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Foot presentation. Cesarean section or not? Features of the management of pregnancy and childbirth in breech presentation of the fetus

Pregnancy, planned or spontaneous, is a physiological process, which means it is not always predictable. Sometimes, up to 35 weeks, the baby changes its position several times, in which case they talk about the unstable position of the fetus. But after 35 weeks, as a rule. position is determined. In most cases, this is head presentation, less often - pelvic, even more rarely - oblique and transverse position of the fetus. We'll talk about such non-standard situations today.

The position of the fetus in the uterus is determined by many factors, both on the part of the mother and the fetus.

Pregnancy and childbirth with a breech presentation of the fetus is classified as pathological obstetrics due to possible risks and complications.

Causes of breech presentation of the fetus

maternal

Anomalies in the development of the uterus. This includes malformations of the genital organs, such as saddle uterus, bicornuate uterus, doubling of the uterus. Sometimes such anomalies are first detected during pregnancy. Pregnancy in these cases is observed in the group of medium and high risk.

Polyhydramnios. An increase in the amount of amniotic fluid creates the prerequisites for repeated movement of the fetus in the uterus, it turns over several times and may remain in breech presentation. in addition, with polyhydramnios and breech presentation, there is a high risk of entanglement of the umbilical cord around the neck and trunk of the fetus.

Low water. Reduced, compared with normal, the amount of amniotic fluid, on the contrary, limits the movement of the fetus. Normally, the fetus at full term turns head down; in case of oligohydramnios, it has practically no space for this action.

Umbilical cord wrap. Sometimes entanglement occurs spontaneously. If at this moment the fetus was in a breech presentation (for example, at 23-24 weeks, as is often the case), then the coup is limited by the mechanical tension of the umbilical cord loop.

- Multiple pregnancy. If you are expecting not one baby, but twins or triplets, then you should be prepared for the fact that not all babies will be born with a head. Again, due to the limited space for the coup, one of the fetuses is more likely to be in the breech presentation. If the first fetus goes with the head, and the second in the breech presentation, then the birth proceeds more safely, since the first baby has time to expand the birth canal.

Myoma of the uterus. Large fibroids also create a purely mechanical obstacle to turning the baby head down. Of particular danger are myomatous nodes growing inward, into the uterine cavity.

Decreased tone and contractility of the uterus. Such a condition can be observed in multiparous women, if a history of several abortions or curettage for therapeutic and diagnostic purposes. In women who have undergone a caesarean section or myomectomy, scars remain on the uterus, which also reduce local contractility of the myometrium and can prevent the baby from turning.

Placenta previa. Placenta previa is the complete or partial occlusion of the internal os by the placenta. Normally, the pharynx is free. the placenta is in the bottom or not lower than 7 cm from the internal pharynx. if the pharynx is blocked, then restrictions are created for stretching the lower segment of the uterus, there is less opportunity for the fetus to turn onto the head.

Short umbilical cord. The absolute shortness of the umbilical cord (less than 40 cm) mechanically prevents movement inside the uterus.

Anatomical narrowing of the pelvis or deformities of the pelvic bones. An anatomically narrow pelvis or displacement of the pelvic bones (as a result of trauma or previous diseases, rickets or tuberculosis of the bones, severe scoliosis) limits the movement of the fetus and prevents rotation.

fruit

Malformations of the fetus. Defects that interfere with the movement of the fetus should be very pronounced. For example, a large goiter (enlargement of the thyroid gland) or hydrocephalus with a significant increase in the size of the head. Such defects are diagnosed by ultrasound and in this case the issue of termination of pregnancy for medical reasons is decided. It is rare, detectable by ultrasound is reliable.

Violations of the formation of the vestibular apparatus in the fetus. There is also such a version of the formation of breech presentation, but the diagnosis of the health of the fetus can be carried out only after childbirth. There is no threat to the life of the fetus in this condition.

Prematurity (unstable position of the fetus up to 35 weeks)

Constitutionally small fetus or intrauterine growth retardation. The small size of the fetus predisposes to active movements and movements of the child inside the uterus.

Classification

Breech presentation is divided into several types. It is very important for a doctor and a pregnant woman to decide on the type of breech presentation, since the tactics of childbirth and the prognosis for the life and health of the baby depend on this.

1. Pure breech presentation. This means that the child lies to the exit with the buttocks, the legs are unbent at the knees and pressed to the stomach. this type of breech presentation occurs in 50 - 70% of cases, more often in primiparas.

2. Mixed. In this case, the child, as it were, squats down. Both the buttocks and the feet of the fetus are presented to the exit from the small pelvis.

3. Foot. The most dangerous type of breech presentation. The legs of the fetus are presented, one (the second is unbent and pressed to the stomach or more often bent at the knee and pressed to the stomach) or both. It is observed in 10 - 30% of cases, mainly in multiparous. Mixed breech presentation is up to 5 - 10%, occurs equally in multiparous and primiparous.

4. Knee. The knees of the fetus are presented to the exit, it is extremely rare. In childbirth, it passes into the foot.

Diagnostics

Primary diagnosis is ultrasound screening. In the second trimester, ultrasound determines the position (longitudinal, transverse) and presentation of the fetus (head, pelvic). The location of the fetus, determined at 20-23 weeks is not final, the situation in most cases changes to the head one by the third screening.

In the third trimester, if breech presentation is preserved, it can be determined during a gynecological examination. With an external obstetric examination, by palpating the abdomen, the doctor can find out the location of the fetal head. When viewed on a chair, it is possible with a high degree of probability to determine the presenting part: the head, buttocks, feet of the fetus.

Complications of childbirth in breech presentation

1. Premature outpouring of waters. This is because there is no pressure on the head and no distinction between front and rear waters.
2. Prolapse of legs during foot presentation, prolapse of umbilical cord loops.
3. Weakness of tribal forces. Primary and secondary weakness of labor activity develops due to weaker pressure (compared to the head) of the soft pelvic end on the uterine os, as well as long and ineffective contractions (it cannot be stimulated).
4. Intranatal hypoxia and fetal asphyxia. During childbirth, the loops of the umbilical cord can be pressed against the walls of the pelvis, if the duration of pressing is more than 5-7 minutes, then severe oxygen deficiency develops.
5. Throwing back the handles and overextension of the head. The pelvic end is soft and narrower than the head, so there is not enough expansion of the birth canal, and the denser and larger part comes out last. This can lead to difficulty in removing the head, tilting. And then, when providing benefits, there is a high risk of overstretching the cervical spine and damage to the nerve plexuses.
6. Aspiration (inhalation) of amniotic fluid. Inhalation of even normal, light amniotic fluid causes aseptic inflammation of varying severity. In the case of meconium aspiration (inhalation of green waters, which are colored with original feces - meconium), the prognosis worsens significantly.

Management of pregnancy in breech presentation of the fetus

Inspection, laboratory and instrumental examinations are performed according to the standard. Consultation of a geneticist in case of suspected congenital malformations of the fetus.

If in the period of 32 weeks or more the fetus has not turned head down, and there are no obvious factors that cause breech presentation (for example, large fibroids or complete placenta previa), then a special set of exercises is performed. It is aimed at the work of the abdominal muscles and increases the likelihood of the baby turning into head presentation.

A set of exercises for breech presentation

Bridge. Lie on the floor, raise your pelvis and place 2-3 pillows under your ass. Then, as you lower yourself onto the pillows, your pelvis and knees form a straight line. Lie in this position for a few minutes, if it does not cause discomfort. Sometimes this exercise helps quickly, but you can repeat it up to 3 times a day. You can not perform this exercise after eating and drinking, if you are already worried about heartburn, if there is a threat of premature birth.

Breath. Stand in the starting position, feet shoulder-width apart, arms down. Inhaling, raise your hands with your palms down to shoulder level, at the same time rise on your toes and slightly bend your lower back forward. Then slowly lower yourself. Repeat 4 times in one go.

Turn. Lie on the floor (the surface should be fairly hard, the sofa will not work), turn on the side towards which the back of the fetus is facing (in a transverse position, on the one where the head is). bend and pull your legs towards you, lie down for 5 minutes.
then take a deep breath and exhale through the back, turn to the other side, lie down for another 5 minutes, breathing is free, even.
Then straighten the upper leg (in the pelvic position) or the lower leg (in the transverse position), take a deep breath and exhale and bend the leg. Take the bent leg outward, without feeling pain and discomfort. If the exercise does not cause discomfort, then you can repeat it up to 5 times in one go.

Bridge-2. Lying on the floor, rest your feet on the floor, arms along the body. As you inhale, lift your pelvis up, hold for a few seconds, and as you exhale, lower yourself. Then, while inhaling, tighten the muscles of the perineum, while exhaling, relax. Repeat several times.
It is better to perform exercises in this order, so the muscles are smoothly included in the work and there is no sharp overload of the body.

If on the ultrasound you saw that the child turned his head, then continue to perform only the last exercise.

Contraindications to exercise: the threat of premature birth, fetal malformations, large fibroids, uterine malformations, complete or partial placenta previa, spotting from the genital tract of an unclear nature, pulling pains in the abdomen and lower back of an unclear nature.

You can perform exercises only in agreement with your doctor, starting from 32 weeks until childbirth.

External rotation of the fetus.

This is an obstetric manual, which was described many years ago by the Russian doctor B.A. Arkhangelsk. Recently, it has attracted increased attention, especially from Western doctors.

The result is achieved in about 50% of cases. It is performed within 34 - 36 weeks, the earlier the rotation is carried out, the more likely it is to be successful. But the likelihood of a reverse reversion also increases.

Contraindications to taking an obstetric turn: the threat of premature birth, spotting, uterine defects, placenta previa, twins / triplets, oligohydramnios, signs of fetal hypoxia.

Previously, external rotation was not performed in women with a uterine scar, now it is a relative contraindication (an individual risk assessment is required, examination by a council of doctors is possible).

External rotation is also not started if leakage of amniotic fluid is detected or cervical dilatation has begun.

Ultrasound of the fetus with fetometry. Necessary conditions: a small weight of the fetus (exclude a large fetus of 4000 g or more), a normal amount of water, no obvious defects, normal localization of the placenta.
- The introduction of beta-agonists (hexoprenaline) intravenously under the control of blood pressure and pulse. Beta-agonists relax the smooth muscles of the uterus and increase the chances of success. For the mother, the introduction of hexoprenaline (gynepral) may be complicated by a decrease in blood pressure, tachycardia, weakness and headache.
- It is possible (but not always) the use of epidural anesthesia.
- The turn is started from the presenting part (putting the hand on the pelvic end), as shown in the picture. The movements are smooth, in a circle, without sharp shocks.

After the turn, both in case of success and in case of a failed turn, the condition of the fetus is monitored. First of all, the fetal heartbeat is heard, then cardiotocography (CTG) is performed. Dopplerometry is controlled according to indications.

Complications of external rotation:

Acute hypoxia of the fetus (due to impaired blood flow in the umbilical cord, pressing the loops), is recorded by CTG (decrease in heart tones, irregularity, muffled tones),
- placental abruption (partial, rarely complete) up to 1.4% of cases. In this case, emergency operative delivery is indicated.
- trauma of the brachial plexus as a result of throwing back the handles.
- antenatal fetal death (acute hypoxia, uterine rupture along the scar and other more rare causes).

With the right tactics, the prognosis for the fetus is favorable. An external obstetric turn, with skillful and competent execution, is also rarely fraught with complications, but it is impossible to insure against them. Whether or not to agree to this procedure is your choice, you can always think it over, discuss all the risks and benefits with your doctor and make a final decision. Independent childbirth with foot and mixed breech presentation does not always have a favorable prognosis, the risk of birth trauma and disability of the child is high.

Birth in breech presentation

In order to determine the tactics of conducting childbirth, a number of factors must be taken into account:

1. Age of the patient. Primiparas over the age of 30 and young primiparas (under 18, and especially under 16) have a greater risk of maternal and fetal injuries during childbirth. This is due to the lesser elasticity and extensibility of the perineal tissues.

2. Obstetric history. It is important to know: what births are in a row (primiparas are more at risk in terms of birth trauma), how the previous births proceeded, whether there were complications, bleeding, trauma to the child, how this pregnancy proceeded.

3. Evaluation of the birth canal
- examination of the cervix, assessment of its maturity (readiness for childbirth),
- evaluation of the woman's pelvis.
If there is an initial anatomical narrowing of the pelvis (even a slight one), then spontaneous childbirth can be dangerous.

4. Assessment of fetal parameters. If classically a large fetus is considered a child weighing more than 4000 grams, then in the case of a breech presentation, a fetus weighing 3600 grams or more is already considered a large fetus.
- Compensated state of the fetus, no signs of hypoxia, palpitations according to CTG and hemodynamic disturbances according to Doppler

5. Features of breech presentation
- type: gluteal, mixed, foot, knee,
- position of the head: flexion (normal), extensor (pathological position).

Independent childbirth

Independent childbirth in the breech presentation is allowed with a purely breech presentation, a compensated state of the fetus weighing from 2500 to 3500 grams, the normal size of the mother's pelvis, and the readiness of the birth canal. Antenatal hospitalization indicated.
Pregnant women with a breech presentation of the fetus are not stimulated for childbirth, do not use the preparation of the cervix with tablets or gels, do not perform amniotomy (opening the membranes).

Women who have a uterine scar from a previous caesarean section or myomectomy are also more likely to have an operative delivery. In this case, they are guided by the desire of the woman (to give birth herself) and the internal protocols of the medical institution.
And take into account all the above factors.

Childbirth is accepted only by a doctor.

During childbirth in head presentation, obstetric assistance is provided by a midwife, only if difficulties arise - by a doctor.

In independent childbirth with breech presentation, an allowance according to Tsovyanov is necessarily provided.

If the allowance for Tsovyanov is provided in the event of a planned birth in the breech presentation (manual according to Tsovyanov No. 1), then the goal is to maintain the safest articulation of the fetal body parts (the legs are extended and pressed to the body), to prevent premature birth of the legs, throwing back the arms and overextension of the head.

The doctor is positioned so that his shoulder girdle is at the level of the woman's perineum. The hands are arranged in a ring, thumbs down, the rest on top. As the buttocks of the fetus advance, the doctor shifts the tissues of the perineum with “removing” movements and gradually releases the presenting part, while the thumbs firmly press the legs in the abdomen of the fetus. In 1 - 2 attempts the fetus is born before the umbilical ring. Then you have to bring the handles out, if they do not fall out on their own, then you need to tilt the body of the fetus downward and the front handle falls out from under the pubic arch.

The thinnest part is the removal of the fetal head. If she is not born easily along with an attempt, then the Morisot-Levre technique is used.

When performing this technique, the fetal body is located on the obstetrician's hand, the 2nd and 3rd fingers of this hand are inserted into the vagina, it is necessary to find the fetal mouth and press the lower jaw. It turns out that we bend the head. The second hand (index and middle fingers) at this time should hold the fetal neck. Extraction is carried out according to the biomechanism of childbirth, depending on which plane of the pelvis the head is located at this time. At the very end, the body is retracted strongly anteriorly and the head is born.

If the allowance for Tsovyanov (manual according to Tsovyanov No. 2) turns out to be in foot presentation, then the scheme of actions is somewhat different. In general, foot presentation is an absolute indication for caesarean section, but if a woman was admitted already in childbirth, with full opening and surgical intervention is impossible, then you have to act according to the situation. Planned such childbirth should not occur.

The goal in providing benefits according to Tsovyanov No. 2 is to prevent premature birth of the legs, throwing back the arms and overextension of the head. This is achieved by the fact that the foot presentation is translated into mixed.

As soon as the legs begin to be determined in the birth canal, the doctor sits down in the same way as when providing the usual benefits according to Tsovyanov, a sterile napkin is placed on the perineum (to weaken the slip) and resistance is exerted with the palm of the hand until the buttocks fall and the fetus "sits on squat."

Then the hands are located in the same way as with the usual Tsovyanov manual, the body of the fetus is wrapped around the hands of the obstetrician and gradually removed using the force of attempts.

When providing any of these benefits, one should not pull the body of the child, only assist the mother's efforts and follow the natural biomechanism of childbirth.

If everything goes well, then the birth of a child goes smoothly, but complications may arise: tilting one or both handles, tilting the head, difficulty in the birth of the head and shoulder girdle.

In these cases, a classic manual aid is provided.

Classic manual manual is performed as follows: the obstetrician's hand is inserted into the vagina on the side of the fetus, with the palmar surface towards the fetus. The angle of the scapula is found and the handle is withdrawn with a "washing" movement. With the left hand, the obstetrician brings out the left handle, with the right hand - the right one. Further, if the head is in the extensor position, then the Morisot-Levre technique is performed. During all the manipulations, the assistant (midwife) holds the bottom of the uterus.

Indications for caesarean section with pelvic presentation of the fetus:

mixed breech presentation,
foot and knee presentation of the fetus,
breech presentation of the fetus in a pregnant woman with a scar on the uterus,
breech presentation of the first fetus from twins,
extensor position of the head in breech presentation,
large fruit (more than 3600 grams),
breech presentation of the fetus in a woman with anatomical narrowing of the pelvis and / or deformity of the pelvis (oblique, oblique pelvis),
lack of biological readiness for childbirth, a tendency to overbearing (immature cervix),
primiparous age over 35 years (relative indication),
aggravated obstetric history (recurrent miscarriage, prolonged infertility, pregnancy as a result of IVF, perinatal losses or perinatal trauma of the fetus in history),
low placentation or marginal placenta previa (relative indication).

These are indications for operative delivery, associated only with the position of the fetus. Other indications may arise independently (acute fetal hypoxia, indications from the heart or blood pressure, about diabetes in a pregnant woman, and so on).

The operation of caesarean section is carried out according to the general canons. As a rule, such surgeries should be carried out in level 3 health facilities (in perinatal centers), where there is resuscitation of newborns and the second stage of nursing children.

Transverse and oblique position of the fetus

These provisions are rare, approximately 0.5 - 0.7% of all cases. They are referred to as incorrect positions of the fetus.
In the transverse (A) position, all parts of the fetus are above the conditional line connecting the iliac spines.
With oblique (B) - the head or pelvic end crosses this line at an angle.
In both cases, the presenting part is not defined.

The reasons for such positions are the same as for breech presentation. Ultrasound reliably confirms the position of the fetus, and it is also possible to identify a possible cause - polyhydramnios, fetal or uterine defects, placenta previa.

Complications due to oblique or transverse position of the fetus: premature outflow of water, premature birth, increased risk of postpartum hemorrhage.

Delivery is only operative.

In a planned manner with a full-term pregnancy, or on an emergency basis with a discharge of water or the development of any other emergency obstetric situation.

Prolapse of small parts of the body is a specific complication that is characteristic only for the transverse, less often oblique position of the fetus. With the outflow of water and a large opening of the uterine pharynx, the uterus begins to develop labor and push the fetus out. The fetus, located incorrectly, cannot be born on its own. There is an acute fetal hypoxia and prolapse of the handle or leg. This is an extremely unfavorable prognostic sign. Most often, in this case, the fetus is no longer viable.

In this case, the mother has a high risk of infection, up to the development of obstetric sepsis.

The non-physiological position of the fetus leads to overstretching of the uterus and an increased risk of rupture, especially the risk is high in multiparous women (dystrophic changes in the uterine wall) and in women with a scar. Pregnancy is carried out under careful supervision, an attempt at an obstetric turn is possible. Antenatal hospitalization indicated.

If you are carrying a baby who is not positioned as you and the doctor would like, then this is an occasion to take your condition more closely, take additional actions and follow the recommendations. But there is no reason for panic and frustration. Look after yourself and be healthy!

95-97% of all newborns occupy the correct position in the uterus head down - head presentation. Deviations from the norm are also possible. So, the breech presentation of the fetus is the position of the fetus, when not the head of the child enters the pelvic floor, but the legs or buttocks (shown below in the pictures). There are several types:

the buttocks enter the pelvic ring, while the legs are straight, extended along the body, - breech presentation;
when the legs are bent, pressed to the chest, they speak of a mixed breech presentation, since the buttocks and legs of the child enter the pelvic ring;
it is also possible to fully present with the feet of the child, while the legs are slightly unbent;
sometimes one leg can be straightened, and the second is in the pelvic ring - while talking about a mixed foot presentation.

Location in the uterus is correct Childbirth
fetal presentation performing gymnastics tiny baby

It should be noted that the breech presentation of the fetus in itself is not some kind of pathology. It is necessary to understand at what time, at how many weeks it is diagnosed, since up to 36-37 weeks, and sometimes up to the moment of birth, the child can take any position. It all depends on the individual characteristics of the course of pregnancy, the anatomical structure of the mother and the development of the fetus.

Location of the fetus in the uterus

All of the above positions of the fetus are longitudinal. A transverse arrangement is also possible. Delivery in this case is exclusively caesarean section (CS).

Main reasons

Among the reasons why the fetus may occupy a conditionally incorrect position, there are three groups:

maternal;
fruit;
placental.

So, breech presentation of the fetus may be the result of pathological changes in the mother's body, such as:

previous operations on the uterus (as a result - the presence of a scar);
congenital abnormal changes in the uterus;
anatomically narrow pelvis (determined not visually, but as the ratio of the fetal head and the distance between the iliac bones of the pelvis);
weak abdominal muscles.

The second group includes:

abnormal development of the fetus;
short gestation period (with breech presentation of the fetus at 32 weeks and earlier);
in multiple pregnancies.

Placental include:

oligohydramnios (makes it difficult for a child to move);
polyhydramnios (on the contrary, it contributes to active, free movements of the fetus);
entanglement with the umbilical cord, restricting the movement of the fetus;
placenta previa (incorrect position of the placenta - close to the throat of the uterus).

Many women are interested in how to determine the location of the child on their own without visiting a doctor. At week 21, the baby is already pushing with might and main, so you can guess about the breech presentation of the fetus by some signs:

with the normal location of the baby, the woman feels strong shocks in the area of \u200b\u200bthe ribs and solar plexus;
sometimes you can observe the protruding knee or foot of the child;
a large rounded protruding part that looks like a head is a buttock;
the most firm and straight is the back (hiccups can also be felt in this area).

If you are attentive to your body, then by these simple signs it is easy to determine how the baby is located inside the tummy.

When the fetus is positioned correctly

What to do?

The first completely natural question that arises in a woman with a headless presentation of the fetus is: what to do, how to give birth? The questions are undoubtedly correct, but it is important not to panic. You should immediately answer - natural childbirth with a breech presentation is possible. This situation is not a disease or diagnosis, therefore, as such, it does not require treatment.

Since the process of bearing a child is as natural and natural as possible, any interference in this process is undesirable. Therefore, “how to turn over” a child, how to change his position - confuses many primiparous women. If at 32 weeks you can still wait a little, then at 34 weeks of pregnancy you need to take possible measures (of course, strictly on the recommendation and under the supervision of a doctor) regarding the breech presentation of the fetus. So, among them.

Special gymnastics.
Ask a child. No matter how strange it may sound, the fact of the connection between the mother and the child has long been proven.
External rotation of the fetus. This is the most drastic measure, which in some cases is carried out by an experienced doctor.

If the child has turned, or if it is necessary to fix the correct position, it is advised to wear a bandage as a preventive measure. It will help reduce the load on the spine, avoid unnecessary stretching, and also fix the correct position of the baby in the tummy. Of course, in any other position other than the head, wearing a bandage is contraindicated, since it can interfere with the free movement of the child.

Births in breech presentation occur in 3-5% of cases and are considered pathological.

Corrective exercises

Considering that recently pregnancy is sometimes treated as a disease, most of the time pregnant women are in a reclining, half-sitting position. Already after the start of the third trimester, you can perform a series of exercises to flip the fetus in breech presentation (see video below).

Slow breath in, exhale in the position on the knees and elbows (starting position).
From the starting position, lower the body as far down as possible while inhaling and raise it as you exhale.
Exercise cat. From a position on all fours, slowly round your back, and then straighten it to a position parallel to the floor.

Repeat all exercises 5-6 times, perform slowly, while not forgetting to breathe calmly and deeply. It is important that the first two exercises should be performed with a straight back, without bending, because during pregnancy the spine already has a large load. By the way, this position (on all fours with a straight back) allows the spine to rest.

These exercises are useful for all pregnant women, even in the absence of violations. Therefore, for the preventive purposes of breech presentation of the fetus and not only, you can perform these exercises already at the 20th week of pregnancy.

Many are also interested in how and on which side it is better to sleep, and whether the stomach drops. Doctors recommend sleeping on the side where the baby's head is shifted. The photo below shows the most correct and comfortable position for sleeping in a breech presentation. As for the stomach, then you should not expect a harbinger, since lowering the stomach in this case is impossible.

Is there something wrong

Natural birth or CS?

How to give birth with the wrong position of the fetus? It should be noted that the very fact of an incorrect longitudinal position of the child is not an indication for CS. Therefore, in the absence of other aggravating circumstances, a woman is allowed to give birth naturally.

Among the factors that complicate the delivery of breech presentation:

first birth after 30 years;
narrow pelvis;
large fetal weight (more than 3600 kg);
different rhesus in mother and child;
overdressing, etc.

In the presence of the above factors, as a rule, a cesarean section is indicated with a breech presentation. However, individual approaches are also possible here. Especially when you consider the fact that sometimes a child can roll over already during labor, both in the correct and in the wrong position. However, with a breech presentation of the fetus at 36 weeks of gestation, a woman needs to go to the hospital for observation and further

Possible Complications

A successful course of labor, as well as the occurrence of complications, is possible in both cases.

So, what is dangerous about the wrong location of the fetus and what consequences can be:

VCHM (intracranial injury);
hip dysplasia;
encephalopathy;
spinal injury;
oxygen starvation of the child;
ruptures of the perineum, uterus in a woman in labor, etc.

Therefore, at the birth of a child, the presence of a neurologist, neonatologist and resuscitator is mandatory in order to monitor how the delivery is going. Mostly, judging by the reviews, childbirth in the breech presentation is successful. And with a favorable outcome, born children are no different from newborns in head presentation.

tiny baby

Today, there are a lot of centers practicing obstetrics. The table below contains the names, addresses and cost of consultations of medical centers in Moscow, St. Petersburg, Minsk, Kyiv.

Final word

Based on the above, it becomes clear what the breech presentation of the fetus means. In order to prevent complications, it is important to be observed during pregnancy, lead a healthy, active lifestyle (taking into account, of course, adjustments in the form of pregnancy), keep the spirits in the most elated mood and engage in preventive gymnastics.

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Attention!

The information published on the site is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The editors of the site do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! Remember that only a complete diagnosis and therapy under the supervision of a doctor will help to completely get rid of the disease!

When the doctor during the consultation reports that the baby is located in the stomach with the head up, 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 a breech presentation of the fetus?

Breech presentation of the fetus is the wrong position of the fetus in the womb. In the process of childbirth, the head of the baby is shown first from the mother's genital tract. Since this is the largest and hardest part of the child's body, its passage through the pelvic bones is of little difficulty. During contractions, the pelvis expands 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. This is how childbirth proceeds when the fetus in the mother's belly is placed correctly, that is, head down.

But in about five out of a hundred women, the baby in the womb assumes an incorrect body position, and it remains so until birth. The baby sits down between the bones of the pelvis with the ass or legs, and when the mother comes to the doctor at the 28th week of pregnancy for a routine examination, he diagnoses the breech presentation of the fetus. At this time, 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 the 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. In a baby sitting head up in his stomach, the internal parts of the brain develop poorly, and because the lower part of the body is sandwiched between the pelvic bones, he often has small hemorrhages, swelling of the tissues of the kidneys and genital organs. A baby in the womb in the wrong position receives little oxygen, suffers from tachycardia, cannot move its limbs normally, runs the risk of heart disease, cerebral palsy or chronic diseases of the gastrointestinal tract.

Gynecologists distinguish three types of breech presentations:

breech presentation of the fetus, when the baby sits on the ass, the legs are raised up, while the feet touch the face, and the knees are pressed to the stomach;
mixed presentation, in which the legs are bent at the knees and pressed to the body, so the child rests on the bones of the mother's pelvis with both buttocks and feet;
foot presentation of the fetus, when the baby seems to be squatting, sometimes one of the legs can stretch out and slip to the exit from the uterus.

Causes of breech presentation of the fetus

A woman who has been diagnosed with a breech presentation of the fetus needs increased attention from the doctor. The gynecologist easily determines the breech presentation of the fetus, simply by feeling the mother's stomach or by performing ultrasound diagnostics. And although with such a feature of the uterine development of an infant, 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 about 22 - 23 weeks of pregnancy. Then he becomes large enough to tumble, or lay down head down, or sit on his legs or bottom, not wanting to change position. If before the 36th week the child has not managed to turn around correctly, then the presentation can no longer be corrected, it remains until the birth. The reasons why the baby behaves so strangely can be very different:

malformations of the embryo;
pathology of the uterus, weakening of the tone of its muscle tissues, malignant tumors;
placenta defects;
polyhydramnios or oligohydramnios of the amniotic sac;
the consequences of caesarean section and other operations on the internal genital organs;
multiple pregnancy.

Symptoms of breech presentation of the fetus

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

First, the doctor probes the abdomen. In breech presentation, the fetal heart beat is clearly heard near the navel, and the uterus is too high. Then the gynecologist examines the vagina and cervix by palpation. If the child sits on the pope, the fingers grope for the soft buttocks and tailbone, and when the baby rests on the pelvis with the legs, the doctor determines his heels and small fingers. In this case, in order to finally confirm the diagnosis, the doctor writes out a referral for an ultrasound examination to the mother.

Birth in breech presentation

Many women panic if childbirth is approaching, and the baby has not turned over head down. Actually, you don't need to worry too much. Mothers who are diagnosed with breech presentation of the fetus are admitted to an obstetric hospital under the close supervision of physicians ahead of time. After a deep examination, the doctor decides how to carry out the delivery: to apply a caesarean section or to allow a natural process.

Usually, childbirth with a breech presentation of the fetus proceeds naturally without any problems, and the obstetrician closely monitors their course. But there are situations when a caesarean section is required to preserve the health and life of a baby.

Emergency surgery is needed if:

the fetus lacks oxygen;
the placenta is deformed;
the uterus has pathologies or tissue tears;
the mother's pelvis is too narrow;
weak contractions are fixed, or the cervix does not open;
the baby is large, overdue;
the baby's legs or umbilical cord fell into the cervix.

Complications during childbirth

When the baby gets out into the light with legs forward, the uterus contracts weakly, the contractions are not intense, the cervix opens to an insignificant width. This happens because the lower body of the fetus is much smaller in volume than the head, which means that it cannot press hard enough on the walls of the uterus when the baby moves through the birth canal. As a result, obstetricians have to stimulate labor activity.

In addition, babies who come out of their mother's belly with their booty forward often throw back their arms or get their heads stuck, which leads to serious injuries. Sometimes babies press the umbilical cord against the wall of the cervix or the birth canal with their heads. The flow of oxygen is abruptly interrupted, the baby begins to suffocate. Doctors urgently accelerate the birth process by an artificial method, until the baby died, before it had time to be born.

Breech exercises

If the baby has not managed to roll over head down before the 34th week of pregnancy, the doctor may advise the mother of 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 education is also strictly prohibited for pregnant women with toxicosis in the later stages, if there are defects on the placenta, if any operations were performed on the uterus, after which scars remained. To avoid problems, before starting gymnastic exercises, it is better to consult a doctor.

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

If, after gymnastics, the doctor during the examination finds that the position of the baby in the abdomen has become normal, the first two exercises can no longer be performed, but it is better to work out the third for prevention until the very birth.

Breech presentation of the fetus refers to the pathological course of childbirth, and often pregnancy. To prevent possible complications in childbirth and perinatal problems in the fetus, the doctor must be highly qualified and have certain skills. To date, the frequency of breech presentation is 3 - 5% of all births.

What is a breech presentation of the fetus?

Normally, the fetus is in the uterus head down, that is, during childbirth, it is pressed against the entrance to the small pelvis with the largest part, which ensures adequate opening of the cervix and expansion of the birth canal for the birth of the trunk, arms and legs of the fetus. If the fetus is pelvic end down, and the head rests against the bottom of the uterus, then they talk about breech presentation. The fetus should turn its head down to 32, and according to some authors up to 34 weeks.

Classification (types) of breech presentation

There are the following types of breech presentation:

breech presentation:
- purely breech presentation (the buttocks of the child are pressed to the entrance to the small pelvis, and the legs are extended along the body);
- mixed breech presentation (buttocks and legs are pressed to the entrance to the small pelvis, bent at the knee and hip joints, the child seems to be squatting).
foot presentation:
- full foot (only both legs are presented);
- incomplete leg (one leg is provided, and the other is extended along the body);
- knee (the child is on his knees).

The most unfavorable and rare type of breech presentation is knee (occurs in 0.3% of cases).

Causes of breech presentation

The causes of breech presentation of the fetus are not well established. All factors that contribute to breech presentation can be divided into 3 groups:

maternal

anomalies in the development of the uterus (saddle-shaped, bicornuate and others);
tumors of the uterus that change its shape;
narrow pelvis and pelvic anomalies (rachitic, with bone exostoses, etc.);
reduced and increased tone of the uterus, in particular the lower segment (threat of interruption, many births, abortions and curettage of the uterus);
scar on the uterus after caesarean section;

fruit

congenital malformations of the fetus (anencephaly, hydrocephalus);
incorrect articulation of the fetus (extension of the head and / or spine);
prematurity;
insufficient muscle tone of the fetus;
multiple pregnancy;
a large fetus (with a breech presentation, a fetus of 3.5 kg or more is considered large);
intrauterine growth retardation.

Placental

or low placentation;
polyhydramnios or oligohydramnios;
absolutely short (less than 40 cm) umbilical cord;
entanglement of the umbilical cord;
true nodes of the umbilical cord;
the placenta is located in the area of the tubal angles.

Diagnosis of breech presentation

Diagnosis of breech presentation, as a rule, is not difficult, except when the muscle tone of the uterus is increased with the threat of abortion, with multiple pregnancy, anencephaly, or with a pronounced subcutaneous fat layer of the anterior abdominal wall with obesity.

During an external obstetric examination, it is established that the fundus of the uterus is higher than it should be for the duration of pregnancy, and the fetal heartbeat is heard at the level of the navel or slightly higher. The presenting part (buttocks) is defined as not balloting (fixed), soft consistency and not palpable cervical sulcus. In the bottom of the uterus, a rounded, dense, balloting formation (the baby's head) is palpable.

With an internal vaginal examination, the soft presenting part is well palpated through the vaults, and in childbirth, when the cervix is opened, the inguinal fold, sacrum and coccyx can be palpated. With foot presentation, the feet of the fetus with a pronounced calcaneus and short fingers are determined.

Also, in breech presentation, amnioscopy (examination of amniotic fluid) is used, during which the color and volume of amniotic fluid, the presence or absence of presentation with a loop of the umbilical cord are ascertained.

The most revealing method in the diagnosis of breech presentation is ultrasound. With the help of ultrasound, it is possible to determine not only the size and presentation of the fetus, but also obvious malformations, the sex of the fetus (it is of great importance in breech presentation), and the location of the placenta. It is very important to determine the degree of extension of the head, which plays a role in the choice of method of delivery. There are 4 degrees of position of the fetal head:

the head is bent (the angle is more than 110 degrees);
the head is slightly extended (angle 100 - 110 degrees or "military posture");
the head is moderately extended (angle 90 - 100 degrees);
excessive extension of the head (angle less than 90 degrees or "looking at the stars").

Management of pregnancy and childbirth

In the antenatal clinic in the period of 32 - 37 weeks of pregnancy, special gymnastic exercises are prescribed to "flip" the fetus onto the head. It is possible (at present it is practically not used due to the high risk of complications) external rotation of the fetus on the head in the period of 34-36 weeks in a hospital.

Hospitalization of women with breech presentation is carried out at 37 - 38 weeks. In the hospital, the anamnesis is carefully collected, ultrasound is repeated, amnioscopy is performed, the condition of the fetus is assessed (non-stress test and CTG) and the readiness of the cervix for childbirth.

burdened obstetric history;
estimated fetal weight of 3.5 kg or more;
3 degree of extension of the head;
anatomically narrow pelvis;
chronic intrauterine fetal hypoxia;
etc.

With a mature cervix and the normal state of the fetus, childbirth is carried out through the natural birth canal after their spontaneous onset.

Childbirth is indicated for:

immunoconflict pregnancy;
anomalies in the development of the fetus;
prenatal outpouring of water.

The period of contractions is carried out with monitoring of the condition of the fetus, timely anesthesia and the introduction of antispasmodics, with a constant assessment of the obstetric situation for a possible emergency caesarean section. The period of attempts is carried out under the protection of antispasmodics and contracting agents, with an episiotomy at the time of the birth of the fetal head and possible extraction of the fetus by the pelvic end according to Mauriceau-Levre-Lachapelle with difficult removal of the head.

You probably already know that the largest part of the baby's body is the head. And it is not surprising that the wise nature asked her to be the first to be born - if the head passes through the birth canal, then the rest of the body will slip through without problems. Therefore, just before the birth, the baby must make a “somersault” in the uterus and turn its crown to its future exit.

But what to do if you saw a breech presentation of the fetus on an ultrasound scan? These words mean that there is a little stubborn inside you, who for some reason decided to turn to the "exit" booty. What to say? Your case is very rare - it is diagnosed in only 4% of women. Is he dangerous? You will learn about this from the article below.

Breech presentation is different

Gluteal. It occurs in 60-70% of women, and mostly in those giving birth to their first child. With this placement, the little one's knees are straightened and pressed against his tummy, and the legs are bent at the hip joint.

Foot. This placement of the doctor is noted in 20-30% of women in labor, more often in those who have already known the joy of motherhood. In this case, the baby's hips (or only one) are straightened, and one leg is already directed towards the exit from the uterus.

Mixed. The rarest case. The baby has both hips and knees bent.

Causes of pelvic placement of the baby

While the baby is small, he somersaults in his mother's belly, as he wants. From 32 weeks, he is already cramped, so he chooses one position - and remains in it until he is born.

This posture can be pelvic for:

pathology of the placenta (say, presentation),
much or little water,
violation of tone and other pathologies of the uterus,
twins or triplets in a woman,
problems with the child himself (for example, hydrocephalus),
consequences of caesarean delivery.

Signs of incorrect presentation of the baby

Even if you carefully (and at the same time carefully) feel your stomach, you will not determine exactly how the little one is located. Breech presentation does not respond to the mother with any pain or discomfort. Only a gynecologist can see it.

For example, there is an opinion that when a baby is in the pelvic position, his heart is relatively strongly audible in the area of \u200b\u200bthe mother's navel. And besides, the uterus rises above the pubis above the norm.

The gynecologist may perform a vaginal examination. If the baby lies with his heels towards the “exit”, the doctor can feel them, or the coccyx or inguinal fold. Finally, there is also an ultrasound room, where they will not only guess, but also see with their own eyes the situation of your prankster.

How will the birth go?

You have two options to choose from: caesarean section or conventional traditional birth.

line of your pregnancy,
your age
illnesses you have had
pelvic measurements,
the type of location of the baby,
the weight of the peanut, the degree of extension of the head, its sex,
history data.

You can expect natural childbirth if you have:

A solid line of pregnancy (greater than 37 weeks).
Relatively small peanut (from 2.5 to 3.5 kg).
The normal size of your pelvis.
Gluteal or mixed crumb position.
Female baby.

You have an early delivery line, a large boy (or vice versa - less than 2.5 kg), a narrow pelvis - in general, all the options from the list above do not apply to your case.
The uzist talks about the overextension of the baby's head.

In some cases, childbirth, which began as normal, turns out to be dangerous, and the woman in labor is transported to a caesarean section. This is an emergency cut. It is prescribed if the doctor notices:

slow delivery,
child hypoxia,
placental abruption,
prolapse of the umbilical cord or legs of the baby,
not opening the cervix in the presence of contractions.

Childbirth with a breech presentation of the baby can pass with complications

On pregnancy, turning the peanut booty to the “exit” with its longitudinal lying does not affect in any way. What can not be said about childbirth.

The birth activity of the mother is directly affected by the baby, which presses from the inside on the birth canal. In the case of pelvic placement, this activity may be weakened, because the legs will press many times weaker than a large head.

Even if the little body “slips”, the head may tilt back during childbirth. This is dangerous - the baby can be injured. In addition to the head, handles can also tilt back.
In such childbirth, the umbilical cord is sometimes clamped - the head presses it against the birth canal. As a result, the baby will not receive enough oxygen, that is, oxygen starvation occurs in a tiny organism.

Is it possible to "move" the baby correctly?

After the doctor's report about the wrong position of the little one, some women do not sleep at night, trying to figure out how to help the baby. Remember! If you were told about a breech presentation at 20-22 weeks, sleep well: the baby still has enough time (and even a little space) to roll over into the desired position. Up to and including 32 weeks, your little acrobatic will still have time to turn around, so lying incorrectly now is not a sentence.

However, even after 32 weeks you should not panic. First, it's bad for you. And secondly, there are still ways to improve the situation. Ask your doctor about special exercises for pregnant women. By doing them regularly, you can "tumble" your baby into the correct position that will not interfere with childbirth.

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