Midline Angle as a Predictor of Neonatal Orbital Compression During Forceps Delivery in Occiput Anterior Presentations.
- 1Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- 2Department of Obstetrics and Gynecology, Graduate School of Medicine, Teikyo University, Tokyo, Japan.
Abstract
Aim
To evaluate the association between intrapartum transperineal ultrasonography findings obtained before forceps delivery and neonatal periorbital compression marks in occiput anterior presentations.Methods
This retrospective observational study included 166 term singleton forceps deliveries performed at the University of Tokyo Hospital between January 2019 and December 2022. Pregnancies with a non-cephalic presentation, congenital anomalies, or occiput posterior or transverse positions were excluded. Maternal and neonatal characteristics, together with intrapartum transperineal ultrasound findings, including the angle of progression and the midline angle retrospectively measured from ultrasound images acquired immediately before forceps delivery, were compared between neonates with periorbital forceps compression marks and those without compression marks. All neonates in the compression mark group underwent ophthalmologic evaluation.Results
The median midline angle was significantly greater in the compression mark group than in the control group (22.0° vs. 13.0°, p < 0.001). No significant differences were observed between the two groups in maternal or neonatal characteristics or in the angle of progression. The cutoff value of 22° yielded a sensitivity of 47.8% and a specificity of 90.9% for predicting forceps-related compression marks. Nine of the 67 neonates with compression marks had confirmed ophthalmic findings: retinal hemorrhage (n = 1), corneal epithelial injury (n = 2), and subconjunctival hemorrhage (n = 6). All findings resolved spontaneously without intervention.Conclusions
A midline angle of > 22° was associated with an increased likelihood of periorbital compression during forceps delivery in occiput anterior presentations. Midline angle assessment may be a useful adjunctive parameter for assessing the risk of periorbital compression marks.
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BibTeX
@article{sayama2026midline,
title = {{Midline Angle as a Predictor of Neonatal Orbital Compression During Forceps Delivery in Occiput Anterior Presentations.}},
author = {Seisuke Sayama and Takahiro Seyama and Takayuki Iriyama and Eriko Yano and Haruka Matsui and Kensuke Suzuki and Mari Ichinose and Masatake Toshimitsu and Keiichi Kumasawa and Miyuki Harada and Yasushi Hirota},
journal = {The journal of obstetrics and gynaecology research},
year = {2026},
month = oct,
doi = {10.1111/jog.70520},
url = {https://europepmc.org/article/MED/42933396},
note = {CC BY},
}
RIS
TY - JOUR
TI - Midline Angle as a Predictor of Neonatal Orbital Compression During Forceps Delivery in Occiput Anterior Presentations.
AU - Seisuke Sayama
AU - Takahiro Seyama
AU - Takayuki Iriyama
AU - Eriko Yano
AU - Haruka Matsui
AU - Kensuke Suzuki
AU - Mari Ichinose
AU - Masatake Toshimitsu
AU - Keiichi Kumasawa
AU - Miyuki Harada
AU - Yasushi Hirota
PY - 2026
DA - 2026/10/30
JO - The journal of obstetrics and gynaecology research
DO - 10.1111/jog.70520
UR - https://europepmc.org/article/MED/42933396
AB - Aim To evaluate the association between intrapartum transperineal ultrasonography findings obtained before forceps delivery and neonatal periorbital compression marks in occiput anterior presentations.Methods This retrospective observational study included 166 term singleton forceps deliveries performed at the University of Tokyo Hospital between January 2019 and December 2022. Pregnancies with a non-cephalic presentation, congenital anomalies, or occiput posterior or transverse positions were excluded. Maternal and neonatal characteristics, together with intrapartum transperineal ultrasound findings, including the angle of progression and the midline angle retrospectively measured from ultrasound images acquired immediately before forceps delivery, were compared between neonates with periorbital forceps compression marks and those without compression marks. All neonates in the compression mark group underwent ophthalmologic evaluation.Results The median midline angle was significantly greater in the compression mark group than in the control group (22.0° vs. 13.0°, p < 0.001). No significant differences were observed between the two groups in maternal or neonatal characteristics or in the angle of progression. The cutoff value of 22° yielded a sensitivity of 47.8% and a specificity of 90.9% for predicting forceps-related compression marks. Nine of the 67 neonates with compression marks had confirmed ophthalmic findings: retinal hemorrhage (n = 1), corneal epithelial injury (n = 2), and subconjunctival hemorrhage (n = 6). All findings resolved spontaneously without intervention.Conclusions A midline angle of > 22° was associated with an increased likelihood of periorbital compression during forceps delivery in occiput anterior presentations. Midline angle assessment may be a useful adjunctive parameter for assessing the risk of periorbital compression marks.
SN - 1341-8076
SN - 1447-0756
ER -