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. 2023 Oct;163(1):271-276.
doi: 10.1002/ijgo.14814. Epub 2023 Apr 28.

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

Pinar Birol Ilter  1   2 , Murat Yassa  1   3 , Hakan Timur  4 , Ozan Dogan  5 , Arzu Bilge Tekin  1 , Ahmad Haydar  6 , Cagri Gulumser  7 , Niyazi Tug  1 , Antonio Malvasi  8 , Andrea Tinelli  9
Affiliations

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

Pinar Birol Ilter et al. Int J Gynaecol Obstet. 2023 Oct.

Abstract

Objective: To investigate the role of intrapartum ultrasound (IU) in the diagnosis of asynclitism and the importance of asynclitism degree in labor outcomes.

Method: This 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.

Results: Severe 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.

Conclusion: Severe 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.

Keywords: asynclitism; dystocia; intrapartum ultrasound; labor; operative delivery.

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References

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