartum Ultrasoundmentioning

confidence: 99%

“…Palpation of the ear for digital diagnosis is possible only in case of severe anterior (anterior ear) and posterior (posterior ear) asynclitism and in prolonged and neglected labors. In contrast, on average, it is difficult to palpate the ear in asynclitism [ 29 , 32 ]. The introduction of the use of ultrasound in the delivery room was late compared to its advent in other fields of gynecology and obstetrics.…”

Section: Digital Examination Versus Intrapartum Ultrasoundmentioning

confidence: 99%

“…Asynclitism was not yet considered an entity of its own, instead seen as belonging to a group of unfavorable fetal head attitudes, according to the wider concept of cephalopelvic disproportion. From that moment on, all research groups on asynclitism focused not only on digital diagnosis but also on ultrasound evaluation, defining it from periodically [ 29 , 31 ].…”

Section: Digital Examination Versus Intrapartum Ultrasoundmentioning

confidence: 99%

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Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review

et al. 2022

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Asynclitism, the most feared malposition of the fetal head during labor, still represents to date an unresolved field of interest, remaining one of the most common causes of prolonged or obstructed labor, dystocia, assisted delivery, and cesarean section. Traditionally asynclitism is diagnosed by vaginal examination, which is, however, burdened by a high grade of bias. On the contrary, the recent scientific evidence highly suggests the use of intrapartum ultrasonography, which would be more accurate and reliable when compared to the vaginal examination for malposition assessment. The early detection and characterization of asynclitism by intrapartum ultrasound would become a valid tool for intrapartum evaluation. In this way, it will be possible for physicians to opt for the safest way of delivery according to an accurate definition of the fetal head position and station, avoiding unnecessary operative procedures and medication while improving fetal and maternal outcomes. This review re-evaluated the literature of the last 30 years on asynclitism, focusing on the progressive imposition of ultrasound as an intrapartum diagnostic tool. All the evidence emerging from the literature is presented and evaluated from our point of view, describing the most employed technique and considering the future implication of the progressive worldwide consolidation of asynclitism and ultrasound.

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Section: Digital Examination Versus Intrapartum Ultrasoundmentioning

confidence: 99%

Section: Digital Examination Versus Intrapartum Ultrasoundmentioning

confidence: 99%

Section: Digital Examination Versus Intrapartum Ultrasoundmentioning

confidence: 99%

See 1 more Smart Citation

Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review

et al. 2022

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“…have not yet been proven in large randomized trials. [3][4][5][6] In contrast, the intrapartum Doppler assessment has shown no benefit in perinatal outcomes. 7 Differentiated normal and abnormal sonographic postpartum findings can also be an extra implement for the patients' well-being when the clinical evaluations are doubtful.…”

Section: Introductionmentioning

confidence: 99%

“… 2 Sonographic assistance during the first and second stages of labor has the potential to improve labor outcomes, although its real benefits have not yet been proven in large randomized trials. 3 4 5 6 In contrast, the intrapartum Doppler assessment has shown no benefit in perinatal outcomes. 7 …”

Section: Introductionmentioning

confidence: 99%

How to Reach the Best Ultrasound Performance in the Delivery Room

Santana

Castello

Passos

et al. 2022

Rev Bras Ginecol Obstet

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Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.

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Intrapartum ultrasound for fetal head asynclitism: Is it possible to establish a degree of asynclitism to correlate to delivery outcome?

İlter

Yassa

Tımur

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo investigate the role of intrapartum ultrasound (IU) in the diagnosis of asynclitism and the importance of asynclitism degree in labor outcomes.MethodThis prospective cohort study included 41 low‐risk pregnant women with fetus in singleton‐vertex. The IU assessment to diagnose asynclitism was performed during labor at two specific steps, including the suspicion and/or diagnosis of labor arrest. The “four‐chamber view” and “squint sign without nose” were classified as marked/severe asynclitism. The “midline deviation” and “squint sign with nose” findings were classified as moderate asynclitism. Obstetric outcomes and maternal‐fetal complications were compared with the degree of asynclitism.ResultsSevere and moderate asynclitism was seen in 17 (41.7%), 10 (58.8%) and seven (41.2%) women, respectively. All pregnant women diagnosed with asynclitism delivered by vacuum extraction (VE) or cesarean section (CS). CS was performed in nine patients with asynclitism (52.9%). The difference between asynclitism type and VE/CS ratios was statistically significant (P = 0.039). Four fetuses with squint sign without nose delivered by VE. A significant correlation was seen between the presence of squint without nose sign and second−/third‐degree perineal injury.ConclusionSevere asynclitism is associated with increasing operative birth and maternal‐fetal complications. Detection of asynclitism degree by IU could be useful, alerting the obstetrics team to possible perinatal problems during delivery.

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Intrapartum ultrasound for the diagnosis of cephalic malpositions and malpresentations

Cited by 11 publications

References 51 publications

Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review

Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review

How to Reach the Best Ultrasound Performance in the Delivery Room

Intrapartum ultrasound for fetal head asynclitism: Is it possible to establish a degree of asynclitism to correlate to delivery outcome?

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