Incorrect presentation of the fetus during pregnancy. Fetal presentation during pregnancy Fetal position during

The location of the fetus in the uterus is determined by its presentation and position. From these characteristics will depend on how exactly the baby will be born: by the method of uncomplicated independent childbirth - or by caesarean section.

What is the presentation of the fetus - types of presentation of the child in the uterus

The condition under consideration is the position in which the baby is in the last weeks of gestation - or immediately before childbirth.

Often, an obstetrician-gynecologist can determine the presentation - or the position of the fetus - after the 32nd week of pregnancy. The thing is that at this stage of development, the fetus increases in size, and there is not enough space in the uterus for it to roll over freely.

Video: Position, presentation, position and view of the position of the fetus

Depending on which part of the body is located closer to the pelvis, there are two types of presentations:

1. Breech presentation

The infant is positioned longitudinally in the uterus with its legs/buttocks facing the pelvic outlet.

There are several types:

Foot (extensor). The fetus rests with one or both legs against the entrance to the small pelvis.
Gluteal (flexion). The baby's feet are practically on the same level with the head, and the legs themselves are extended along the body.
Mixed.

Options for breech presentation of the fetus - leg extensor, gluteal flexion, mixed

2. Head presentation

The fetus is in a longitudinal position, its head is turned towards the entrance to the woman's small pelvis.

There are several options for the considered type of fetal presentation:

Occipital. During labor, due to the deformation of the cervix, the back of the head appears first, which is turned forward.
Anterior head (anteroparietal). The main emphasis at the exit is on a large fontanel. This makes childbirth more protracted, and also increases the risk of injury to the baby.
Execution. The wire point at the time of labor activity is the forehead of the child. In this case, natural childbirth is impossible - surgical intervention should be performed.
Facial. Often, with such a presentation, doctors prepare a woman in labor for, although natural delivery is also possible. The child comes out of the small pelvis with the back of the head, and the chin serves as the leading point.

Head presentation of the fetus is diagnosed in 96-97% of cases

Types of position of the child in the uterus

When determining the placement of the fetus in the uterus, use two basic concepts:

Axis (length) of the uterus- a straight line, conditionally passing through the bottom and cervix.
fetal axis- a transverse line that stretches along the back from the back of the head to the coccyx.

When determining the position of the fetus, the direction of its axis in relation to the length is taken into account.

In the event that the axes of the baby and uterus coincide, there is a place to be longitudinal position of the fetus. In simple terms, if the expectant mother is standing, the fetus will also be vertical. The head should ideally be aimed towards the exit from the small pelvis, and the pelvis towards the uterine fundus.

The position of the fetus is considered incorrect if it:

transverse. The infant's head and pelvic bone are palpated in the lateral sections of the uterus. Diagnostic measures confirm that the axis of the uterus and fetus are at an angle of 90 degrees with respect to each other.
Oblique. The angle between the uterine axis and the fetal axis is 45 degrees. In some cases, this value may increase.

Causes of the incorrect position of the child in the uterus and pathological presentation

There may be several reasons for the pathological phenomena under consideration, but all of them are conditionally divided into 2 large groups:

1. Those caused by errors in the structure of the uterus

2. Pathological phenomena that provoke an increase or decrease in the motor activity of the fetus:

Errors in the development of the fetus. Absence of the brain, dropsy of the brain can lead to the fact that the baby takes an oblique position in the womb.
The presence of several fetuses in the uterus. This phenomenon significantly limits the mobility of babies.
Hypertension of the uterus. Such a pathological condition can be triggered by curettage of the uterus, inflammation of the cervix / body of the uterus, abortion. In addition, frequent overwork, stress, neurosis, etc. can lead to an increase in the tone of the uterus.
Much or little water. In the first case, the uterus increases in parameters, which creates conditions for active movements for the baby. If the amniotic fluid is below normal, the child is simply not able to take the correct position.
The weight of the fetus is very large (from 4 kg and above) or very small. In the latter case, the child is able to freely and regularly change position in the uterine cavity.
Weakness of the abdominal muscles. This is especially true for women who have a history of 4 births or more. Muscles lose their elasticity and are not able to restrain the movements of the fetus.

According to the observations, gynecologists-obstetricians note a hereditary factor in the pathological presentation or incorrect placement of the child in the uterus.

Why is the wrong position of the child in the uterus dangerous?

With a non-standard fetal position in the uterine cavity, a favorable independent resolution of childbirth is extremely unlikely.

Often, labor activity is accompanied by the following negative phenomena:

Premature release of amniotic fluid. Due to the lack of pressure on the entrance to the small pelvis.
Inflammatory processes in the walls of the fetal bladder, as well as infection of the amniotic fluid. With the penetration of harmful microorganisms into the uterine cavity, peritonitis and sepsis may develop.
Acute fetal oxygen deficiency.
Violation of the integrity of the uterus. Earlier discharge of amniotic fluid can be the result of a strong indentation of the shoulder girdle into the entrance to the small pelvis. Against the background of active contractions of the uterus, its lower section is stretched, and can break.
Prolapse of small parts of the child's body with the rapid discharge of amniotic fluid. When the umbilical cord is clamped, serious circulatory failures occur, and childbirth, as a rule, is fatal for the baby.
Injury to a child during childbirth.

With a strong contraction of the uterus and the transverse position of the fetus, it is possible to bend it in half. In this case, the sternum comes out first, then the stomach with the head pressed against it. The lower limbs come out last. Such a development of events often ends in the death of the baby.

Signs and symptoms of malpresentation or position of the fetus in the uterus - can you notice it yourself?

Self-determination of the position of the fetus inside the uterus is a difficult task, and not always effective. Better for similar purposes contact an appropriate specialist and/or undergo an ultrasound examination.

Obstetrician-gynecologists, as a preliminary diagnosis, feel the belly of the future woman in labor.

If in the upper part it is soft and inactive, and a dense, rounded and movable part is felt below, this indicates a longitudinal presentation of the fetus.
If palpation of the upper and lower sections of the uterus confirms the emptiness of the uterine fundus, and the head and buttocks of the baby are palpated in its lateral sections, the position of the fetus is transverse.
With an oblique location of the baby in the uterine cavity, its head (dense part) will be localized in the iliac zone.

Diagnosis of the position of the fetus in the uterus

Diagnostic measures to determine the posture of the fetus are complex. They consist of several procedures, which carried out not earlier than on the 34th week of gestation:

External inspection. In the normal course of pregnancy, the uterus should have an oval-elongated shape. If the fetus is placed incorrectly, the abdomen will visually appear obliquely stretched (oblique position of the child) or transversely stretched (transverse position of the baby). If the baby’s position is incorrect, the uterus is spherical, not oval, and the bottom of the uterus is not high enough.
Internal inspection. It is informative only after the discharge of water and the opening of the uterine os by several centimeters. In such cases, it is necessary to conduct vaginal examinations very carefully - with the transverse placement of the fetus in the uterine cavity, the handle, leg or umbilical loop may fall out. If the fetus is turned with its buttocks towards the entrance to the small pelvis, the obstetrician, upon examination, will be able to examine the coccyx, sacrum, and also the baby's feet.
Palpation of the abdomen. The details of this procedure were described in the previous section. At this stage, the doctor also determines the fetal heartbeat. With a longitudinal arrangement, it is palpable in the right / left part of the uterus.
Ultrasound procedure. Determines the pose of the fetus with 100 percent accuracy.

Features of childbirth with incorrect presentation and position of the fetus in the uterus

Independent childbirth with an incorrect fetal position is possible with a combined external-internal rotation.

The obstetric situation should be uncomplicated, which includes the following conditions:

The uterus should open completely.
The woman in labor agrees to such a procedure.
A catheter is inserted into the bladder.
The fruit is not too large in size and can be expanded.
Pregnancy is singleton.
There are no pathologies on the part of the future mother and baby.

Surgical delivery with oblique / transverse placement of the fetus before the onset of contractions is carried out under the following pathological conditions:

Early discharge of amniotic fluid.
Overlapping a child.
placenta previa.
Oxygen starvation of the fetus.

- incorrect location of the fetus in the uterus, in which its longitudinal axis intersects with the axis of the uterus at an angle of 90 °; while large parts of the fetus (buttocks, head) are located above the line of the crests of the iliac bones of the pelvis. The transverse position of the fetus is determined using an external obstetric and vaginal examination, ultrasound. Pregnancy with a transverse position of the fetus can proceed uncomplicated, however, premature birth is possible, which can pose a threat to the life of the mother and fetus. The optimal tactic in the transverse position of the fetus is operative delivery.

General information

The transverse position of the fetus occurs in 0.5-0.7% of pregnancies, and in primiparous women 10 times less than in multiparous women. The danger of the transverse position of the fetus lies in the likelihood of developing severe complications during childbirth if timely obstetric care is not provided: early outflow of water, loss of parts of the fetus, rupture of the uterus, the occurrence of a neglected transverse position of the fetus, death of the fetus and mother.

Variants of malposition of the fetus also include an oblique position, characterized by the intersection of the axis of the fetus and uterus at an acute angle and the placement of one of the large parts of the fetus (head or pelvic end) below the line connecting the iliac crests. The oblique position of the fetus is considered transitional - during childbirth, it can turn into a longitudinal or transverse position.

The position in the transverse position of the fetus is determined by the head: 1st position - when the head is located on the left, 2nd position - the head is determined on the right. The type of position depends on the turn of the back: the back facing the anterior wall of the uterus is regarded as an anterior view, towards the back - a rear view. With the transverse position of the fetus, it is also important to consider the ratio of the back of the fetus to the fundus of the uterus.

Causes of the transverse position of the fetus

The intrauterine transverse position of the fetus may be due to various factors. These, first of all, include conditions that ensure excessive fetal mobility: polyhydramnios, flabbiness of the muscles of the abdominal wall, fetal hypotrophy, etc. , increased tone of the uterus, the threat of spontaneous abortion, anomalies in the structure of the uterus (saddle or bicornuate uterus), uterine fibroids, etc.

The transverse position of the fetus in some cases is the result of anatomical reasons that prevent the insertion of the head into the small pelvis, in particular, placenta previa, tumors of the lower segment of the uterus or pelvic bones, narrow pelvis. Fetal abnormalities such as anencephaly and hydrocephalus may contribute to the transverse position.

Diagnosis of the transverse position of the fetus

An incorrect (oblique or transverse) position of the fetus is established during an obstetric examination of a pregnant woman, palpation of the abdomen and vaginal examination. With the transverse position of the fetus, the abdomen acquires a transversely stretched (obliquely stretched) irregular shape. Due to transverse stretching, the uterus has a spherical, rather than elongated-oval shape. Attention is drawn to the excess of the norm of the circumference of the abdomen in comparison with the gestational age and the insufficient height of the fundus of the uterus.

In the process of palpation, the presenting part of the fetus is not determined; the head can be felt to the right or left of the median axis of the body of the pregnant woman, and large parts (head or pelvic end) - in the lateral sections of the uterus. With the transverse position of the fetus, the heartbeat is better heard in the navel. Difficulties in determining the position and position of the fetus may arise in situations of multiple pregnancy, polyhydramnios, uterine hypertonicity. Obstetric ultrasound reliably confirms the transverse position of the fetus.

In rare cases, with the transverse position of the fetus during childbirth, self-torsion in the head or pelvic presentation or the birth of a baby with a double body can occur. Such an outcome of childbirth is an exception and is possible in case of strong contractions, deep prematurity of the fetus, or with a dead fetus.

Tactics of conducting labor in the transverse position of the fetus

For up to 34-35 weeks of gestation, the oblique or transverse position of the fetus is considered unstable, since it can independently change to a longitudinal one. When diagnosing the transverse position of the fetus, a complete gynecological examination of the pregnant woman is required to identify the causes of the anomaly, the choice of tactics for further management of pregnancy and the method of delivery.

At a period of 30-34 weeks of pregnancy, corrective gymnastics may be prescribed, which contributes to the reversal of the fetus in the head presentation. Special sets of exercises are indicated in the absence of signs of a threatened abortion, a scar on the uterus, fibroids, spotting, decompensated heart defects in a pregnant woman, etc. and are carried out under the supervision of an obstetrician-gynecologist observing the woman. Also, in the transverse position of the fetus, the pregnant woman is recommended to lie on her side for more time, corresponding to the determined position.

After 35-36 weeks of gestation, the fetus takes a stable position, therefore, while maintaining the transverse position, the pregnant woman is hospitalized in the maternity hospital to determine the tactics of delivery.

The optimal method of delivery for patients with a transverse position of the fetus is a planned caesarean section. Absolute indications for operative delivery are post-term pregnancy, the fact of the presence of placenta previa, premature discharge of amniotic fluid, scars on the uterus, the development of fetal hypoxia. When the fetus is in a transverse position with a prolapse of its handle or umbilical cord, the reduction of the prolapsed parts is unacceptable.

In the case of full disclosure of the cervix, determined by the live fetus and its mobility, it is possible to turn the fetus on the leg and its subsequent removal. However, the prognosis for the fetus in this case is less favorable. Turning on a leg and natural childbirth are justified in case of prematurity or childbirth with twins, when one fetus occupies a transverse position.

In a situation of a long anhydrous period, complicated by the development of an infectious process, and the viability of the fetus after a cesarean section, a hysterectomy (removal of the uterus) and drainage of the abdominal cavity are performed. With a dead fetus, a fruit-destroying embryotomy operation is performed.

Data on the location of the fetus is necessary to determine the tactics of delivery of a woman. The normal course of childbirth is possible with the correct positions and presentation of the child.

In the first half of pregnancy, the fetus is small and moves freely in the uterus. Closer to 34-35 weeks, he begins to take a stable position, which in most cases persists until childbirth. At this time, the doctor leading the pregnancy can already decide on the method of childbirth: naturally or by caesarean section.

Fetal positions

Fetal position is the ratio of the axis of the fetus to the length of the uterus. Distinguish three positions:

Longitudinal(the axis of the fetus and uterus coincide or lie parallel). One of the large parts (head or buttocks) is located at the entrance to the pelvis, the other lies in the region of the fundus of the uterus;
transverse(the axes of the fetus and uterus intersect at right angles). The head and buttocks of the fetus are located in the lateral sections of the uterus;
Oblique(axes intersect at an acute angle). One of the large parts is located in the upper lateral part of the uterus, the other - in the lower part.

Information The longitudinal position is considered correct, in the absence of other contraindications, a woman can give birth naturally.

The main reasons for the appearance of incorrect positions fetus (oblique and transverse) are:

Multiple pregnancy;
Anomalies in the development of the uterus;
Flabbiness of the muscles of the anterior abdominal wall;
Tumors of the uterus (myoma).

Diagnosis of malpositions of the fetus:

visual inspection. In incorrect positions, the abdomen is spherical in shape, and not stretched forward;
Measurement of abdominal circumference and fundal height. Characteristically, the excess of the norm of the circumference of the abdomen compared with normal values for a given period of pregnancy and a decrease in the height of the fundus of the uterus;
External obstetric examination. On palpation of the abdomen, the presenting part is not determined, the head or pelvic part is palpated in the lateral parts of the uterus. The fetal heartbeat is heard in the navel;
fetus.

Incorrect fetal positions can lead to a number of complications during pregnancy and childbirth:

Premature termination of pregnancy;
Prolapse of small parts: umbilical cord, arm or leg;
The neglected transverse position of the fetus during childbirth (the arm, together with the shoulder, is driven into the pelvic bones, preventing the head and torso from passing through the birth canal);
Anomalies of tribal forces;
Fetal hypoxia during childbirth;

Conducting childbirth with incorrect positions of the fetus

When transverse fetal labor cannot end spontaneously. A woman needs to be hospitalized at 37 weeks and scheduled for delivery by caesarean section.

In an oblique position make an attempt to achieve a coup of the fetus. To do this, the woman is laid on her side, where a large part of the fetus (head or buttocks) is located in the iliac region. Often, when advancing into the pelvic cavity, the child takes a longitudinal position. If the position on the side does not correct the situation, then delivery is also carried out operatively.

Fetal presentation

Fetal presentation- this is the ratio of a large part (head or buttocks) to the entrance to the pelvis. presenting part they call that part of the fetus that is located at the entrance to the small pelvis and is the first to pass through the birth canal.

Allocate two types of presentation:

Head presentation of the fetus

occipital;
Anterocephalic;
Frontal;
Facial.

Breech presentation of the fetus

Purely gluteal;
Mixed gluteal;
Foot.

additionally The correct presentation is head occipital presentation (the child enters the birth canal with the head tightly pressed to the chin). Incorrect (extensor) insertion of the head complicates the course of childbirth, and often the birth of a child can occur only by caesarean section.

The main causes of extensor cephalic presentation:

narrow pelvis;
Multiple entanglement of the umbilical cord around the fetal neck;
Small or large head sizes;
Labor disorders;
Flabbiness of the muscles of the anterior abdominal wall;
decline.

With an anterior presentation the chin slightly moves away from the chest, the extension of the head is not very pronounced. Childbirth usually ends spontaneously, but can be protracted. In the first and second stages of labor, the prevention of fetal hypoxia is mandatory.

frontal presentation is the second degree of extension of the head. Spontaneous childbirth is possible only with a large pelvis, a small weight of the child and sufficient strength. However, vaginal delivery can lead to a number of complications (prolonged labor, fetal hypoxia, etc.), so it is preferable to deliver a woman by surgery.

Face presentation manifested by inserting the head into the pelvis with the front part. This is the extreme degree of extensor presentation. Delivery through natural routes is almost impossible, leading to serious complications, up to the death of the fetus. In this case, it is advisable to carry out an emergency delivery of a woman by caesarean section.

breech presentation- this is the longitudinal location of the fetus, in which the presenting part is the pelvic end.

Main reasons development of breech presentations:

Anomalies in the development of the uterus;
premature pregnancy;
Decreased tone of the uterus.

With pure breech presentation the buttocks are adjacent to the entrance to the pelvis, while the legs are bent at the hip joints, unbent at the knees and adjacent to the body.

With mixed gluteal presentation, the legs are bent at the hip and knee joints and are presented together with the buttocks to the pelvic cavity.

With foot presentation both legs are presented to the pelvis, unbent at the joints (full leg) or one leg, while the second lies higher and bent at the hip joint (incomplete leg).

The course of pregnancy is not much different from head presentation, but there are frequent cases of premature discharge of amniotic fluid. A woman 2-3 weeks before the expected date of birth should be hospitalized in a hospital. First of all, it is necessary to determine the tactics of childbirth.

Conducting childbirth through natural routes often results in to serious complications

Birth trauma of the fetus;
Weakness of tribal forces;
Fetal hypoxia;
Compression of the umbilical cord leading to asphyxia and fetal death;
Injuries of the birth canal in a woman.

Important Due to the high risk of complications, delivery of the woman by caesarean section is recommended.

Fetal Turning Exercises

There are special gymnastic exercises that contribute to the turning of the fetus. The optimal period for such techniques is 30-32 weeks. Exercises can be carried out at a later date, but then the fetus is already large, and the likelihood of its overturn is extremely small.

It is necessary to start exercises only after the permission of the doctor leading the pregnancy, because. there are contraindications:

Scars on the uterus after surgery;
placenta previa;
Tumors of the uterus(myoma);
Severe diseases of other organs and systems in the mother.

A set of exercises must be performed 3-4 times a day for 7-10 days:

turns. Lying on the bed, turn from one side to the other 3-4 times (you should lie on each side for 7-10 minutes);
Pelvic tilt. It is necessary to lie on a hard surface and raise the pelvis so that it is 25-30 cm higher than the head. You should be in this position for 5-10 minutes. The exercise can be repeated up to 2-3 weeks;
Exercise "Cat". Get on your knees and rest your hands on the floor. While inhaling, raise your head and tailbone, bend your lower back. As you exhale, lower your head and arch your back. Exercises are repeated up to 10 times;
Knee-elbow position. Stand on your elbows and knees, the pelvis should be above the head. In this position, you should remain for 15-20 minutes;
Half bridge. Lie on the floor, put a few pillows under the buttocks so that the pelvis is 35-40 cm higher, and raise your legs. Shoulders, knees and pelvis should be at the same level;
Lying on your back. Lie on a hard surface, bend your legs at the knee and hip joints, rest your feet on the floor. While inhaling, lift and hold the pelvis. As you exhale, lower your pelvis and straighten your legs. Exercises should be repeated 6-7 times.

Gymnastic exercises are often effective and lead to a rollover of the fetus in the first 7 days.

How the birth will take place depends on the location of the fetus in the mother's tummy. If the child has a normal posture, then the woman may well give birth on her own. If the baby is not located as intended by Mother Nature, then a caesarean section is necessary. Among the characteristics of the posture are: the presentation of the fetus, its position and the type of position.

Let's try to figure out what these terms mean.

The fetus grows and develops in the uterus throughout pregnancy. From a tiny embryo, he gradually turns into a little man. In the first half of pregnancy, he can change his position quite often.

With the approach of childbirth, the activity of the fetus decreases, since it is already very difficult to change the position, because it grows, and there is less and less free space in the uterus.

After about 32 weeks, you can already find out the presentation of the fetus, that is, to determine which part of the child's body (head or buttocks) is located at the entrance to the small pelvis. Sometimes doctors talk about the position of the baby in the tummy before 32 weeks.

Some women in position are given this information at 20-28 weeks of pregnancy. However, it should not be taken seriously at such an early date, because the baby can change the position that is objectionable to him several times.

There are the following types of fetal presentation:

1. Pelvic (the pelvic end of the child lies at the entrance to the woman's small pelvis):

buttock. The fetus is located in the uterus head up. The legs are extended along the body. The feet are practically at the head;
foot presentation of the fetus. At the entrance to the small pelvis, one or both legs of the baby can be located;
mixed (gluteal-leg). Buttocks and legs are presented to the entrance to the small pelvis of a pregnant woman.

2. Head (the head of the child lies at the entrance to the female pelvis):

occipital. The back of the head, facing forward, is the first to be born;
anterior parietal or anterior head. The head is the first to be born during childbirth. At the same time, it passes through the birth canal somewhat larger than with the occipital presentation of the fetus;
frontal. For this species, it is characteristic that the forehead serves as a conducting point during expulsion;
facial. This presentation is characterized by the birth of the head with the back of the head.

Types of breech presentation occur in 3-5% of women in position.

Head presentation is the most common (in 95-97% of pregnant women).

Fetal position: definition and types

Obstetricians-gynecologists call the ratio of the conditional line of the child, passing from the back of the head to the coccyx along the back, to the axis of the uterus - the position of the fetus. In the medical literature, it is classified as follows:

longitudinal;
oblique;
transverse.

The pelvic or head presentation of the fetus in the longitudinal position is characterized by the fact that the axes of the uterus and fetus coincide. With an oblique variety, conditional lines intersect at an acute angle. If the doctor has established a pelvic or head presentation of the fetus, a transverse position, this means that the axis of the uterus intersects the axis of the fetus at a right angle.

Together with the presentation and position, obstetrician-gynecologists determine position type. This term refers to the relationship of the child's back to the uterine wall. If the back is facing forward, then this is called the anterior view of the position, and if backward, the posterior view (or posterior presentation of the fetus).

For example, the doctor may say that the baby is in the uterus in the occiput, longitudinal, anterior position. This means that the baby is in the uterus along its axis. Its back of the head is adjacent to the entrance to the small pelvis, and the back is turned to the front side of the uterus.

Anterior presentation of the fetus is most common. The second variety is less common. The rear view of the position, as a rule, becomes the cause of protracted labor.

Incorrect presentation of the fetus: their features, options for childbirth

Head presentation of the occipital type is the most common and correct position in which babies are born. All other types of presentation are incorrect.

Childbirth in various types is considered pathological. During delivery, serious complications can occur (for example, hypoxia of the child, infringement and extension of his head, throwing back the handles). Most often, childbirth is carried out by caesarean section, especially if the baby is male. However, natural childbirth is not excluded.

The specific delivery option for mixed, foot, breech presentation of the fetus is chosen by the doctor depending on various factors.

Childbirth with extensor presentation of the fetus (anteroparietal, frontal, facial) rarely occurs naturally. With the anterior parietal form, the tactics of delivery is expectant. A caesarean section is performed when there is a threat to the health and life of the mother and baby.

Self-delivery with frontal cephalic presentation is undesirable, since ruptures of the uterus and perineum, asphyxia and death of the child are possible.

With facial presentation, the fetus can be born both through natural childbirth and with the help of surgery. The first option is chosen only if the female pelvis is of normal size, labor is active, and the size of the fetus is small.

Features of low presentation of the fetus

Very often, doctors diagnose pregnant women with a low presentation of the fetus, which implies the premature lowering of the baby's head into the pelvis.

Normally, this process occurs closer to childbirth, 1-4 weeks before them. However, in some pregnant women, due to certain anatomical features, this can happen much earlier.

Low presentation can be determined by the doctor during the examination by palpation of the uterus. The head is located quite low, and at the same time it is motionless or slightly mobile.

The pregnant woman herself can feel the consequences of lowering the baby's head - it will become easier for her to breathe, heartburn will decrease.

The low location of the fetus is a danger to him. The pregnancy may be terminated. To prevent this from happening, a woman should be much more attentive to herself. If the pregnant woman feels unwell due to the low location of the baby, then the specialist can recommend methods of treatment and preventive measures.

Incorrect positions of the fetus: their features, options for childbirth

Incorrect positions are such postures of the child in the mother's tummy, in which the longitudinal axis of the uterus does not coincide with the longitudinal axis of the fetus. They occur in 0.5-0.7% of cases. With women who give birth not for the first time, this happens most often.

Among the existing types of fetal position, two incorrect ones are distinguished: oblique and transverse. The course of pregnancy with them is not characterized by any features. A woman may not suspect that her baby is not located in the tummy in the way that nature predetermined.

Incorrect positions and presentation of the fetus can be the cause of premature birth. If medical care is absent, then serious complications will arise (early rupture of amniotic fluid, loss of fetal mobility, prolapse of a pen or leg, uterine rupture, death).

If a pregnant woman has an oblique position of the fetus, then she is laid on her side during childbirth in order to achieve a change in the position of the child (it can change to longitudinal or transverse), but this is not always possible. If the oblique position is preserved with the pelvic or cephalic presentation of the fetus, then delivery is carried out by surgery.

Causes of incorrect positioning of the child in the uterus

Many experts believe that the child takes a particular position in the uterus due to the influence of a number of reasons. The main ones are the active movements of the child and the reflex activity of the uterus, which does not depend on human efforts and desires.

Other causes of pure breech, lateral presentation of the fetus and any other malposition:

multiple pregnancy;
anomalies in the shape of the uterine cavity;
constitutional features of a woman.

Diagnosis of the location of the fetus in the uterus

The question of how to determine the presentation of the fetus, its position and position is of interest to all pregnant women, because the course of childbirth depends on the location of the fetus in the uterus.

Medical workers a few years ago determined the location of the child in the uterus by external examination. The diagnoses were not always correct. Now it is not difficult to determine the location, since this can be done using ultrasound. The method is very effective, informative and safe for the expectant mother and fetus. With it, you can very accurately and quickly determine the presentation, position, type of position.

How to independently determine the presentation of the fetus?

How to independently determine the presentation of the fetus, and is it possible? This question worries many of the fair sex in position. This is mainly of interest to those who do not want to constantly run for ultrasound, because the child can change his position very often, especially when it comes to a gestational age of less than 32 weeks.

Among the reasons for the formation of incorrect positions of the fetus, the main importance belongs to a decrease in the tone of the muscles of the uterus, a change in the shape of the uterus, excessive or sharply limited fetal mobility. Such conditions are created with developmental anomalies and tumors of the uterus, fetal developmental anomalies, placenta previa, polyhydramnios, oligohydramnios, multiple pregnancies, flabbiness of the anterior abdominal wall, as well as in conditions that make it difficult to insert the presenting part of the fetus into the entrance to the small pelvis, for example, with tumors of the lower segment of the uterus or with a significant narrowing of the size of the pelvis. Abnormal position, especially oblique, may be temporary.

How to recognize the wrong position of the fetus?

The transverse and oblique position of the fetus in most cases is diagnosed without much difficulty. When examining the abdomen, the shape of the uterus, which is elongated in the transverse direction, attracts attention. The circumference of the abdomen always exceeds the norm for the corresponding gestational age at which the examination is carried out, and the height of the uterine fundus is always less than the norm. When using Leopold's techniques, the following data are obtained:

in the bottom of the uterus there is no any large part of the fetus, which is found in the lateral sections of the uterus: on the one hand - round dense (head), on the other hand - soft (pelvic end);
the presenting part of the fetus above the entrance to the small pelvis is not determined;
the fetal heartbeat is best heard in the navel;
the position of the fetus is determined by the head: in the first position, the head is determined on the left side, in the second - on the right;
the type of fetus is recognized by the back: the back is facing forward - front view, the back is backward - rear. If the back of the fetus is turned down, then there is an unfavorable option: it creates unfavorable conditions for the extraction of the fetus.

A vaginal examination done during pregnancy or at the beginning of labor with a whole fetal bladder does not provide much information. It only confirms the absence of the presenting part. After the outflow of amniotic fluid with sufficient opening of the cervix (4-5 cm), you can determine the shoulder, shoulder blade, spinous processes of the vertebrae, inguinal cavity.

Ultrasound is the most informative diagnostic method that allows you to determine not only the incorrect position, but also the expected body weight of the fetus, the position of the head, the location of the placenta, the amount of amniotic fluid, entanglement of the umbilical cord, the presence of an anomaly in the development of the uterus and its tumor, anomalies in the development of the fetus, etc. .

The course and tactics of pregnancy

Pregnancy with the wrong position of the fetus passes without any special deviations from the norm. The risk of premature rupture of amniotic fluid increases, especially in the third trimester.

The preliminary diagnosis of malposition of the fetus is established at 30 weeks of gestation, the final diagnosis is at 37-38 weeks. Starting from the 32nd week, the frequency of spontaneous rotation decreases sharply, so it is advisable to correct the position of the fetus after this period of pregnancy.

In the antenatal clinic in the period of 30 weeks. to activate the self-rotation of the fetus on the head of the pregnant woman, it is necessary to recommend corrective exercises: position on the side opposite to the position of the fetus; knee-elbow position for 15 minutes 2-3 times a day. From the 32nd to the 37th week, a set of corrective gymnastic exercises is prescribed according to one of the existing methods.

Contraindications to the implementation of gymnastic exercises are the threat of premature birth, placenta previa, low attachment of the placenta, anatomically narrow pelvis II-III degree. Do not carry out an external prophylactic rotation of the fetus on the head in the conditions of the antenatal clinic.

External rotation of the fetus on the head

Further management of pregnancy is to attempt external rotation of the fetus on the head during full-term pregnancy and further induction of labor or expectant management of pregnancy and an attempt to rotate the fetus with the onset of labor if its incorrect position persists. In most cases, with expectant management of pregnancy, fetuses that had wrong position, are located longitudinally to the beginning of childbirth. Only less than 20% of the fetuses that were located transversely before 37 weeks. pregnancy, remain in this position until the onset of labor. At 38 weeks. determine the need for hospitalization in an obstetric hospital of the III level according to such indications: the presence of a burdened obstetric and gynecological history, a complicated course of this pregnancy, extragenital pathology, the possibility of external rotation of the fetus. In an obstetric hospital, in order to clarify the diagnosis, ultrasound is performed, the condition of the fetus is assessed (BPP, if necessary, Doppler is performed), the possibility of external rotation of the fetus to the head, and the readiness of the female body for childbirth are determined.

The birth plan is developed by a council of doctors with the participation of an anesthesiologist and a neonatologist and coordinates it with the pregnant woman. In the case of a full-term pregnancy in a hospital of level III, by the beginning of labor, it is possible to perform an external rotation of the fetus on the head with the informed consent of the pregnant woman. The external rotation of the fetus on the head in the case of a full-term pregnancy leads to an increase in the number of physiological births in the cephalic presentation.

Carrying out an external rotation to the head during full-term pregnancy makes it possible to more often spontaneously rotate the fetus. Thus, waiting for delivery reduces the number of unnecessary external rotation attempts. In full-term pregnancy, in the event of complications of rotation, emergency abdominal delivery of a mature fetus can be performed. After a successful external cephalic rotation, reverse spontaneous rotations are less common. The disadvantages of external fetal rotation at full term is that it may be prevented by premature rupture of the membranes or labor that began before the planned attempt at this procedure. The use of tocolytics in external rotation reduces the failure rate, facilitates the procedure, and prevents the development of fetal bradycardia. These benefits of using tocolytics should be weighed against their possible side effects on the maternal cardiovascular system. It should be noted that the risk of complications during external rotation is reduced, since the procedure takes place directly in the maternity ward with continuous monitoring of the fetal condition.

Conditions for carrying out an external turn

estimated fetal weight

Contraindications for external rotation

Complicated course of pregnancy at the time of making a decision on external rotation (bleeding, fetal distress, preeclampsia), burdened obstetric and gynecological history (recurrent miscarriage, perinatal losses, history of infertility), polyhydramnios or oligohydramnios, multiple pregnancy, anatomically narrow pelvis, the presence of cicatricial changes in the vagina or cervix, placenta previa, severe extragenital pathology, uterine scar, adhesive disease, fetal anomalies, uterine anomalies, tumors of the uterus and its appendages.

Technics

The doctor sits on the right side (face to face of the pregnant woman), places one hand on the head of the fetus, the other on its pelvic end. With careful movements, the fetal head gradually shifts to the entrance to the small pelvis, and the pelvic end to the bottom of the uterus.

Complications during external rotation

Premature detachment of a normally located placenta, fetal distress, uterine rupture. In the case of careful and skilled external rotation of the fetus on the head, the frequency of complications does not exceed 1%.

The course and tactics of labor in the transverse position of the fetus

Childbirth in the transverse position is pathological. Spontaneous delivery through the natural birth canal with a viable fetus is impossible. If childbirth begins at home and there is not enough observation of the woman in labor, then complications can begin already in the first period. With the transverse position of the fetus, there is no division of amniotic fluid into anterior and posterior, therefore, untimely discharge of amniotic fluid is often observed. This complication may be accompanied by prolapse of the loops of the umbilical cord or the handle of the fetus. Deprived of amniotic fluid, the uterus tightly fits the fetus, a neglected transverse position of the fetus is formed. During normal labor, the fetal shoulder descends deeper and deeper into the pelvic cavity. The lower segment is overstretched, the contraction ring (the border between the body of the uterus and the lower segment) rises and takes an oblique position. There are signs of a threatening rupture of the uterus and, in the absence of adequate assistance, it may rupture.

In order to avoid such complications, 2-3 weeks before the expected birth, the pregnant woman is sent to an obstetric hospital, where she is examined and prepared for the completion of the pregnancy.

The only way of delivery in the transverse position of the fetus, which ensures the life and health of the mother and child, is a caesarean section in the period of 38-39 weeks.

Classical obstetric rotation of the fetus on the leg

Previously, the operation of the classical external-internal rotation of the fetus on the leg was often used, followed by extraction of the fetus. But it gives many unsatisfactory results. Today, with a live fetus, it is carried out only in the case of the birth of a second fetus with twins. It should be noted that the operation of the classic obstetric pediculation of the fetus is very complicated and, therefore, given the trends in modern obstetrics, is performed very rarely.

Conditions for the obstetric classic rotation operation

full dilatation of the cervix;
sufficient fetal mobility;
correspondence between the size of the fetal head and the mother's pelvis;
the fetal bladder is whole or the water has just passed;
live fruit of medium size;
accurate knowledge of the position and position of the fetus;
absence of structural changes in the uterus and tumors in the vaginal area;
the consent of the woman in labor to turn.

Contraindications to the operation of obstetric classic rotation

neglected transverse position of the fetus;
threatening, initiated or completed uterine rupture;
congenital malformations of the fetus (anencephaly, hydrocephalus, etc.);
fetal immobility;
narrow pelvis (II-IV degree of narrowing);
oligohydramnios;
large or giant fruit;
scars or tumors of the vagina, uterus, small pelvis;
tumors that prevent natural delivery;
severe extragenital diseases;
severe preeclampsia.

Preparation for surgery includes the activities necessary for vaginal surgery. The pregnant woman is placed on the operating table in the supine position with legs bent at the hip and knee joints. Empty the bladder. Disinfect the external genitalia, inner thighs and anterior abdominal wall, cover the stomach with a sterile diaper. The obstetrician's hands are treated as for abdominal surgery. With the help of external techniques and vaginal examination, the position, position, type of fetus and the condition of the birth canal are studied in detail. If the amniotic fluid is intact, the fetal bladder is torn immediately before the rotation. The combined rotation should be performed under deep anesthesia, which should provide complete muscle relaxation,

Stage I

Any hand of the obstetrician can be inserted into the uterus, however, it is more easy to turn when introducing the hand, the same position of the fetus: in the first position - the left hand, and in the second - the right. The hand is inserted in the form of a cone (fingers are extended, their ends are pressed against each other). With the second hand, the genital gap is bred. The folded inner arm is inserted into the vagina in the direct size of the exit from the small pelvis, then with light helical movements it is transferred from the direct size to the transverse one, while moving towards the internal pharynx. As soon as the inner hand is fully inserted into the vagina, the outer hand is moved to the bottom of the uterus.

Stage II

The advancement of the hand in the uterine cavity may be hindered by the shoulder of the fetus (in the transverse position) or the head (in the oblique position of the fetus). In this case, it is necessary to move the fetal head towards the back with the inner hand or grab the shoulder and carefully move it towards the head.

Stage III

When performing the III stage of the operation, it should be remembered that today it is customary to make a turn on one leg. An incomplete foot presentation of the fetus is more favorable for the course of the birth act than a complete foot presentation, since the bent leg and buttocks of the fetus represent a larger part, which better prepares the birth canal for the passage of the next head. The choice of the stem to be grasped is determined by the type of fetus. In the anterior view, the lower leg is captured, in the posterior view, the upper one. If this rule is observed, the rotation ends in the anterior view of the fetus. If the leg is chosen incorrectly, then the birth of the fetus will occur in the posterior view, which will require turning to the anterior view, since birth in the posterior view with breech presentation through the natural birth canal is impossible. There are two ways to find the stem: short and long. At the first, the obstetrician's hand moves directly from the side of the tummy of the fetus to the place where the legs of the fetus are approximately located. More accurate is the long way to find the legs. The obstetrician's inner hand gradually slides along the lateral surface of the fetal body to the ischial region, further to the thigh and lower leg. With this method, the obstetrician's hand does not lose touch with the parts of the fetus, which allows you to navigate well in the uterine cavity and correctly find the right leg. At the moment of finding the leg, the outer hand lies on the pelvic end of the fetus, trying to bring it closer to the inner hand.

After finding the leg, it is captured with two fingers of the inner hand (index and middle) in the ankle area or with the entire hand. Capturing the leg with the whole hand is more rational, since the leg is firmly fixed, and the obstetrician's hand does not get tired as quickly as when grasping with two fingers. When capturing the lower leg with the whole hand, the obstetrician places the extended thumb along the tibial muscles so that it reaches the popliteal fossa, and the other four fingers clasp the lower leg in front, and the lower leg is, as it were, in the tire along the entire length, which prevents its fracture.

Stage IV

The rotation itself is performed, which is carried out by lowering the legs after it has been captured. With the outer hand, the fetal head is simultaneously moved to the bottom of the uterus. Traction is carried out in the direction of the leading axis of the pelvis. The turn is considered complete when the leg is removed from the genital gap to the knee joint and the fetus has taken a longitudinal position. After that, following the rotation, the fetus is removed by the pelvic end.

The leg is grasped with the whole hand, placing the thumb along the length of the leg (according to Fenomenov), and with the rest of the fingers covering the lower leg in front.

Then traction is carried out down, it is possible with both hands.

Under the symphysis, the region of the anterior inguinal fold and the wing of the ilium appear, which is fixed so that the posterior buttock can be cut above the perineum. The front thigh, captured with both hands, is lifted up, and the back leg falls out on its own; after the birth of the buttocks, the obstetrician's hands are placed in such a way that the thumbs are placed on the sacrum, and the rest on the inguinal folds and thighs, then the traction is carried out on itself, and the torso is born in an oblique size. The fetus is turned back to the symphysis.

Then the fetus is rotated 180° and the second handle is removed in the same way. The release of the fetal head is carried out by the classical method.

When performing an obstetric turn, a number of difficulties and complications may arise:

rigidity of the soft tissues of the birth canal, spasm of the uterine pharynx, which are eliminated by the use of adequate anesthesia, antispasmodics, episiotomy;
prolapse of the handle, removal of the handle instead of the leg. In these cases, a loop is put on the handle, with the help of which the handle moves away while turning towards the head;
Uterine rupture is the most dangerous complication that can occur during rotation. Accounting for contraindications to the operation,
examination of a woman in labor (determining the height of the contraction ring), the use of anesthesia are necessary to prevent this formidable complication;
prolapse of the umbilical cord loop after the end of the turn requires the mandatory quick extraction of the fetus by the leg;
acute fetal hypoxia, birth trauma, intranatal fetal death are frequent complications of internal obstetric rotation, which generally lead to an unfavorable prognosis of this operation for the fetus. In this connection, in modern obstetrics, the classic external-internal rotation is rarely performed;
infectious complications that may occur in the postpartum period also worsen the prognosis of the internal obstetric turn.

In the case of a neglected transverse position of the dead fetus, childbirth is completed by performing a fruit-destroying operation - decapitation. After the classic pedunculation of the fetus or after a fruit-destroying operation, a manual examination of the walls of the uterus should be performed.