title: ["The two fontanelles sign": A new clinical sign for quality control in fetal head position diagnosis?]
abstract: OBJECTIVE
  Determine the frequency at which palpation of two fontanelles is possible, in order to describe a new clinical diagnosis approach: "the two fontanelles sign".
  
  
  METHODS
  Descriptive study established in the obstetric and gynecology department at Lyon-Sud university hospital between March and November 2013. We followed-up one thousand successive singleton deliveries in cephalic presentation after 30 weeks of gestation. Before starting expulsive efforts, the number of fontanelles perceived (1, 2 or any) was documented. If the number of fontanelles were not noted, the patient was excluded.
  
  
  RESULTS
  Nine hundred and seventy-eight patients were included. In 39.3% of cases (n=384), 2 fontanelles were found, in 57.5% (n=563) only one and in 3.2% (n=31), none.
  
  
  CONCLUSIONS
  Both fontanelles palpation is frequently possible and enables quality control of fetal head presentation variety without ultrasound assessment. In order to prove the reliability of clinical examination, study comparing presentation ultrasonography and digital examination finding 2 fontanelles is needed.
authors.affiliation: CHU Lyon-Sud, 69310 Pierre-Bénite, France.
authors.forename: O
authors.initials: O
authors.lastname: Dupuis
authors.affiliation: CHU Lyon-Sud, 69310 Pierre-Bénite, France. Electronic address: bilitisben@hotmail.fr.
authors.forename: B
authors.initials: B
authors.lastname: Brocco
authors.affiliation: CHU Lyon-Sud, 69310 Pierre-Bénite, France.
authors.forename: E
authors.initials: E
authors.lastname: Decullier
authors.affiliation: CHU Lyon-Sud, 69310 Pierre-Bénite, France.
authors.forename: L
authors.initials: L
authors.lastname: Coulange-Benevise
mesh_terms: D000328:Adult; D055762:Cranial Fontanelles; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007746:Labor Presentation; D009774:Obstetrics / Q000379:methods*; D010173:Palpation / Q000379:methods*; D011247:Pregnancy; D011786:Quality Control
keywords: Contrôle qualité; Digital examination; Fetal head position; Presentation ultrasonography; Quality control; Toucher vaginal; Variété de présentation; Échographie de présentation