title: Sagittal suture overlap in cephalopelvic disproportion: blinded and non-participant assessment.
abstract: OBJECTIVE
  To determine the role of assessment of overlap of fetal skull bones (molding) in intrapartum prediction of cephalopelvic disproportion (CPD).
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  South African high-risk obstetric unit that receives referrals from other facilities.
  
  
  METHODS
  Women of at least 37 weeks' gestation in the active phase of labor, with singleton vertex presentations and live fetuses, and without previous cesarean sections.
  
  
  METHODS
  The researcher was blinded to parity and previous clinical information on the women, and not involved in their obstetric care. The researcher performed clinical assessments, including estimation of level of head, cervical dilatation, head flexion, position, overlap of fetal skull bones, caput succedaneum and asynclitism. A single assessment was done on each woman.
  
  
  METHODS
  CPD, defined as cesarean section for poor progress in labor.
  
  
  RESULTS
  The author examined 504 women, and CPD occurred in 113 (22.4%). In multivariate logistic regression analysis, sagittal suture overlap was independently associated with CPD. Other factors associated were maternal height, duration of labor, birth weight, and the interaction between caput succedaneum and cervical dilatation at the time of examination. Lambdoid suture overlap was not significantly associated with CPD, and could be determined in only 66.5% of examinations because of frequent head deflexion.
  
  
  CONCLUSIONS
  Assessment of sagittal suture overlap, but not lambdoid suture overlap, is useful for prediction of CPD. Knowledge of sagittal suture overlap may assist in decisions on clinical management where there is poor progress in a trial of labor.
authors.affiliation: Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa. eckhart.buchmann@wits.ac.za
authors.forename: Eckhart J
authors.initials: EJ
authors.lastname: Buchmann
authors.forename: Elena
authors.initials: E
authors.lastname: Libhaber
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D001827:Body Height; D002508:Cephalometry; D002585:Cesarean Section; D003393:Cranial Sutures / Q000002:abnormalities*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications; D010298:Parity; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012886:Skull / Q000002:abnormalities*; D013997:Time Factors