Semeiotics of Intrapartum Ultrasonography: New Diagnostic Sonographic Sign of Fetal Malpositions and Malrotations

Malvasi, Antonio; Gustapane, Sarah; Malvasi, Mariaelena; Vinciguerra, Marina; Tinelli, Andrea; Beck, Renata

doi:10.1007/978-3-030-57595-3_22

Cited by 3 publications

(3 citation statements)

References 46 publications

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“…Other ultrasonographic signs that suggest the diagnosis of OT are the "transverse thalamus sign" (the thalamus is observed at 90 degrees to the transverse ultrasound probe), "transverse cerebellum sign" (the cerebellum is observed at 90 degrees to the transverse ultrasound probe), "left or right occiput signs" (the fetal occiput is seen left or right of the pubic rami) and "left or right sinciput signs" (the fetal sinciput is seen to the left or right of the pubic rami). 46 A fetus can be identified as OT by visualizing midline intracranial structures in transverse as in Figure 10. 40 When the head is engaged, the transabdominal approach can be very difficult to interpret due to shadowing from maternal pelvic bones and a transperineal approach may be more effective.…”

Section: Occiput Transverse Positionmentioning

confidence: 99%

“…20 Posterior asynclitism is diagnosed when the clinician visualizes only the posterior orbit and it is associated with "the posterior squint sign", the "south thalamus sunset sign", and the "south cerebellum sunset sign," or otherwise noted as when the midline is above 9:00 o'clock and 3 o'clock. 46 Alternatively, in order to diagnose posterior asynclitism, one can perform a transperineal ultrasound, in the axial plane. In this view the anterior parietal bone may appear in close relation to the maternal pubic symphysis, but the midline of the fetal head may not be sufficiently seen unless the probe is rotated upwards, and the ultrasound beam angulated with respect to the long axis of the maternal spine (Figure 4) 46 .…”

Section: Asynclitismmentioning

confidence: 99%

“…46 Alternatively, in order to diagnose posterior asynclitism, one can perform a transperineal ultrasound, in the axial plane. In this view the anterior parietal bone may appear in close relation to the maternal pubic symphysis, but the midline of the fetal head may not be sufficiently seen unless the probe is rotated upwards, and the ultrasound beam angulated with respect to the long axis of the maternal spine (Figure 4) 46 .…”

Section: Asynclitismmentioning

confidence: 99%

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Intrapartum ultrasound for the diagnosis of cephalic malpositions and malpresentations

Gimovsky

2021

American Journal of Obstetrics & Gynecology MFM

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Occiput Transverse Positionmentioning

confidence: 99%

Section: Asynclitismmentioning

confidence: 99%

Section: Asynclitismmentioning

confidence: 99%

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Intrapartum ultrasound for the diagnosis of cephalic malpositions and malpresentations

Gimovsky

2021

American Journal of Obstetrics & Gynecology MFM

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Is it time for midwives to do intrapartum ultrasound in the delivery ward?

Malvasi¹,

Vimercati

2022

The Journal of Maternal-Fetal & Neonatal Medicine

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AIDA (Artificial Intelligence Dystocia Algorithm) in Prolonged Dystocic Labor: Focus on Asynclitism Degree

Malvasi,

Malgieri,

Cicinelli

et al. 2024

J. Imaging

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Asynclitism, a misalignment of the fetal head with respect to the plane of passage through the birth canal, represents a significant obstetric challenge. High degrees of asynclitism are associated with labor dystocia, difficult operative delivery, and cesarean delivery. Despite its clinical relevance, the diagnosis of asynclitism and its influence on the outcome of labor remain matters of debate. This study analyzes the role of the degree of asynclitism (AD) in assessing labor progress and predicting labor outcome, focusing on its ability to predict intrapartum cesarean delivery (ICD) versus non-cesarean delivery. The study also aims to assess the performance of the AIDA (Artificial Intelligence Dystocia Algorithm) algorithm in integrating AD with other ultrasound parameters for predicting labor outcome. This retrospective study involved 135 full-term nulliparous patients with singleton fetuses in cephalic presentation undergoing neuraxial analgesia. Data were collected at three Italian hospitals between January 2014 and December 2020. In addition to routine digital vaginal examination, all patients underwent intrapartum ultrasound (IU) during protracted second stage of labor (greater than three hours). Four geometric parameters were measured using standard 3.5 MHz transabdominal ultrasound probes: head-to-symphysis distance (HSD), degree of asynclitism (AD), angle of progression (AoP), and midline angle (MLA). The AIDA algorithm, a machine learning-based decision support system, was used to classify patients into five classes (from 0 to 4) based on the values of the four geometric parameters and to predict labor outcome (ICD or non-ICD). Six machine learning algorithms were used: MLP (multi-layer perceptron), RF (random forest), SVM (support vector machine), XGBoost, LR (logistic regression), and DT (decision tree). Pearson’s correlation was used to investigate the relationship between AD and the other parameters. A degree of asynclitism greater than 70 mm was found to be significantly associated with an increased rate of cesarean deliveries. Pearson’s correlation analysis showed a weak to very weak correlation between AD and AoP (PC = 0.36, p < 0.001), AD and HSD (PC = 0.18, p < 0.05), and AD and MLA (PC = 0.14). The AIDA algorithm demonstrated high accuracy in predicting labor outcome, particularly for AIDA classes 0 and 4, with 100% agreement with physician-practiced labor outcome in two cases (RF and SVM algorithms) and slightly lower agreement with MLP. For AIDA class 3, the RF algorithm performed best, with an accuracy of 92%. AD, in combination with HSD, MLA, and AoP, plays a significant role in predicting labor dystocia and labor outcome. The AIDA algorithm, based on these four geometric parameters, has proven to be a promising decision support tool for predicting labor outcome and may help reduce the need for unnecessary cesarean deliveries, while improving maternal-fetal outcomes. Future studies with larger cohorts are needed to further validate these findings and refine the cut-off thresholds for AD and other parameters in the AIDA algorithm.

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Semeiotics of Intrapartum Ultrasonography: New Diagnostic Sonographic Sign of Fetal Malpositions and Malrotations

Cited by 3 publications

References 46 publications

Intrapartum ultrasound for the diagnosis of cephalic malpositions and malpresentations

Intrapartum ultrasound for the diagnosis of cephalic malpositions and malpresentations

Is it time for midwives to do intrapartum ultrasound in the delivery ward?

AIDA (Artificial Intelligence Dystocia Algorithm) in Prolonged Dystocic Labor: Focus on Asynclitism Degree

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