Intrapartum Ultrasound for the Diagnosis of Cephalic Malpositions and Malpresentations
22 Jul 2021-Vol. 3, Iss: 6, pp 100438
TL;DR: In this article, the use of intrapartum ultrasound to assess fetal position and presentation, in addition to fetal attitude, to predict and aid in decision making regarding delivery can help in improving management decision making.
Abstract: Fetuses with malpresentation and malposition during labor represent important clinical challenges. Women with fetuses presenting with malpresentation or malposition are at risk of increased perinatal complications, such as cesarean delivery, failure of operative vaginal delivery, neonatal acidemia, and neonatal intensive care admission. Intrapartum ultrasound has been found to be more reliable than digital examination in assessing malpresentation and malposition. The use of intrapartum ultrasound to assess fetal position and presentation, in addition to fetal attitude, to predict and aid in decision making regarding delivery can help in improving management decision making. Cephalic malpresentation and malposition is a unique subset of fetal orientation and can benefit from intrapartum ultrasound identification and assessment for delivery.
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22 Jul 2021
3 citations
TL;DR: In this paper , a review of the applicability of ultrasound in the delivery room, considering the main stages of labor, is presented, where it is used to correlate with physiological findings and physical examination.
Abstract: Abstract 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.
1 citations
TL;DR: A finite element model of the fetal head and maternal structures was used to perform childbirth simulations with the fetus in the occipito-anterior (OA) and OP position of the vertex presentation, considering a flexible-sacrum maternal position, indicating that an OP position can be more harmful to the pelvic floor and pelvic bones from a biomechanical point of view.
TL;DR: The use of transabdominal and transperineal sonography has been shown to yield higher accuracy than vaginal examination in characterizing fetal malposition, and some guidelines endorse its use for the verification of the occiput position before performing an instrumental delivery as mentioned in this paper .
TL;DR: In this paper , the authors re-evaluated the literature of the last 30 years on asynclitism, focusing on the progressive imposition of ultrasound as an intrapartum diagnostic tool.
Abstract: 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.
References
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TL;DR: Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of the most common indications, including labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.
626 citations
National Institutes of Health1, Georgetown University2, University of Utah3, Baystate Medical Center4, Maimonides Medical Center5, Cedars-Sinai Medical Center6, Summa Health System7, University of Texas Health Science Center at Houston8, MetroHealth9, University of Miami10, University of Illinois at Chicago11, Christiana Care Health System12
TL;DR: In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described.
617 citations
TL;DR: Key points were identified to assist with reduction in cesarean delivery rates including that labor induction should be performed primarily for medical indication; if done for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient.
569 citations
TL;DR: There was a substantial decrease in the need for additional pain relief in women receiving epidural analgesia compared with opioid analgesia, and a higher proportion were satisfied with their pain relief, reporting it to be "excellent or very good" (average risk ratio (RR) 1.47).
Abstract: Background
Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non‐epidural or no analgesia in labour), last published in 2011.
292 citations
TL;DR: Persistent occiput posterior position is associated with a higher rate of complications during labor and delivery, and in this population, the chances that a laboring woman with persistent occipUT posterior position will have a spontaneous vaginal delivery are only 26% for nulliparas and 57% for multiparas.
247 citations