Parietal adjustment

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The parietal bone setting , even Asynklitismus, is an obstetric setting abnormality of the child in the womb during birth. There is an illegal setting of the arrow seam in the pelvic entrance . The arrow seam has deviated forwards or backwards, the front or rear parietal bone has taken the lead.

Classification

Anterior parietal bone adjustment (also anterior asynclitism or Naegele obliquity ): The arrow suture has deviated laterally to the rear and approached the sacrum . The front parietal bone has taken the lead. Here the child's head has the opportunity to overcome the pelvic entrance, possibly narrowed in a straight diameter, with the help of the so-called buttonhole mechanism. The two halves of the head pass through the pool entrance one after the other. It is a favorable attempt at adapting the child's head. Spontaneous delivery is possible.

Posterior parietal bone adjustment (also posterior asynclitism or Litzmann obliquity ): The arrow suture has deviated forwards and the symphysis has come closer. The posterior parietal bone has taken the lead. Stepping down is not possible for the head. It is an unfavorable attempt to adjust the child's head, as this setting is impossible to deliver. Usually a caesarean section is necessary.

Note: front setting: "vörderlich"; rear setting: "obstructive".

causes

The vertex position is always an indication of a possible disproportion between the mother's pelvis and the child's head.

  • Maternal cause: Unfavorable pelvic shape, e.g. B. flat, flat-rachitic or long pelvis
  • Child-side cause: Unfavorable head shape, e.g. B. large long head or hydrocephalus

Diagnosis

The opening period of childbirth is very delayed. During the internal examination, the parietal bone that has taken the lead is noticeable. The arrow seam deviating forwards or backwards is to be felt (the arrow seam is not synclitic = in the lead, but asynclic = not in the lead line). It may be possible to feel a configuration of the child's skull plates that reduces the circumference (approx. 2 cm). After the rupture of the bladder , a large birth tumor can usually be felt. There may be a tendency towards an abnormal posture (e.g. Roederer head posture ). Since the parietal bones adjustment is often associated with a relative or absolute disproportion , a pelvic blanking must be carried out in order to be able to get an idea of ​​the spatial requirements. In addition, the Zangemeister handle can be carried out and the Michaelis diamond assessed.

therapy and progress

With the anterior parietal bone adjustment, initially only monitor the child's heart rate and labor activity, the woman giving birth on the side of the small fontanel. If the contractions are good, the head can configure itself and move deeper into the sacral sinus.

In the case of the posterior parietal position, one can initially wait with careful monitoring of mother and child, as well as apparently favorable space conditions between the child's head and the mother's pelvis. In order to give the child's head the opportunity to readjust itself, the woman can be placed in the knee-elbow position for a few contractions . If the position of the child's head does not change, the anterior parietal bone is pressed onto the symphysis with increasing labor activity until further flexion is no longer possible. The pool entrance cannot be overcome. By pushing the parietal bones on top of one another, the skull hooks onto the symphysis in a stepped manner so that it is not possible to step down. The birth should be ended early by caesarean section.

Complications

Usually the (posterior) parietal adjustment is accompanied by a birth arrest. The strong compression of the child's head can lead to a lack of oxygen , cerebral bleeding and pressure necrosis. Since an attitude that is impossible to give birth and thus a disproportion is present, hyperkinetic labor disorders (labor storm) can occur; now there is a risk of a uterine rupture . Particularly when adjusting the posterior parietal bones, attention must always be paid to the band groove .

Specialty

The parietal bone adjustment should not be confused with physiological asynclitism . This is understood to mean the temporary lateral approach of the arrow suture to the sacrum. However, this attitude is overcome in the further course of the birth. Like the parietal bones adjustment, it serves to overcome the pelvic entrance area. The demarcation from the irregularity is difficult. A real attitude should arise with the first-giving birth at the beginning, with the multiparous woman in the course of the opening period.

literature

  • Mändle, Opitz, Kreuter: The midwifery textbook of practical obstetrics ISBN 3-7945-1765-2
  • Pschyrembel "Practical Obstetrics"