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Ami O, Maran JC, Gabor P, Whitacre EB, Musset D, Dubray C, Mage G, Boyer L. Three-dimensional magnetic resonance imaging of fetal head molding and brain shape changes during the second stage of labor. PLoS One 2019; 14:e0215721. [PMID: 31091263 PMCID: PMC6519794 DOI: 10.1371/journal.pone.0215721] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
To demonstrate and describe fetal head molding and brain shape changes during delivery, we used three-dimensional (3D) magnetic resonance imaging (MRI) and 3D finite element mesh reconstructions to compare the fetal head between prelabor and the second stage of labor. A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1 Tesla open field MRI. Seven of these patients subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head molding and brain shape changes. Varying degrees of fetal head molding were present in the infants of all seven patients studied during the second phase of labor compared with the images acquired before birth. The cranial deformation, however, was no longer observed after birth in five out of the seven newborns, whose post-natal cranial parameters were identical to those measured before delivery. The changing shape of the fetal brain following the molding process and constraints on the brain tissue were observed in all the fetuses. Of the three fetuses presenting the greatest molding of the skull bones and brain shape deformation, two were delivered by cesarean-section (one after a forceps failure and one for engagement default), while the fetus presenting with the greatest skull molding and brain shape deformation was born physiologically. This study demonstrates the value of 3D MRI study with 3D finite element mesh reconstruction during the second stage of labor to reveal how the fetal brain is impacted by the molding of the cranial bones. Fetal head molding was systematically observed when the fetal head was engaged between the superior pelvic strait and the middle brim.
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Affiliation(s)
- Olivier Ami
- Ramsay Generale de Sante, La Muette Clinic, Paris, France
- Image Guided Therapies, Pascal Institute, UCA CNRS SIGMA, University of Clermont Auvergne, Clermont-Ferrand, France
- GIE IMIDF, Clinique de l'Essonne, Evry, France
- * E-mail:
| | - Jean Christophe Maran
- Image Guided Therapies, Pascal Institute, UCA CNRS SIGMA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Petra Gabor
- Department of Obstetrics and Gynecology, Hospital Center of Argenteuil, Argenteuil, Île-de-France, France
| | - Eric B. Whitacre
- Breast Center of Southern Arizona, Tucson, AZ, United States of America
| | - Dominique Musset
- Paris-Sud University Faculty of Medicine, Le Kremlin-Bicetre, Île-de-France, France
| | - Claude Dubray
- Center for Clinical Research, University of Auvergne, Clermont-Ferrand, France
| | - Gérard Mage
- Department of Obstetrics and Gynecology, University of Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- Image Guided Therapies, Pascal Institute, UCA CNRS SIGMA, University of Clermont Auvergne, Clermont-Ferrand, France
- Department of Radiology, CHU Clermont-Ferrand Gabriel Montpied, Clermont Ferrand, France
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Umamaheswara Reddy V, Agrawal A, Suryaprakash H, Srikanth V, Mithilasri G. Extensive subdural hematoma in full term neonate due to falcine laceration. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2015. [DOI: 10.1016/j.epag.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Idiopathic chronic subdural hematoma, MCA infarct and cortical atrophy with status epilepticus in infants. Indian J Pediatr 2007; 74:1046-8. [PMID: 18057692 DOI: 10.1007/s12098-007-0196-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Spontaneous chronic subdural hematomas in infants are extremely rare. A very limited number of cases are known and reported in literature. The clinical presentation can be myriad varying from asymptomatic cases to gross neurological deficits. We report the cases of 2 infants who presented to us with repeated episodes of generalized tonic clonic seizures since birth. No etiology could be established for either of them. Subsequent imaging revealed chronic subdural hematoma, MCA infarct and cortical atrophy in both the cases. Both the cases improved following evacuation of the chronic subdural hematoma. One of the infants had secondary craniosynostosis for which additional coronal suturectomy had to be done. The management of such cases and a brief review of literature are discussed.
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Abstract
Subdural hemorrhage (SDH) and primary subarachnoid hemorrhage (SAH) are two forms of intracranial bleeding that can be encountered in infants. These events can be life threatening to the infant and devastating to his family. Neonatal nurses need to have an understanding of these unfortunate, yet not uncommon, types of intracranial hemorrhage. This article explains the etiology, the diagnosis, and the treatment of SDH and SAH, concluding
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Affiliation(s)
- Stacie Barker
- Boone Hospital Center, ICN, Columbia, MO 65201, USA.
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