Fetal molding examined with transperineal ultrasound and associations with position and delivery mode
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND: To accommodate passage through the birth canal, the fetal skull is compressed and reshaped, a phenomenon known as molding. The fetal skull bones are separated by membranous sutures that facilitate compression and overlap, resulting in a reduced diameter. This increases the probability of a successful vaginal delivery. Fetal position, presentation, station, and attitude can be examined with ultrasound, but fetal head molding has not been previously studied with ultrasound.
OBJECTIVE: This study aimed to describe ultrasound-assessed fetal head molding in a population of nulliparous women with slow progress in the second stage of labor and to study associations with fetal position and delivery mode.
STUDY DESIGN: This was a secondary analysis of a population comprising 150 nulliparous women with a single fetus in cephalic presentation, with slow progress in the active second stage with pushing. Women were eligible for the study when an operative intervention was considered by the clinician. Molding was examined in stored transperineal two-dimensional and three-dimensional acquisitions and differentiated into occipitoparietal molding along the lambdoidal sutures, frontoparietal molding along the coronal sutures, and parietoparietal molding at the sagittal suture (molding in the midline). Molding could not be classified if positions were unknown, and these cases were excluded. We measured the distance from the molding to the head midline, molding step, and overlap of skull bones and looked for associations with fetal position and delivery mode. The responsible clinicians were blinded to the ultrasound findings.
RESULTS: Six cases with unknown position were excluded, leaving 144 women in the study population. Fetal position was anterior in 117 cases, transverse in 12 cases, and posterior in 15 cases. Molding was observed in 79 of 144 (55%) fetuses. Molding was seen significantly more often in occiput anterior positions than in non-occiput anterior positions (69 of 117 [59%] vs 10 of 27 [37%]; P=.04). In occiput anterior positions, the molding was seen as occipitoparietal molding in 68 of 69 cases and as parietoparietal molding in 1 case with deflexed attitude. Molding was seen in 19 of 38 (50%) of occiput anterior positions ending with spontaneous delivery, 42 of 71(59%) ending with vacuum extraction, and in 7 of 8 (88%) with failed vacuum extraction (P=.13). In 4 fetuses with occiput posterior positions, parietoparietal molding was diagnosed, and successful vacuum extraction occurred in 3 cases and failed extraction in 1. Frontoparietal molding was seen in 2 transverse positions and 4 posterior positions. One delivered spontaneously; vacuum extraction failed in 3 cases and was successful in 2. Only 1 of 11 fetuses with either parietoparietal or frontoparietal molding was delivered spontaneously.
CONCLUSION: The different types of molding can be classified with ultrasound. Occipitoparietal molding was commonly seen in occiput anterior positions and not significantly associated with delivery mode. Frontoparietal and parietoparietal moldings were less frequent than reported in old studies and should be studied in larger populations with mixed ethnicities.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:223 |
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| Enthalten in: |
American journal of obstetrics and gynecology - 223(2020), 6 vom: 15. Dez., Seite 909.e1-909.e8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Iversen, Johanne Kolvik [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 04.01.2021 Date Revised 04.01.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ajog.2020.06.042 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM311635547 |
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| 100 | 1 | |a Iversen, Johanne Kolvik |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Fetal molding examined with transperineal ultrasound and associations with position and delivery mode |
| 264 | 1 | |c 2020 | |
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| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 04.01.2021 | ||
| 500 | |a Date Revised 04.01.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: To accommodate passage through the birth canal, the fetal skull is compressed and reshaped, a phenomenon known as molding. The fetal skull bones are separated by membranous sutures that facilitate compression and overlap, resulting in a reduced diameter. This increases the probability of a successful vaginal delivery. Fetal position, presentation, station, and attitude can be examined with ultrasound, but fetal head molding has not been previously studied with ultrasound | ||
| 520 | |a OBJECTIVE: This study aimed to describe ultrasound-assessed fetal head molding in a population of nulliparous women with slow progress in the second stage of labor and to study associations with fetal position and delivery mode | ||
| 520 | |a STUDY DESIGN: This was a secondary analysis of a population comprising 150 nulliparous women with a single fetus in cephalic presentation, with slow progress in the active second stage with pushing. Women were eligible for the study when an operative intervention was considered by the clinician. Molding was examined in stored transperineal two-dimensional and three-dimensional acquisitions and differentiated into occipitoparietal molding along the lambdoidal sutures, frontoparietal molding along the coronal sutures, and parietoparietal molding at the sagittal suture (molding in the midline). Molding could not be classified if positions were unknown, and these cases were excluded. We measured the distance from the molding to the head midline, molding step, and overlap of skull bones and looked for associations with fetal position and delivery mode. The responsible clinicians were blinded to the ultrasound findings | ||
| 520 | |a RESULTS: Six cases with unknown position were excluded, leaving 144 women in the study population. Fetal position was anterior in 117 cases, transverse in 12 cases, and posterior in 15 cases. Molding was observed in 79 of 144 (55%) fetuses. Molding was seen significantly more often in occiput anterior positions than in non-occiput anterior positions (69 of 117 [59%] vs 10 of 27 [37%]; P=.04). In occiput anterior positions, the molding was seen as occipitoparietal molding in 68 of 69 cases and as parietoparietal molding in 1 case with deflexed attitude. Molding was seen in 19 of 38 (50%) of occiput anterior positions ending with spontaneous delivery, 42 of 71(59%) ending with vacuum extraction, and in 7 of 8 (88%) with failed vacuum extraction (P=.13). In 4 fetuses with occiput posterior positions, parietoparietal molding was diagnosed, and successful vacuum extraction occurred in 3 cases and failed extraction in 1. Frontoparietal molding was seen in 2 transverse positions and 4 posterior positions. One delivered spontaneously; vacuum extraction failed in 3 cases and was successful in 2. Only 1 of 11 fetuses with either parietoparietal or frontoparietal molding was delivered spontaneously | ||
| 520 | |a CONCLUSION: The different types of molding can be classified with ultrasound. Occipitoparietal molding was commonly seen in occiput anterior positions and not significantly associated with delivery mode. Frontoparietal and parietoparietal moldings were less frequent than reported in old studies and should be studied in larger populations with mixed ethnicities | ||
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| 650 | 4 | |a cesarean delivery | |
| 650 | 4 | |a head position | |
| 650 | 4 | |a head sutures | |
| 650 | 4 | |a labor | |
| 650 | 4 | |a molding | |
| 650 | 4 | |a sonography | |
| 650 | 4 | |a transperineal ultrasound | |
| 650 | 4 | |a vacuum extraction | |
| 650 | 7 | |a Oxytocics |2 NLM | |
| 650 | 7 | |a Oxytocin |2 NLM | |
| 650 | 7 | |a 50-56-6 |2 NLM | |
| 700 | 1 | |a Kahrs, Birgitte Heiberg |e verfasserin |4 aut | |
| 700 | 1 | |a Torkildsen, Erik Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Eggebø, Torbjørn Moe |e verfasserin |4 aut | |
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