home › Happiness › Causes of breech presentation. Breech presentation

Causes of breech presentation. Breech presentation

The situation when a pregnant woman has a baby in a breech position in her last stages is considered rare - out of 100 pregnant women there are about 5 women with this deviation. This explains the fact that many pregnant women do not know how breech presentation of the fetus, the incorrect position of the baby’s head in the uterus, can threaten the child and the pregnant woman herself during childbirth, what pathologies arise in the baby if the birth is not carried out skillfully and competently. In other cases, the pelvic position of the fetus is an indication for cesarean section, as the safest method of childbirth.

What is breech presentation of the fetus?

During the entire pregnancy, the embryo changes its position in the uterus several times. Gynecologists consider these movements to be a normal process until the last period of pregnancy, when, in most cases, the fetus takes a head-down position, which is considered the correct presentation for a natural birth. The fetal head is the most voluminous part of the body, therefore, during normal childbirth, when the head has passed through the perineum, the rest of the body follows it inertly, without causing problems during obstetrics.

The situation when, after the 30th week of pregnancy, an anatomical breech or leg presentation of the fetus is recorded by an obstetrician, can greatly complicate childbirth. The baby's legs or buttocks are born first, which do not take up much volume, and only then the head is born, the passage of which through the birth canal may cause difficulties, fraught with the threat of serious pathologies in the newborn baby.

Causes

If the fetus is in a breech position in the last stages of pregnancy, then there are many reasons for this condition. Factors influencing abnormal presentation of the fetus are divided into three main groups:

Dependent on the mother, or maternal. These include: a narrow pelvis, which prevents the child from taking the correct position with the head towards the pelvic floor, a history of fibroids or fibroids, ovarian tumors, hypoplasia, pathological abnormalities in the structure of the uterus.
Caused by abnormalities in the development of the fetus, or fruit. These include: polyhydramnios, entanglement of the umbilical cord around the embryo, its length being too short, hypoxia, hydro-, anen- and microcephaly of the fetus, twins or triplets according to ultrasound results.
Placental, when the breech presentation of the child is facilitated by low placenta previa and high tone of the lower parts of the uterus, caused by various operations, scars, and frequent curettage of the uterine cavity. The fetus tries to take the upper position when its head is not pressed by the spasming muscles of the uterus.

Classification

There are several types of abnormal presentation of the fetus in the mother’s pelvic ring:

Fully breech presentation of the fetus, when the buttocks of the fetus are lowered down, and the legs are bent and pressed with the arms to the tummy.
Foot presentation, when the fetus has one or two feet in the pelvic ring. Sometimes the fetal knees end up there.
Mixed presentation. In this case, the buttocks and one foot are located on the pelvic ring, the second leg is straightened.

Why is it dangerous?

The condition with a breech presentation recorded by obstetricians is dangerous due to the risk of early termination of pregnancy, which interferes with the normal formation of the central nervous system and endocrine systems of the fetus. In the last stages of gestation, the medulla oblongata of the fetus is formed, and the pelvic position of the fetus can lead to disruption of this process, causing cerebral edema in the newborn baby. Developmental defects may also be recorded, including heart failure, abnormal development of bones, muscles, central nervous system, and genital organs.

Does the stomach drop during breech presentation?

One of the most important signs that the fetus is in a breech presentation is that the pregnant woman’s belly in the last stages does not fall, but is in an elevated state. The belly is pulled down by the head, which after 30-32 weeks descends to the pelvic ring. If the head is located on the upper segments of the uterus, and below are the buttocks, feet or knees of the fetus, then the abdomen will not move down.

Diagnostics

A stable breech presentation is recorded by gynecologists starting from the 32nd week of gestation during a routine gynecological examination of the pregnant woman. At the bottom of the uterus, a large head can be felt, the heartbeat is felt opposite the navel, and at the entrance of the womb you can feel the sacrum, spine, soft, irregularly shaped parts of the child’s body, in which the buttocks, heels, feet and toes can be guessed. Based on the visual examination data, the gynecologist or obstetrician records the abnormal position of the embryo.

A pregnant woman is prescribed the following additional procedures to confirm the diagnosis of pathological presentation: examination of the child using three-dimensional ultrasound, which gives a three-dimensional picture of the position of the embryo in the uterus, Dopplerography and cardiotocography, which allow assessing the health of the internal organs of the fetus that has become malpresented.

Management of pregnancy with breech presentation of the fetus

The difference between observing a woman with a fixed breech or leg presentation of the fetus from standard pregnancy management is attempts to correct the pelvic position of the fetus. The following methods are used for this:

The woman is prescribed special gymnastics, in which she must turn from one side to the other and lift the pelvis above head level from a lying position. Exercises have contraindications: exercises cannot be done with scars on the uterus, low placenta previa, or preeclampsia.
If gymnastics does not help, then doctors can hospitalize the patient and attempt external rotation in a hospital setting. If the external rotation is incorrect, it can cause rupture of the placenta, membranes, rupture of amniotic fluid and premature birth.

Childbirth

To determine how childbirth will proceed with a breech presentation of the fetus, the pregnant woman is admitted to the hospital at 33 weeks of gestation. The decision on the method of delivery is made based on an assessment of the general condition of the patient, the position of the baby in the womb, the presence of a history of diseases that can negatively affect the intrauterine development of the baby, the age, blood pressure of the pregnant woman, the number of previous pregnancies of the expectant mother, her willingness to follow orders obstetrician

Biomechanism of labor in breech presentation

The pelvic position of the fetus determines other obstetric methods of natural childbirth than the cephalic position. Since the buttocks are considered the largest part of the baby’s body after the head, the baby will be born according to the following algorithm:

The buttock that is closest to the birth canal is born first. It descends into the small pelvis, where the buttock is inverted and shifted onto the finger, as a result of which it extends end forward, emerging from the birth canal.
Then the baby's pelvic region is fixed at the end of the pubic arch, the baby's spine is strongly curved, and the second buttock is born.
If the baby's legs are bent at the knees, then they are born at the same time as the buttocks. With the legs positioned along the body, the obstetrician waits for the next contractions of the woman in labor to pull the legs out of the birth canal.
The baby's torso passes through the birth canal easily if the birth of the baby's buttocks and legs has passed without complications before this stage.
The baby's shoulders are born one at a time, with a fixed fixation point. At the same time, the handles are released.
Then the head is born, passing with its sharp end forward in a transverse dimension. From the moment the baby is born to the shoulders until the head is removed, no more than 10 minutes should pass, because the head compresses the umbilical cord and the baby begins to suffocate from lack of oxygen.

When the doctor during the consultation reports that the baby is positioned head up in the stomach, the mother begins to worry. And you really need to worry, because this position of the fetus in the last stages of pregnancy is abnormal. A fully formed baby in the womb should lie head down, so it will be easier for him to get out through the birth canal.

What is breech presentation of the fetus?

Breech presentation of the fetus is the incorrect position of the fetus in the womb. During the birth process, the baby's head is first exposed from the mother's genital tract. Since it is the bulkiest and hardest part of the baby's body, its passage through the pelvic bones presents little difficulty. During contractions, the pelvis moves as wide as possible to push the head forward, and as soon as this happens, the rest of the baby’s body easily jumps out after it. This is how childbirth proceeds when the fetus is placed correctly in the mother’s belly, that is, head down.

But in about five out of a hundred women, the baby in the womb takes on an incorrect body position, and remains so until birth. The baby sits between the bones of the pelvis with her butt or legs, and when the mother, at 28 weeks of pregnancy, comes for a routine examination to the doctor, he diagnoses the fetus as breech. At this stage, the fetus is already quite large, so the likelihood that it will unfold on its own is small. Usually, special massage and gymnastic procedures are used to turn the baby.

Types of breech presentation

Although breech presentation of the fetus does not pose a clear threat to the health and life of the baby and mother, it is still a pathology. And any pathology is fraught with consequences. A baby sitting in the stomach with its head up has poor development of the internal parts of the brain, and because the lower part of the body is squeezed between the pelvic bones, it often experiences minor hemorrhages and swelling of the tissues of the kidneys and genitals. A baby who is in the wrong position in the womb receives little oxygen, suffers from tachycardia, cannot move his limbs normally, and runs the risk of heart disease, cerebral palsy, or chronic gastrointestinal diseases.

Gynecologists distinguish three types of breech presentations:

breech presentation of the fetus, when the baby sits on the bottom, the legs are raised up, with the feet touching the face and the knees pressed to the stomach;
mixed presentation, in which the legs are bent at the knees and pressed against the body, so the baby rests against the bones of the mother’s pelvis with both the buttocks and feet;
foot presentation of the fetus, when the baby seems to be squatting, sometimes one of the legs can stretch out and slide towards the exit of the uterus.

Causes of breech presentation of the fetus

A woman diagnosed with breech presentation of the fetus needs increased attention from a doctor. A gynecologist can easily determine the breech presentation of the fetus by simply feeling the mother’s belly or conducting ultrasound diagnostics. And although with this peculiarity of the uterine development of the baby, pregnancy proceeds as usual, the doctor must carefully monitor the fetus, its health and well-being.

Each embryo actively tosses and turns in the mother's womb until approximately 22 - 23 weeks of pregnancy. Then he becomes large enough to somersault, or lays head down, or sits on his legs or butt, not wanting to change position. If by the 36th week the baby has not managed to turn around correctly, then the presentation cannot be corrected; it persists until birth. The reasons why the baby behaves so strangely can be very different:

embryonic developmental defects;
pathologies of the uterus, weakening of the tone of its muscle tissue, malignant tumors;
placental defects;
polyhydramnios or oligohydramnios;
consequences of cesarean section and other operations on the internal genital organs;
multiple pregnancy.

Symptoms of breech presentation of the fetus

Mom doesn’t notice any changes at all: her stomach looks normal, there is no pain or discomfort, she feels normal. If a pregnant woman for some reason does not attend routine examinations with a gynecologist, then she may not find out until the very birth that her baby is not lying correctly in the uterus. Therefore, it is so important not to ignore medical advice during pregnancy.

First, the doctor palpates the abdomen. With a breech presentation, the fetal heartbeat is clearly heard near the navel, and the uterus is too high. The gynecologist then examines the vagina and cervix through palpation. If the child is sitting on his bottom, his fingers feel the soft buttocks and tailbone, and when the baby rests his legs on the pelvis, the doctor determines his heels and small toes. In this case, in order to finally confirm the diagnosis, the doctor writes a referral to the mother for an ultrasound examination.

Birth with breech presentation

Many women panic if labor is approaching and the baby has not yet turned head down. There's really no need to worry too much. Mothers diagnosed with breech presentation of the fetus are admitted to the obstetric hospital under close medical supervision ahead of schedule. After a thorough examination, the doctor decides how to perform obstetrics: use a caesarean section or allow a natural process.

Usually, childbirth with a breech presentation of the fetus proceeds naturally without any special problems; its progress is closely monitored by an obstetrician. But there are situations when a caesarean section is required to preserve the health and life of the baby.

Emergency surgery is necessary if:

the fetus lacks oxygen;
the placenta is deformed;
the uterus has pathologies or tissue tears;
the mother has a too narrow pelvis;
weak contractions are recorded, or the cervix does not dilate;
the baby is large, post-term;
The baby's legs or umbilical cord have fallen into the cervix.

Complications during childbirth

When the baby comes out into the light with its legs forward, the uterus contracts weakly, contractions do not appear intensely, and the cervix opens to a small width. This happens because the lower part of the fetal body is much smaller in volume than the head, which means it cannot put enough pressure on the walls of the uterus as the baby moves through the birth canal. As a result, obstetricians have to stimulate labor.

In addition, babies who come out of their mother's belly with their butts forward often have their arms thrown back or their heads get stuck, which leads to serious injuries. Sometimes children press the umbilical cord with their head against the wall of the cervix or birth canal. The flow of oxygen is abruptly interrupted, and the baby begins to suffocate. Doctors urgently use an artificial method to speed up the birth process before the baby dies before it can even be born.

Exercises for breech presentation

If the baby is unable to turn head down before the 34th week of pregnancy, the doctor may advise the mother on special gymnastic exercises. Since gymnastics against breech presentation is performed in a supine position, it is advisable not to do it after a heavy meal, so as not to cause dizziness, heartburn and nausea. Physical exercise is also strictly prohibited for pregnant women with toxicosis in the later stages, if there are defects in the placenta, or if any operations have been performed on the uterus, after which scars remain. To avoid problems, before starting gymnastics, it is better to consult a doctor.

Exercise 1. You need to lie on your back and make smooth body turns from one side to the other: 3 - 5 times for 10 minutes. The exercise should be performed at least 3 times a day.
Exercise 2. Lying on your back, place some cushion of a pillow, rolled up towel or blanket under your lower back so that your head is about 20 cm below your pelvis. You need to stay in this position for up to 15 minutes, but no more. This lesson is carried out 2 - 3 times a day.
Exercise 3. Lying on your back, spread your legs shoulder-width apart and bend your knees so that your feet rest completely on the floor. You need to raise your pelvis, leaning on your feet and shoulders, tensing the muscles of your buttocks, then slowly lower it, and so on 5-7 times. The exercise is done 3 times a day.

If after gymnastics the doctor discovers during an examination that the baby’s position in the stomach has become normal, the first two exercises can no longer be performed, but for prevention it is better to do the third until birth.

- longitudinal position of the fetus in the uterus with the legs or buttocks facing the entrance to the pelvis. Pregnancy with a breech presentation of the fetus often occurs under conditions of threat of miscarriage, gestosis, fetoplacental insufficiency, fetal hypoxia, and birth injuries. Diagnosis of breech presentation of the fetus is made using external and vaginal examination, echography, Dopplerography, CTG. Treatment of breech presentation includes complexes of corrective gymnastics, preventive external rotation of the fetus, and early selection of the method of delivery.

General information

Breech presentation of the fetus in obstetrics and gynecology occurs in 3-5% of all pregnancies. Management of pregnancy and childbirth with a breech presentation of the fetus requires qualified and highly professional assistance to the woman and child. With a breech presentation of the fetus during childbirth, the baby’s buttocks or legs are the first to pass through the birth canal. At the same time, the cervix is still in an insufficiently smoothed and open state, so the advancement of the head, as the largest and densest part of the fetus, turns out to be difficult. With breech presentation, childbirth can proceed uncomplicated, but there is an increased risk of asphyxia, fetal stillbirth, and birth injuries to the child and mother.

Classification of breech presentations of the fetus

Variants of breech presentation of the fetus include leg and breech presentation. Foot presentations account for 11-13% of cases of all pelvic presentations of the fetus. Leg presentation can be complete (both legs), incomplete (one leg) or knee (fetal knees). Breech births are the most common. In 63-75% of cases, an incomplete (purely breech) presentation is diagnosed, in which only the buttocks are adjacent to the entrance to the pelvis, and the fetal legs are extended along the body. In mixed breech presentation (20-24%), not only the buttocks, but also the legs of the fetus, bent at the knee or hip joints, are facing the entrance to the pelvis.

With different types of breech presentation of the fetus, the development of the biomechanism of labor has its own characteristics. With a purely breech presentation, a small fetus and normal size of the mother's pelvis, uncomplicated independent childbirth is possible. With foot and mixed presentation, childbirth through the birth canal is associated with significant risks for the newborn - asphyxia, prolapse of the umbilical cord and individual parts of the fetus.

Causes of breech presentation of the fetus

The factors that determine breech presentation of the fetus are numerous and not fully studied. The presence of uterine fibroids, ovarian tumors, anatomical narrowing or irregular shape of the pelvis, anomalies in the structure of the uterus (intrauterine septum, hypoplasia, bicornuate or saddle uterus) may prevent the head from positioning itself at the entrance to the pelvis.

Breech presentation can be observed with increased fetal mobility caused by polyhydramnios, malnutrition or prematurity, hypoxia, microcephaly, anencephaly, hydrocephalus and other factors associated with the pathology of the child. On the other hand, limited mobility of the fetus in the uterine cavity with oligohydramnios, a short umbilical cord or its entanglement also contributes to the formation of malpresentation.

The mother's obstetric and gynecological history, aggravated by repeated uterine curettage, endometritis, cervicitis, multiple pregnancies, abortions, complicated childbirth, can lead to breech presentation of the fetus. These conditions often lead to the development of pathological hypertonicity of the lower segments of the uterus, in which the head tends to take a position in the upper, less spasmodic parts of the uterine cavity. Changes in myometrial tone can also be caused by a scar on the uterus, neurocirculatory dystonia, neurosis, overwork of the pregnant woman, stress, etc. Breech presentation of the fetus is often combined with low location or placenta previa.

In numerous observations carried out by obstetrics and gynecology, it is noted that breech presentation of the fetus develops in those women who themselves were born in a similar situation, therefore the issue of hereditary conditioning of leg and breech presentations is being considered.

Features of pregnancy

With a breech presentation of the fetus, the course of pregnancy, much more often than with a cephalic presentation, is associated with a threat or spontaneous abortion, the development of gestosis and fetoplacental insufficiency. These conditions, in turn, negatively affect the maturation of the nervous, endocrine and other systems of the fetus. With breech presentation in the fetus from 33-36 weeks of gestation, the processes of maturation of the structures of the medulla oblongata slow down, which is accompanied by pericellular and perivascular edema. In this case, the neurosecretory cells of the fetal pituitary gland begin to work with increased activity, leading to premature depletion of the function of the adrenal cortex and a decrease in the protective and adaptive reactions of the fetus.

Changes in the fetal gonads are represented by hemodynamic disorders (venous stasis, pinpoint hemorrhages, tissue edema), which may later manifest as gonadal pathology - hypogonadism, ovarian wasting syndrome, oligo- or azoospermia, etc. With breech presentation, the incidence of congenital malformations increases heart, central nervous system, gastrointestinal tract, musculoskeletal system in the fetus. Disturbances of the uteroplacental blood flow are manifested by hypoxia, high heart rate, and decreased fetal motor activity. During childbirth with a breech presentation, the fetus often develops discoordinated or weak labor. The most severe changes are observed in cases of mixed breech or leg presentation.

Diagnosis of breech presentation of the fetus

A stable breech presentation of the fetus should be discussed after the 34-35th week of gestation. Before this period, the location of the presenting part may be changeable. Breech presentation of the fetus is determined by external obstetric and vaginal examinations.

Breech presentation of the fetus is characterized by a higher position of the uterine fundus, which does not correspond to the gestational age. External examination techniques make it possible to identify in the area of the womb a soft, irregularly shaped, inactive part of the fetus that is not capable of procreation. In the area of the uterine fundus, on the contrary, it is possible to palpate a large, round, hard and movable part - the fetal head. The heartbeat can be heard above or at the level of the navel.

Management of pregnancy and childbirth

In patients belonging to high-risk groups for the formation of breech presentation, measures are taken during pregnancy to prevent fetoplacental insufficiency, disorders of uterine contractility, and fetal complications. A pregnant woman is recommended to follow a gentle regimen with a full night's sleep and daytime rest, and a balanced diet to prevent fetal hypertrophy.

Psychoprophylactic work is carried out with pregnant women, aimed at teaching techniques for muscle relaxation and relieving nervous excitability. From the 35th week of gestation, corrective gymnastics is prescribed according to Dikan, Grishchenko and Shuleshova, Kayo, which helps to change the tone of the myometrium and abdominal wall muscles, transferring the fetus from breech presentation to cephalic presentation. In some cases, antispasmodic drugs are prescribed in intermittent courses.

Carrying out external preventive rotation of the fetus on the head according to Arkhangelsky in some cases turns out to be ineffective and even dangerous. The risks of such an obstetric appointment may include the onset of premature placental abruption, rupture of membranes, premature birth, uterine rupture, trauma and acute fetal hypoxia. In recent years, these circumstances have limited the use of external obstetric aids in the practice of treating breech fetuses.

A pregnant woman with a breech presentation of the fetus at the 38-39th week of gestation is hospitalized in an obstetric hospital to plan delivery tactics. In an uncomplicated obstetric situation (satisfactory condition of the fetus and the woman in labor, proportionality of the pelvis and fetus, biological readiness of the maternal body, purely breech presentation, etc.), childbirth through the natural birth canal is possible. This includes prevention of premature opening of the amniotic sac, constant CTG monitoring of the fetus and uterine contractions, and drug prevention of labor anomalies.

Children born in breech presentation often have intracranial injuries, encephalopathy, spinal injuries, hip dysplasia. If fetal asphyxia or aspiration of amniotic fluid is detected, appropriate resuscitation measures are required. Newborns in the early neonatal period are subject to careful examination by a neurologist. Birth injuries typical for breech presentation of the fetus in women include ruptures of the perineum, cervix, vagina and vulva, and damage to the pelvic bones.

The preventive direction involves a thorough examination and correction of disorders in women planning pregnancy; identifying pregnant women at risk for the development of breech presentation of the fetus and conducting timely and adequate preparation for childbirth; early choice of labor tactics and their management under continuous monitoring

In the early stages of pregnancy, the baby is still so small that it moves freely in the uterine cavity and can occupy any position there. However, over time, the baby grows and his movements in the uterus become more limited. Thus, by approximately the 28th–30th week of pregnancy, it occupies a certain position - as a rule, longitudinally with the head down. This position of the baby is called cephalic presentation. Normally, a baby is born head first. But sometimes a situation arises when the child’s buttocks or legs are installed above the entrance to the pelvis towards the end of pregnancy. In this case, they speak of breech presentation of the fetus. The incidence of this complication varies between 2.7–5.4 %.

There are several types of breech presentation of the fetus:

purely gluteal (the buttocks of the fetus are installed above the entrance to the small pelvis, with the legs bent at the hip joints, straightened at the knees and extended along the body);
mixed gluteal (buttocks present with one or two legs bent at the hip and knee joints);
leg (full - both legs are presented and incomplete - one leg is presented).

Pure breech presentation is the most common (approximately 65 % of cases).

Often during childbirth, a transition from one type of breech presentation to another may occur. Pure breech presentation is more often observed in primiparous women, mixed breech and leg presentation in multiparous women, which is associated with a decrease in the muscle tone of the uterus and anterior abdominal wall: the fetus has the ability to move more. It has been noted that breech presentation in multiparous women occurs approximately 2 times more often than in primiparous women.

Risk factors

There are a number of factors that can contribute to the occurrence of breech presentation:

narrow pelvis;
abnormal shape of the pelvis (for example, after suffering from rickets in childhood);
malformations of the uterus (saddle-shaped, bicornuate uterus, presence of a septum in the uterus);
uterine fibroids (benign tumors) and tumors of the uterine appendages;
placenta previa (the placenta partially or completely blocks the exit from the uterine cavity). In this and other conditions listed above, the normal position of the fetus is disrupted, the head cannot take the correct position due to the presence of an obstacle and it is more convenient for the child to position his buttocks down;
excessive mobility of the child with polyhydramnios or limited mobility with oligohydramnios, multiple births;
pathological hypertonicity of the lower segment of the uterus and decreased tone of its upper sections. In this case, the fetal head, as the largest and densest part of the body, is pushed away from the entrance to the pelvis and takes a position in the upper part of the uterine cavity. Such disturbances in the contractile activity of the uterus in the third trimester of pregnancy can be caused by dystrophic changes in the myometrium due to inflammatory processes, repeated curettage, multiple pregnancies and complicated childbirth;
malformations of the fetus (for example, hydrocephalus - an excessive increase in cerebrospinal fluid in the cranial cavity, when the enlarged head is too crowded in the lower segment of the uterus and the fetus turns down with the pelvic end).
In addition, it was noted that those patients who were themselves born in a breech presentation often experience a similar situation during their own pregnancy. These facts may indicate a hereditary predisposition to breech presentation. However, this issue requires further study.

Diagnostics

The location of the fetus in the uterus can be determined during a routine external examination by a doctor at the antenatal clinic. With breech presentation, the following signs are determined:

When you feel the abdomen, the fetal head is located in the fundus of the uterus (its upper part) in the form of a dense formation, and the buttocks are located below the entrance to the pelvis (large, irregularly shaped, softer presenting part).

The fetal heartbeat is heard more clearly at the level of the navel and above, in contrast to cephalic presentation, when the heartbeat is heard below the navel.

The nature of fetal presentation is most accurately revealed by ultrasound, during which it is important to establish the type of breech presentation, trace the location of the legs in a breech presentation, determine whether the head is bent or straightened, and what are the features of the location of the umbilical cord. All these data are important in determining further tactics when choosing a method of delivery.

Correction methods

The final pattern of presentation is formed by the 34th–36th week of pregnancy; before this period, the baby can still roll over. Breech presentation of the fetus up to 28 weeks of pregnancy is the norm and does not require any measures to correct the situation - just dynamic observation is enough. Turning of the baby onto its head occurs spontaneously before birth in 70% of multigravidas and in 30% of primigravidas with breech presentation.

If, during pregnancy over 28–30 weeks, the doctor reveals a breech presentation during examination and it is confirmed at the third screening ultrasound of the fetus (at 32–34 weeks of pregnancy), the pregnant woman is recommended to carry out a set of gymnastic exercises to help turn the fetus onto its head. The essence of all these exercises comes down to creating discomfort in the child in a certain position, after which he strives to take a convenient and comfortable position by turning over.

There are several methods of such exercises:

Methodology of Grishchenko I. I. and Shuleshova A. E.

Exercises are performed before meals 4-5 times a day. It is necessary to lie on the side opposite to the position of the fetus (that is, opposite to the position of the child’s back). Bend your legs at the knees and hip joints. You should spend about 5 minutes in this position, and then straighten your upper leg and, while inhaling, press it to your stomach; while exhaling, straighten your leg, bending slightly forward. These movements must be repeated slowly for 10 minutes. Then you should lie down for 10 minutes without moving on your back, and then take the knee-elbow position for 5-10 minutes. Thus, the child is subject to additional pressure that creates inconvenience, and he tends to turn around in order to get into more comfortable conditions.

Dikan's technique I. F.

Exercises are performed 3–4 times a day. It is necessary to alternately lie on your right and left sides for 10 minutes. You need to change position 4-5 times during the exercise. This technique is well suited for pregnant women with increased uterine tone, since in the lateral position, uteroplacental blood flow improves, the muscles of the uterus relax, and the baby has room to move and the ability to roll over.

"Bridge". You need to lie down on a flat sofa or bed, or on the floor, place a pillow under your lower back so that your pelvis is 20–30 cm higher than your head. You should remain in this position for 10–15 minutes. Performed 2 times a day before meals. During this exercise, the baby's head strongly presses against the fundus of the uterus, creating significant discomfort for the baby, and he tends to turn.

It should be remembered that for all these exercises there are certain contraindications, which include:

a scar on the uterus (after a cesarean section in a previous birth or other operations on the uterus);
placenta previa;
threat of premature birth;
oligohydramnios;
polyhydramnios;
multiple births;
gestosis (toxicosis of the second half of pregnancy, manifested by edema, increased blood pressure, and the presence of protein in the urine);
uterine tumors;
severe maternal concomitant diseases (for example, heart defects, arterial hypertension, diabetes mellitus).

According to various authors, the effectiveness of these exercises is about 75%.

To the hospital before giving birth

Upon reaching 38–39 weeks, all pregnant women with breech presentation are advised to undergo prenatal hospitalization in a hospital. An in-depth examination of the pregnant woman is carried out there:

Ultrasound to determine the type of presentation (pure breech, mixed breech or leg), the degree of extension of the head (normally the fetal head is bent and the chin is pressed to the chest, extension of the head can complicate its birth), the size of the fetus;
according to indications (for example, if a large fetus is expected) - X-ray pelviometry (accurate determination of the size of the pelvis using computed tomography or magnetic resonance imaging);
assessing the condition of the fetus using cardiotocography - studying the fetal heartbeat and uterine tone, conducting a non-stress test (studying the reaction of the fetal cardiovascular system in response to its movements: with physical activity, the heart rate increases);
assessment of a woman’s body’s readiness for childbirth.

Based on the examination results, the prognosis of labor and the choice of obstetric tactics for its management are determined. During the examination, pregnant women are divided into 3 groups according to the risk level of upcoming birth for the fetus.

TO Group I Pregnant women are classified as high risk:

estimated fetal weight more than 3600 g – large fetus;
narrowing of the pelvis;
chronic hypoxia (lack of oxygen) of the fetus;
extragenital (not related to pregnancy) diseases affecting the condition of the fetus and labor, for example arterial hypertension, diabetes mellitus, renal failure;
primigravidas over 30 years of age.

These pregnant women usually undergo a elective cesarean section.

In II group includes pregnant women who may develop complications during childbirth (for example, with a low placenta, entanglement of the umbilical cord, rapid labor in the past). Childbirth in this group must take place under mandatory intensive monitoring of the state of labor and the fetal heartbeat. If complications arise during childbirth, a caesarean section is performed.

TO III group pregnant women are classified as low risk. Their birth is carried out with usual supervision. This includes women under 30 years of age without serious chronic diseases, an estimated fetal weight of up to 3600 g, normal pelvic dimensions and satisfactory fetal condition according to CTG and Doppler measurements (a method for studying utero-fetal-placental blood flow).

Indications for surgery

The absolute indications for performing a planned caesarean section are:

extragenital diseases that require the exclusion of attempts (for example, heart defects, including operated ones, threatening retinal detachment, etc.);
severe disturbance of fat metabolism (obesity of the 2nd degree and higher);
pregnancy after IVF;
post-term pregnancy (pregnancy 42 weeks or more);
malformations of the internal genital organs;
narrowing of the pelvis;
scar on the uterus;
estimated fetal weight less than 2000 g or more than 3600 g;
placenta previa (situations when the placenta partially or completely covers the internal os of the cervix);
cicatricial changes in the cervix;
multiple pregnancy (breech presentation of the first fetus located closer to the entrance to the pelvis). In other cases, cesarean section is performed according to a combination of indications (for example, the age of the expectant mother is over 30 years, complications during pregnancy, chronic fetal hypoxia).
The caesarean section rate for breech presentation is 80 % or more.

How will the birth go?

The main difference between birth in a breech presentation through the natural birth canal and birth in a cephalic presentation is as follows. The largest part of the fetus - the head - during childbirth in the cephalic presentation, is the first to overcome all the narrow parts of the bony pelvis, being configured by soft sutures and fontanelles. If there is a discrepancy between the sizes of the head and the bony pelvis, then the child simply cannot be born on its own and an emergency caesarean section is performed. If the head has successfully passed all the narrow parts of the pelvis and was born, then the remaining parts of the baby are born without much effort. With a breech presentation, the narrow sections of the pelvis are the first to overcome the baby’s buttocks, which happens quite easily, but when it comes to the head, a discrepancy may arise, which will be critical, and surgical intervention will be required.

During childbirth with breech presentation, the following complications may develop:

Premature rupture of amniotic fluid (rupture of the membranes before the opening of the cervix by 5–6 cm is considered premature, since until this moment the amniotic sac is involved in the process of dilatation). This occurs due to the strong pressure of small parts of the fetus on the lower pole of the amniotic sac.
The loss of small parts of the fetus and the umbilical cord occurs with premature rupture of the membranes and rupture of amniotic fluid due to the lack of tight contact between the pelvic end of the fetus and the lower segment of the uterus.
Primary weakness of labor occurs at the beginning of labor due to premature rupture of amniotic fluid and insufficient pressure of the pelvic end of the fetus, which is softer than the head, on the cervix.
Secondary weakness of labor develops during labor due to the fact that the woman in labor becomes fatigued with prolonged labor. It manifests itself as weak contractions, during which the opening of the cervix slows down or stops.
As the fetal head passes through the birth canal, the umbilical cord may become tightly pressed against the walls of the pelvis. If it lasts more than 5–7 minutes, then fetal death may occur (as oxygen-carrying blood stops flowing to the fetus and severe hypoxia occurs).
The throwing back of the arms and the extension of the head in the second stage of labor occurs reflexively at the birth of the body.
Aspiration of amniotic fluid is the entry of water into the baby’s respiratory tract when trying to take a breath when his head is still in the birth canal and has not been born.
Injuries to the birth canal and fetal injuries (traumatic brain injury with cerebral hemorrhages) occur when the birth of the fetal head and shoulders is difficult.

Management of childbirth

In the first stage of labor, constant monitoring of the condition of the fetus (CTG recording) and contractile activity of the uterus is necessary. Timely pain relief during labor and the administration of antispasmodic drugs are carried out in order to accelerate the dilatation of the cervix. Timely diagnosis of possible complications, their correction and determination of further labor management tactics are important.

During contractions, a pregnant woman is recommended to rest in bed; a vertical position is unacceptable, as premature rupture of water and loss of umbilical cord loops are possible. This is due to the size of the presenting part, which is smaller than the head and does not press tightly against the entrance to the pelvis.

A doctor delivers a breech birth, as opposed to a physiological birth, which is performed by a midwife under the supervision of a doctor. In the second stage of labor (during pushing), it is desirable to monitor cardiotocography, while during normal labor, sometimes simply listening to the fetal heartbeat between pushes with an obstetric stethoscope is sufficient. OXYTOCIN (a drug that increases contractile activity of the uterus) is injected intravenously to prevent weakness in pushing. Dissection of the perineum (episiotomy) is mandatory to speed up the passage of the head after the pelvic end and reduce the duration of compression of the umbilical cord by the head. Depending on the type of breech presentation, after eruption of the presenting part, special obstetric care is provided (actions performed by an obstetrician-gynecologist). The most common is the Tsovyanov manual - it is used for pure breech presentation. It is based on the preservation of the normal position of the fetus (the legs are kept in a bent position, pressed to the body until they are fully born), which prevents the development of such serious complications as throwing back the arms and straightening the head. Next, a classic manual aid is performed for breech presentations (releasing the shoulder girdle and fetal head).

In mixed breech presentation, support is provided from the moment the lower corners of the shoulder blades emerge from the genital slit; it is aimed at freeing the fetal shoulder girdle and facilitating the birth of the head.

The birth tumor (swelling of the soft tissues of the presenting part) with breech presentation is located on the buttocks, with leg presentation - on the child’s legs, which from this become swollen and blue-purple. Often the birth tumor moves from the buttocks to the external genitalia of the fetus, which looks like swelling of the scrotum or labia.

The need for a cesarean section during natural childbirth may arise in the following cases:

when umbilical cord loops or small parts of the fetus fall out;
when the condition of the fetus worsens due to increasing hypoxia;
in case of uncorrectable weakness of labor within 2–3 hours or in case of ineffective labor stimulation during this time during prenatal rupture of waters;
with premature detachment of a normally located placenta.

In conclusion, it should be said that no matter where your baby is located and no matter how he is born, the most important thing is that he is born healthy. And don’t be upset if doctors recommend a cesarean section. When you are close to your child, you will forget all your doubts and just enjoy happy motherhood! But if the doctor talks about the possibility of a natural birth and sees no indication for a cesarean section, you should not be afraid of a natural birth. The main thing is a positive attitude, confidence that everything will go well, and careful implementation of all the doctor’s recommendations during childbirth.

Expectant mothers, having learned from the doctor that their baby is positioned head up in the tummy, begin to worry, because this position of the fetus is considered incorrect. It is called breech presentation. The baby should be positioned head down in the uterus, as it is the widest part of the fetus.

It is best if the head appears first during childbirth, and then the rest of the body. However, 3-5% of women experience childbirth with a breech presentation of the fetus, which is fraught with complications.

The location of the baby in the uterine cavity is classified as follows:

Foot– both hips or only one of them are extended, and one leg is located at the exit from the uterus. This type of presentation is observed in 10-30% of pregnant women (most often in multiparous women).
Gluteal– the fetal legs are bent at the hip joints, and the knees are pressed to the tummy and straightened. This presentation occurs in 50-70% of pregnant women (most often in primigravidas).
Mixed(gluteal-leg) – knees and hips are bent. This type of presentation occurs in 5-10% of cases.

Causes of breech presentation of the fetus

Until the 32nd week, the fetus can take different positions in the mother's tummy. Having free space in the uterus allows it to move. As the child grows, he tends to position himself head down.

For the following reasons, breech presentation of the fetus may persist until delivery:

oligohydramnios or;
pathologies of the placenta: location in the area of the tubal angles;
pathologies of the uterus: impaired tone, fibroids;
fetal pathologies: anencephaly, hydrocephalus;
multiple pregnancy;
consequence of cesarean section.

Signs of breech presentation of the fetus

Many women are concerned about the question of what breech presentation of the fetus means and by what signs it can be determined. Pregnant women do not feel at all that their baby is lying incorrectly in the uterus. There is no discharge or pain. Breech presentation can only be determined by a doctor during examination.

Experts note that when the baby is positioned head up, there is a higher position of the uterine fundus above the pubis, which does not correspond to the gestational age. In the navel area, the fetal heartbeat can be heard more clearly.

With a vaginal examination, the doctor can identify signs of breech presentation of the fetus. With the mixed and leg position of the child, his feet are palpated, and with the gluteal position - the sacrum, inguinal fold, soft volumetric part, tailbone. Despite all the signs, an accurate diagnosis is determined only by ultrasound.

Delivery with breech presentation of the fetus

The baby can be born in a breech position naturally or as a result of a caesarean section.

The choice of a specific method of delivery depends on the following factors:

age of the pregnant woman;
gestational age;
anamnesis data;
existing diseases;
pelvic size;
type of breech presentation;
sex and weight of the fetus, degree of extension of its head.

Childbirth with a breech presentation of the fetus can occur naturally if: the gestational age is more than 37 weeks; the average estimated weight of the fetus is 2500-3500 g; the size of the mother's pelvis is normal; it is known that a girl will be born, not a boy; presentation is breech or gluteal-foot.

If the above conditions are not met, then it is required. In addition, surgery is necessary if: birth is premature; fetal weight is less than 2500 or more than 3500 g; male fetus; breech presentation is foot, ultrasound revealed hyperextension of the fetal head.

The doctor, having begun to deliver the child naturally, may decide to perform a caesarean section. It will be called emergency. Indications for immediate surgery may be as follows:

weak labor activity;
loss of the baby's legs, arms or umbilical cord;
incoordination of labor (contractions are observed, but the cervix does not dilate).

Possible complications during childbirth with a breech presentation of the fetus

Breech presentation of the fetus in a longitudinal position has absolutely no effect on the course of pregnancy. Complications may occur during childbirth.

Firstly, labor may be weak. This is explained by the fact that the pelvic end of the fetus is smaller in volume than the head. It puts little pressure on the uterus, and as a result it contracts worse, its cervix opens more slowly.

Secondly, during childbirth the baby's head may tilt back. Her birth will be difficult. There is a risk that the child will be injured.

Thirdly, often with a breech presentation of the fetus, the umbilical cord is clamped between the wall of the birth canal and the head. This will impede the flow of oxygen. The fetus will begin to experience hypoxia.

Fourthly, during childbirth, throwing back of the arms is possible. This is also fraught with various injuries.

Is it possible to correct breech presentation of the fetus?

Many new mothers begin to panic too early when they learn that their baby is in the wrong position in the tummy. For example, some women learn from an ultrasound that the fetus is breech at 20, 21 or 22 weeks and are already beginning to look for ways to correct its position. However, it is too early to think about this. For most pregnant women, the baby is in the correct position by 32 weeks or even later.

If at 32 weeks an ultrasound showed that the fetus did not turn over and remained in the head up position, then you can begin to perform special exercises. They are effective, and in most cases, thanks to them, the baby’s breech presentation is replaced by a cephalic presentation.

Exercises can be started with a breech presentation of the fetus from 33 weeks. You should consult your doctor first. During pregnancy with complications, you may have to give up exercise altogether so as not to harm the baby. Only a doctor will tell you whether it is possible to perform physical exercises, and whether they will negatively affect the condition of the expectant mother and fetus.

It is recommended to start all classes with a warm-up. Within a few minutes, a pregnant woman can walk at a normal pace, and then on her toes and heels. Hand movements (rotation, raising and lowering), and raising the knees to the side of the stomach will not be superfluous. Below are some examples of simple exercises that can be done after 32 weeks with a breech presentation.

Exercise 1

Stand up with your back straight and legs apart. Your arms should hang freely along your body. Then you should stand on your toes and spread your arms to the sides, arch your back, and inhale. After this, exhale and return to the starting position. Do the exercise 4 - 5 times.

Exercise 2

To complete this you will need pillows. They are necessary to raise the pelvis. A pregnant woman should lie on the floor and support her with several pillows. As a result, the pelvis should rise above shoulder level by 30-40 cm. The pelvis, knees and shoulders should form a straight line. It is recommended to perform this exercise a couple of times a day for 5-10 minutes, but not on a full stomach.

Exercise 3

Get on all fours, tilting your head down. As you inhale, round your back. Then return to the starting position. Exhale, bending at the lumbar region and raising your head up.

Exercise 4

You need to lie on your back, spread your legs shoulder-width apart and bend them. The feet should rest on the floor. Your arms need to be relaxed and extended along the body. When inhaling, you should raise your back and pelvis, resting on your shoulders and feet, and when exhaling, take the starting position. Then you need to straighten your legs, take a breath, drawing in your stomach. The muscles of the perineum and buttocks should be tense. As you exhale, return to the starting position. It is recommended to repeat this exercise 6-7 times.

If you want to start doing physical exercises earlier (for example, at 30 weeks with a breech presentation), then you should definitely consult a doctor.

Not only physical exercise can affect the position of the fetus. Proper nutrition and walks in the fresh air are of great importance.

It is advisable for pregnant women to sit on chairs with a firm and straight back and a hard seat. When sitting on upholstered furniture, it is recommended to spread your legs slightly so that your stomach rests freely. If possible, you should buy a fitball and perform special exercises on it that can affect the position of the baby in the mother’s tummy.

Thus, you should not panic if you learn from your doctor about the breech presentation of the fetus before the 27th week. The baby may change its position several times before birth. If desired, from 30-32 weeks, in the absence of contraindications, you can begin to perform special physical exercises.

If they do not affect the position of the fetus, then the doctor will select the optimal option for delivery (caesarean section or natural birth), which will not harm either the woman herself or her child.

Replies

Popular in the category: