title: Asynclitism: a literature review of an often forgotten clinical condition.
abstract: Asynclitism is defined as the "oblique malpresentation of the fetal head in labor". Asynclitism is a clinical diagnosis that may be difficult to make; it may be found during vaginal examination. It is significant because it may cause failure of progress operative or cesarean delivery. We reviewed all literature for asynclitism by performing an extensive electronic search of studies from 1959 to 2013. All studies were first reviewed by a single author and discussed with co-authors. The following studies were identified: 8 book chapters, 14 studies on asynclitism alone and 10 papers on both fetal occiput posterior position and asynclitism. The fetal head in a laboring patient may be associated with some degree of asynclitism; this is seen as usual way of the fetal head to adjust to maternal pelvic diameters. However, marked asynclitism is often detected in presence of a co-existing fetal head malposition, especially the transverse and occipital posterior positions. Digital diagnosis of asynclitism is enhanced by intrapartum ultrasound with transabdominal or transperineal approach. The accurate diagnosis of asynclitism, in an objective way, may provide a better assessment of the fetal head position that will help in the correct application of vacuum and forceps, allowing the prevention of unnecessary cesarean deliveries.
authors.affiliation: a Department of Gynecology and Obstetric , Santa Maria Hospital , Bari , Italy .|b Department of Applied Mathematics , Moscow Institute of Physics and Technology (State University), International Translational Medicine and Biomodelling Research Group , Moscow , Russian Federation .
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.affiliation: c Banner Health Clinic, Ob-Gyn Department , North Colorado Medical Center , Greeley , CO , USA .|d School of Medicine, University of Denver , Aurora , CO , USA .
authors.forename: Antonio
authors.initials: A
authors.lastname: Barbera
authors.affiliation: e Department of Obstetric & Gynecology , Umberto I Hospital , Corato-Terlizzi , Bari , Italy .
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Vagno
authors.affiliation: f Division of Maternal-Fetal Medicine,Department of Obstetrics and Gynecology , Jefferson Medical College of Thomas, Jefferson University , Philadelphia , PA , USA .
authors.forename: Alexis
authors.initials: A
authors.lastname: Gimovsky
authors.affiliation: f Division of Maternal-Fetal Medicine,Department of Obstetrics and Gynecology , Jefferson Medical College of Thomas, Jefferson University , Philadelphia , PA , USA .
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
authors.affiliation: g Department of Obstetric & Gynecology , Policlinico S.Orsola-Malpighi , Bologna , Italy .
authors.forename: Tullio
authors.initials: T
authors.lastname: Ghi
authors.affiliation: h Department of Obstetric & Gynecology and Centre for Perinatal and Reproductive Medicine , Santa Maria della Misericordia University Hospital , Perugia , Italy , and.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Di Renzo
authors.affiliation: b Department of Applied Mathematics , Moscow Institute of Physics and Technology (State University), International Translational Medicine and Biomodelling Research Group , Moscow , Russian Federation .|i Department of Gynecology and Obstetrics , Vito Fazzi Hospital , Lecce, Italy , Lecce , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
mesh_terms: D036861:Delivery, Obstetric; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal
keywords: Asynclitism; birth canal; cesarean section; delivery; fetal head; malposition; obstructed labor; occiput position; pelvis