The importance of asynclitism in birth trauma and intrapartum sonography

Vlasyuk, Vasily Vasilievich; Malvasi, Antonio

doi:10.1080/14767058.2020.1777270

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…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%

“…Similarly, in posterior asynclitism, an anterior twisting of the fetal head makes the sagittal suture close to the pubis with the posterior parietal bone as the leading part [ 2 ]. There are three degrees of asynclitism; the first (mild) is physiological asynclitism with 15 mm deviation of the sagittal suture from the midline axis, the second (moderate) is when the sagittal suture approaches the pubic joint or sacral promontory, and the third (severe) is when the suture extends beyond those two [ 32 ]. Asynclitism is caused by anomalies of the birth canal (i.e., android pelvis, cephalopelvic disproportion, myomas, or other soft-tissue structure) and an abnormal descent of the leading part through the birth canal [ 1 , 3 , 46 ].…”

Section: Asynclitism: a New Old Entitymentioning

confidence: 99%

“…In light asynclitism, the fetal head is partially twisted, while the nose and one orbit are visible, which is known as “the squint sign with or without nose”. However, when the head is completely flexed on the homolateral shoulder and/or column, the nose and orbits are not visible, which is diagnostic of a marked asynclitism [ 18 , 20 , 32 ].…”

Section: Asynclitism: a New Old Entitymentioning

confidence: 99%

“…The degree of asynclitism directly correlated with the degree of injury. They concluded that dynamic monitoring of the state of asynclitism during labor by intrapartum US is important in order to predict and prevent complications and birth trauma [ 32 ]. Vlasyuk et al demonstrated that, while VE reduces perineal injuries, it can have adverse effects on the fetus.…”

Section: Operative Vaginal Delivery: Forceps and Vacuummentioning

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: Asynclitism: a New Old Entitymentioning

confidence: 99%

Section: Asynclitism: a New Old Entitymentioning

confidence: 99%

Section: Operative Vaginal Delivery: Forceps and Vacuummentioning

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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“…29,30 Identifying asynclitism is important before considering instrumental delivery because it will help the clinician to apply the vacuum and forceps over the sagittal suture rather than on the parietal bone, thereby avoiding adding on tension forces of the tentorium cerebelli (TC) and hence birth trauma to the brain and skull. 31 In extreme situation whereby the fetal head is malpositioned with marked asynclitism, there might be deep transverse arrest and therefore Cesarean delivery might be a safer method of delivery. 30 Assessment of fetal head station Fetal head station is the level of the fetal head in the birth canal in relation to the imaginary line between the maternal ischial spines.…”

Section: Assessment Of Asynclitismmentioning

confidence: 99%

Intrapartum ultrasound and the choice between assisted vaginal and cesarean delivery

Chan

Lau

2021

American Journal of Obstetrics & Gynecology MFM

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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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The importance of asynclitism in birth trauma and intrapartum sonography

Cited by 13 publications

References 11 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

Intrapartum ultrasound and the choice between assisted vaginal and cesarean delivery

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

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