Effect of different labor forces on fetal skull molding

Fetal head molding is important for adapting the fetal head to the birth canal during vaginal delivery; however, excessive deformation of fetal head may lead to severe complications. Although labor force is one of the major factors which cause deformation of the fetal head, its effect on fetal head molding has not been quantitatively investigated yet. We examined this effect by using a finite element modeling approach. Firstly, a geometric model was created by scanning a polyethylene replica of fetal skull model with a white light three-dimensional scanner. Secondly, a nonlinear finite element model was proposed based on the geometric model. Next, the simulation results of the proposed model were verified against the experimental data reported in other literatures and they showed good agreement with the experimental observations. After this validation, the proposed model was used to simulate the fetal skull deformations under different labor forces. Simulation results illustrated that the fetal skull diameters and modified molding index (MMI) increased when the labor force was increased. Parietal bone around bregma and frontal bone around coronal suture undertook more stress, and parietal and frontal bones around coronal suture undertook more spatial and rotational displacement under larger labor force. The suboccipito-bregmatic diameter (SOBD) was more sensitive to the changes of labor force than other fetal skull diameters. The simulation results revealed the quantitative relationship between the labor force and fetal skull molding during delivery. In the future, if the degree of fetal skull molding is directly related to that of the head injury, the relationship investigated in this study may be used to predict the head injury by measuring the labor force during delivery.