Fetal head molding

BACKGROUND: Childbirth is a physiologic process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a non-invasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process...

BACKGROUND: The incidence of carcinoma during pregnancy is reported to be 1:1000-1:1500 pregnancies with the breast carcinoma being the most commonly diagnosed. Since the fetus is most sensitive to ionizing radiation during the first two trimesters, there are mixed clinical opinions and no uniform guidelines on the use of radiotherapy during pregnancy. Within this study the pregnant female phantom in the second trimester, that can be used for radiotherapy treatment planning (as DICOM data), Monte Carlo simulations (as voxelized geometry) and experimental dosimetry utilizing 3D printing of the molds (as ...

Neonatal subpial hemorrhage has been underrecognized until recently and its pathophysiology remains unclear. Advances in magnetic resonance imaging have facilitated the identification of hemorrhage within the subpial space and cohort studies recently reported its imaging and clinical features. We encountered two cases of neonatal subpial hemorrhage along the medial side of the temporal lobe. Case 1: A 1-day-old boy had repeated apneic attacks with cyanosis from 2 hours after birth at 39 weeks of gestation by vacuum extraction delivery...

Birth trauma affects millions of women and infants worldwide. Levator ani muscle avulsions can be responsible for long-term morbidity, associated with 13-36% of women who deliver vaginally. Pelvic floor injuries are enhanced by fetal malposition, namely persistent occipito-posterior (OP) position, estimated to affect 1.8-12.9% of pregnancies. Neonates delivered in persistent OP position are associated with an increased risk for adverse outcomes. The main goal of this work was to evaluate the impact of distinct fetal positions on both mother and fetus...

BACKGROUND: Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is based on the distal part of the fetal skull, whereas assessing engagement is based on the proximal part. Prerequisites for assisted vaginal birth are that the fetal head should be engaged and its lowermost part at or below the level of the ischial spines. The part of the fetal head above the pelvic inlet reflects the true descent of the largest diameter of the skull...

The fetus has birth traumatic, compression-hypoxic, and hypoxic-ischemic brain lesions during childbirth. There are problems in their differentiation in clinical and anatomopathological practice. It is proposed to divide birth traumatic injuries into two types: 1) obvious traumatic injuries and 2) compression-hypoxic traumatic injuries. Signs of compression-hypoxic birth injuries were found in 24.4% of the examined fetuses and newborns delivered via vacuum extraction and application of obstetric forceps. This allows compression hypoxia to be attributed to birth injury rather than to hypoxic-ischemic encephalopathy...

During vaginal delivery, the fetal head molds into an elongated shape to adapt to the birth canal, a process known as fetal head molding. However, excessive molding can occur due to prolonged labor or strong contractions, leading to several disorders on the fetal head. This work aims to perform a numerical study on the biomechanics of fetal head molding by measuring specific diameters and the corresponding molding index. A finite element model of the pelvic floor muscles and the fetal body was used. The fetal head is composed of the skin and soft tissues, the skull with sutures and fontanelles, and the brain...

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...

PURPOSE: Craniosynostosis may lead to hampered fetal head molding and birth complications. To study the interaction between single suture craniosynostosis and delivery complications, an international, multicentre, retrospective cohort study was performed. MATERIALS AND METHODS: All infants born between 2006 and 2012 in the Netherlands and Sweden with sagittal or metopic suture synostosis were included. All births were included as a reference population. The primary outcome measure was rate of medically assisted labor...

Congenital microcephaly can be the result of genetic, teratogenic, mechanical, infectious, and other factors affecting the fetal brain. Transient craniofacial asymmetries and cranial molding can mimic congenital microcephaly caused by brain abnormalities or neurotropic infectious pathogens, including Zika. We present two neonates who were born with head circumference at or below the 3rd percentile for gestational age, and had improving head measurements at discharge from the nursery and resolution of the microcephaly by the second month of life...

Intracranial laceration due to traumatic birth injury is an extremely rare event affecting approximately one newborn per a population of 4.5 million. However, depending on the mode of injury, the resulting brain damage may lead to lifelong sequelae, for example, cerebral palsy for which there is no cure at present. Here we report a rare case of neonatal arterial ischemic stroke and cerebral palsy caused by fetal traumatic molding and parietal depression of the head during delivery caused by functional cephalopelvic disproportion due to a "long pelvis...

AIM: Fetal skull molding is important for the adaptation of the head to the birth canal during vaginal delivery. Importantly, the fetal head must rotate around the maternal symphysis pubis. The goals of this analysis were to observe a human birth in real-time using an open magnetic resonance imaging (MRI) scanner and describe the fetal head configuration during expulsion. METHODS: Real-time cinematic MRI series (TSE single-shot sequence, TR 1600 ms, TE 150 ms) were acquired from the midsagittal plane of the maternal pelvis during the active second stage of labor at 37 weeks of gestation...

Because levator ani (LA) muscle injuries occur in approximately 13% of all vaginal births, insights are needed to better prevent them. In Part I of this paper, we conducted an analysis of the bony and soft tissue factors contributing to the geometric "capacity" of the maternal pelvis and pelvic floor to deliver a fetal head without incurring stretch injury of the maternal soft tissue. In Part II, we quantified the range in demand, represented by the variation in fetal head size and shape, placed on the maternal pelvic floor...

Pelvic floor injuries during vaginal delivery are considered a significant risk factor to develop pelvic floor dysfunction. The molding of the fetus head during vaginal delivery facilitates the labor progress, since it adjusts to the birth canal geometry. In this work, a finite element model was used to represent the effects induced by the passage of the fetus head on the pelvic floor. The numerical model used for this simulation included the pelvic floor muscles attached to the bones, and a fetus body. The model of the fetus head included the skin and soft tissues, the skull with sutures and fontanelles, and the brain...

Recent guidelines issued jointly by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine for assessing labor progress differ substantially from those described initially by Friedman, which have guided clinical practice for decades. The guidelines are based on results obtained from new and untested methods of analyzing patterns of cervical dilatation and fetal descent. Before these new guidelines are adopted into clinical practice, the results obtained by these unconventional analytic approaches should be validated and shown to be superior, or at least equivalent, to currently accepted standards...

The anterior fontanelle (AF) is an integral element of the developing human infant craniofacial system. Consideration of the AF is crucial for assessing craniofacial growth, as altered development of this feature may indicate abnormal growth. Moreover, prolonged patency of the AF may represent a derived hominin feature. The AF is regarded as essential for fetal head molding during birth in humans, with deformation of the head during birth often necessary for successful delivery. However, the function of a patent AF among fossil hominins is unclear...

Fetal head molding is important for adapting the fetal head to the birth canal during vaginal delivery; however, excessive deformation of fetal head may lead to severe complications. Although labor force is one of the major factors which cause deformation of the fetal head, its effect on fetal head molding has not been quantitatively investigated yet. We examined this effect by using a finite element modeling approach. Firstly, a geometric model was created by scanning a polyethylene replica of fetal skull model with a white light three-dimensional scanner...

Vaginal delivery is accomplished by the force of the labor overcoming the resistance forces of birth canal. During this process, the fetal head passes through the birth canal and the skull receives pressure on the lateral aspect, resulting in molding, the convex shaping of the cranium. Also, the infant's skull is compressed by the mother's pelvic bony structures. These forces may lead to skull fractures and brain injuries. The hypothesis by the authors is that many skull fractures of the newborn present as incomplete fractures...

OBJECTIVE: To develop and use a biomechanical computer model to simulate the effect of varying the timing of voluntary maternal pushes during uterine contraction on second-stage labor duration. METHODS: Published initial pelvic floor geometry was imported into technical computing software to build a simplified three-dimensional biomechanical model with six representative viscoelastic levator muscle bands interconnected by a hyperelastic iliococcygeal raphe. An incompressible sphere simulated the molded fetal head...

Cleft lip and palate deformities are the most common congenital abnormalities of the head and neck. Advancements in the various multidisciplinary fields involved in cleft management have substantially improved functional and aesthetic outcomes. The legitimacy of such controversial topics as gingivoperiosteoplasty, primary rhinoplasty, and presurgical nasoalveolar molding is heavily contested. Bone morphogenetic protein and other recombinant growth factors may play important roles in future cleft care. As the candidate alleles that contribute to cleft lip and palate are further elucidated, the complex interplay of environmental influence and genetic predisposition is emphasized...