External obstetric rotation of the fetus. What is external obstetric fetal rotation? When is an external obstetric turn performed?

Not correct position a baby in the uterus often causes a caesarean section. By the 36th perinatal week, the fetus is in its final position. If the buttocks or legs stand in the pelvic area, then this is considered wrong.

For several decades, doctors have been practicing the method of external obstetric rotation. The essence of the technique is to turn the child into the correct position through the abdominal wall of the mother.

How is the fetus rotated breech presentation? What are the consequences for the woman and child? In what cases is it better to refuse the procedure? We'll talk about this later in the article.

What is special

The term "breech presentation" means wrong location a child in the uterine cavity, in which the pelvic part of the baby's body is presented to the entrance to the uterus.

Depending on the part of the body that is present, this pathology is divided into types:

• partially gluteal;
• foot;
• mixed.

The baby can change its position inside the uterus before the 32nd week of pregnancy. For more late term it becomes difficult for the baby to turn due to the large size.

There are many reasons for the occurrence of this pathology. These include:

• several fetuses in the uterus;
• an insufficient amount amniotic fluid;
• polyhydramnios;
• intrauterine malformations of the child;
• pathologies and anomalies in the structure of the uterus and genital tract of a woman;
• various placental pathologies;
• having had a caesarean section in the past.

Indications

Outer obstetric turn a child is made in the following cases:

Modern obstetric practice is more inclined to believe that with similar complications more expedient to carry out the operation.

Types of external obstetric rotation:

• turning the fetus on the leg;
• outer turn fruit per head.

This procedure can be carried out under the following conditions:

• the child moves well;
• a woman has a pliable wall of the abdominal cavity;
• a woman has a wide pelvis;
• No additional complications or contraindications.

When performed

It is rational to carry out external obstetric rotation of the fetus in late pregnancy. Up to 32 weeks, the child moves relatively freely in the uterine cavity and can independently change its position.

This procedure can be carried out only in a hospital and with the necessary equipment.

The room where the external turn is made must be equipped with an ultrasound machine.

Diagnostics

Before starting an external obstetric turn, it is necessary to undergo a comprehensive examination. It includes the following procedures:

• clinical blood test;
• for group and Rhesus compatibility.

Ultrasound examination allows you to determine the following parameters:

• intrauterine position of the child;
• the amount of amniotic fluid;
• site of attachment and localization of the placenta.

When both parents of a child have rhesus negative-factor a woman needs an injection of immunoglobulin.

Throughout the procedure, doctors monitor the condition heart rate child.

Before the procedure, it is necessary to empty the intestines and bladder. On the eve of the procedure, refuse excess food.

At proper preparation and competent diagnosis of a woman’s condition, the rotation procedure takes several minutes and does not cause discomfort.

How is it carried out

The obstetric rotation procedure consists of several stages:

1. hospitalization of a pregnant woman in a perinatal center for a period of 36 weeks;
2. holding all necessary research(ultrasound, CTG, blood tests);
3. the introduction of special drugs that reduce the contractile activity of the uterus;
4. direct carrying out the rotation of the child;
5. Ultrasound of the fetus and uterus after rotation to monitor the condition.

During a direct change in the position of the child, a woman may experience some discomfort and minor pain.

The woman needs to take a prone position on the couch. The doctor stands on the side and turns to face the patient.

With one hand, the specialist needs to grope for the head, lower the other to the woman's pelvic area. The doctor begins to gently move the child in the following directions:

• buttocks towards the back;
• back towards the head;
• head to belly.

All manipulations should be very accurate, but at the same time confident and rhythmic.

What is dangerous

The procedure for obstetric external rotation of a child is associated with some risks.

Complications after this procedure are quite rare. However, the possibility of their occurrence exists.

Consequences of an obstetric turn:

• change in heart rate in a child.

Still remains open question about the safety of this method of changing the position of the child inside the womb.

A few decades ago, external rotation was used extremely rarely, and was banned in some clinics. This is due to the fact that there was no special equipment that may be required if complications develop.

Modern obstetric practice is increasingly using this method.

Equipping perinatal centers with modern equipment allows you to take the necessary measures in a timely manner in case of unforeseen situations.

Possible Complications

During the procedure of external rotation of the fetus, the following complications may occur:

• child asphyxia;
• damage to the integrity of the uterus;
• placental abruption;
• prolapse of umbilical cords;
• spasm of the internal pharynx;
• instead of a child's leg, a handle is displayed;
• it is impossible to complete the turn due to poor mobility of the child;
• uterine rupture and profuse bleeding.

For timely prevention possible complications The procedure is carried out under constant ultrasound control and CTG. This allows you to track the condition of the child and the woman.

If complications arise during the rotation, then the procedure must be stopped and an emergency caesarean section should be started.

In some cases, turning on the leg is performed during childbirth. This is necessary to facilitate the passage of the child through the birth canal.

Contraindications

There are situations in which it is strictly forbidden to turn the baby through the mother's abdominal wall. These include:

• premature outflow of amniotic fluid from the uterine cavity;
• individual intolerance of a woman medical preparations, which have a relaxing effect on the uterus;
• the presence of additional complications and pathologies of pregnancy that require delivery by caesarean section;
• the presence of a child intrauterine pathologies development;
• incorrect position of the baby's head (extensor);
• the presence of several fetuses in the uterus;
• anatomical pathologies of the structure of the uterus in a woman.

If a woman has a history of the above factors, then an external obstetric turn is extremely dangerous.

Pros and cons

External obstetric twist like others medical procedures has a number of advantages and disadvantages.

Advantages of the method:

Flaws:

• there is a possibility of development serious complications that threaten the life of the mother and child;
• there is a possibility that the child will not change his position;
• She can always do this procedure.

External obstetric rotation may eliminate the need for delivery by caesarean section.

However this procedure has its risks and potential for complications. Therefore, it should only be carried out by a specialist.

Useful video: is it possible to turn the child from breech to head presentation

obstetric turn I (versio obstetrica)

an operation with the help of which they change the unfavorable for the course of labor to a longitudinal one. In clinical practice, the following types of A. p. are used: external rotation on the head, external-internal classical rotation on the leg, rotation according to Braxton Hicks.

External rotation of the fetus on the head produced only by external methods (through the abdominal wall) with transverse and oblique positions of the fetus, less often with breech presentations. The operation is performed after the 35th week of pregnancy with good fetal mobility (until amniotic fluid), normal sizes pelvis or its slight narrowing (true not less than 8 cm), the absence of indications for the rapid end of labor ( , premature detachment placenta, etc.).

With oblique positions of the fetus, for external rotation, it is sometimes enough to lay the woman in labor on the side towards which the presenting part is deviated. For example, with the left oblique position of the fetus (head to the left), the woman is laid on her left side. In this position, the bottom of the uterus, together with the buttocks of the fetus, deviates to the left, and the head in the opposite direction, to the entrance to the small one.

With a transverse and persistent oblique position of the fetus, special external manual techniques are used for external rotation. Pregnant or childbirth over 30 min before surgery, administered subcutaneously 1 ml 1% solution of promedol. Must be emptied before operation. The woman is laid on a hard couch on her back, her legs are slightly bent and drawn to her stomach. The doctor sitting on the side on the edge of the couch puts both hands on the woman in labor so that one lies on the head, grabbing it from above, and the other on the underlying buttock of the fetus ( rice. one ). Having clasped in this way, with one hand they shift the head of the fetus towards the entrance to the small pelvis, and with the other they push the pelvic end up, to the bottom of the uterus. These manipulations should be done persistently, but extremely carefully.

With breech presentation of the fetus in case of ineffectiveness of the complex of special exercise aimed at correcting the position of the fetus, the doctor may try in a hospital to perform an operation of external rotation of the fetus on the head - the so-called prophylactic rotation. It is usually carried out at the 35-36th week of pregnancy. General rules external preventive rotation is as follows: shift towards the back, back - towards the head, head - towards the entrance to the small pelvis. After turning, it is necessary to systematically monitor the pregnant woman.

When carrying out external rotation (using manual techniques), complications are possible: fetus, premature detachment of the placenta. When the first signs of complications appear, the operation of the external rotation is stopped, according to indications, an operation is performed.

External-internal classical rotation of the fetus on the leg produced by a physician emergency cases- . When it is carried out, one hand is inserted into the uterus, the other is placed on the stomach of the woman in labor. The indications are the transverse position of the fetus, incl. the transverse position of the second fetus from twins, and extensor head presentation of the fetus (for example, frontal), which is dangerous for the mother. In the presence of one fetus, the operation is carried out, as a rule, with a dead fetus. With a live fetus in similar situations, a caesarean section is preferable. Conditions for the external-internal classical rotation: full opening of the uterine os, full fetal mobility, with a live fetus, the size of the pelvis of the woman in labor should correspond to the size of the fetal head. A contraindication to turning is the so-called neglected transverse position of the fetus, in which it is immobile. Before the operation, the woman in labor should empty the bladder, disinfect the external genital organs. The operation is performed on the operating table or on the Rakhmanov bed in the position of a woman on her back. Apply deep ether or intravenous. There are three stages of the operation: the introduction of a hand into the uterus, the search for and capture of the pedicle of the fetus, the actual rotation of the fetus.

At transverse position the fetus into the uterus is recommended to enter the hand corresponding to the position of the pelvic end of the fetus. At front view transverse position (back to the front), the underlying fetal leg should be captured (when the overlying leg is captured, the anterior transverse position can easily go into the rear view, which is unfavorable for labor). In the rear view of the transverse position (back back), the overlying leg should be captured ( rice. 2, a ), because rear view is easier to convert to front view. Two methods of finding the fetal pedicle are recommended. When using the so-called short way the hand is held directly to the peduncle of the fetus; The “long” method consists in moving the hand along the back of the fetus to the buttocks, then along the thigh, lower leg. With the “outer” hand (lying on the abdominal wall), the pelvic end of the fetus is brought down to the entrance to the small pelvis towards the “inner” hand, thus helping to find the leg. As soon as the fetal pedicle is found and grasped (with two fingers or with the whole hand), the "outside" hand is immediately transferred from the pelvic end to the fetal head and the head is pushed to the fundus of the uterus ( rice. 2b ). Traction () for the leg is performed outside, down, towards the perineum until the fetal knee appears from the genital gap. When the leg is brought out to the knee and the fetus has taken longitudinal position, turn completed. Following this, an operation is usually performed to extract the fetus by the pelvic end (see. Pelvic presentation of the fetus).

In the case of head presentation of the fetus, the arm that corresponds to the position of the small parts of the fetus is inserted into the uterus as deeply as possible (up to the elbow). Previously, the fetal head is pushed to the side. After the leg is captured, it is important to transfer the “outer” hand from the pelvic end to the head end. In order not to confuse the fetal leg with a handle, it is necessary to insert the hand deeper into the uterus, and when grasping, turn to the heel tubercle.

With the external-internal classical turn of the fetus on the leg, handles, fetal heads can occur. If the umbilical cord prolapses, it should not be set, because. the reduced part of the umbilical cord usually falls out again; the turn should be continued, trying not to press the umbilical cord. When the handle falls out, a loop is placed on it so that in the future it cannot tip over the head. If the head is infringed, it is necessary first of all to try to gently push it away; if unsuccessful, the second leg should be brought down to create more space in the uterine cavity, and again make an attempt to push the head; with the ineffectiveness of these manipulations and the dead fetus, the heads are shown (see Fruit-destroying operations). dangerous complication operation is the uterus (see Childbirth).

Rotation of the fetus according to Braxton Hicks, or turning the fetus on a leg when not full disclosure cervix (4-6 cm), can be carried out with a transverse or oblique position of the fetus, as well as with head presentation in case of partial presentation placenta. Due to the danger to the mother and fetus, it is used extremely rarely, only with a dead or premature non-viable fetus. Necessary condition is fetal mobility. The operation is performed under general anesthesia with the woman in the supine position. Two fingers are inserted into the uterus through, open, grab the fetal leg and, with the help of a hand located on the abdominal wall, turn the fetus onto the leg. Then the leg is removed from the vagina to the popliteal fossa and a weight of 400-500 is suspended from it. G(with placenta previa - no more than 250 G). The expulsion of the fetus occurs spontaneously after sufficient dilatation of the cervix.

Bibliography: Bodyazhina V.I., Zhmakin K.N. and Kiryushchenkov A.P. , With. 443, M., 1986; Grishchenko I.I. and Shuleshova A.E. Prenatal corrections of incorrect positions of the fetus, Kyiv, 1974; Multi-volume guide to obstetrics and gynecology, ed. L.S. Persianinova, vol. 6, book. 1, p. 73, M., 1961.

II Obstetric turn (versio obstetrica)

Obstetric twist classic(v. obstetrica classica; . A. p. combined external-internal) - A. p., in which the fetus is turned on the leg with the full opening of the cervix with two hands - one inserted into the uterus and the other acting through the anterior abdominal wall.

Obstetrical rotation combined external-internal- see Obstetric turn classic.

Obstetric turn external(v. obstetrica externa) - A. p., produced with the help of hands only through the abdominal wall.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

- (B. A. Arkhangelsky, 1890 1954, Soviet obstetrician gynecologist) external obstetric turn on the head, performed with a transverse or oblique position of the fetus or with breech presentation, the main principle of which is the displacement of the buttocks to the side ... ... Big Medical Dictionary

- (J. H. Wigand, 1769 1817, German gynecologist) external obstetric rotation of the fetus on the head without taking into account the position of the fetus, but considering only the ease of its movement; used at the end of pregnancy and childbirth ... Big Medical Dictionary

BRAXTON-GEEKS TURN- BRAXTON GIKSA TURN, see Obstetrical turn. BRE MER, Hermann (Hermann Brehmer, 1826 89), a German physician who first began to promote ideas about the curability of tuberculosis and developed new method treatment, in accordance with their view of the causes ... ...

PHANTOM OBstetric- PHANTOM OB-BATHER, visual tutorial for teaching obstetrics, ch. arr. course and mechanism of childbirth and obstetric operations. In its simplest form, F. a. consists of a bone female pelvis and a skeletonized head of a full-term fetus. ... ... Big Medical Encyclopedia

Breech presentation is a fairly common pathological phenomenon in which the child is located with the legs or buttocks down. Why is this happening? Shortly before birth (usually starting from the 32nd week of pregnancy), the fetus takes a certain position that contributes to the easy flow of childbirth. In 90% of cases, we are talking about head presentation, when the child is in the body head down, just above the womb. This means that this particular part of the body, the largest in a newborn, will be the first to be born. It is with its release that the most discomfort and the most difficult. The passage through the birth canal of the rest of the body (shoulders, torso, limbs) is usually almost not felt.

However, in some cases, the fetus is pelvis down. This can be determined by visiting the doctor leading the pregnancy through visual examination and palpation. Also, the longitudinal location of the fetus in the uterus is quite easily diagnosed by ultrasound. It makes sense to fix such a position from about 32 weeks of pregnancy, since for more early dates the fetus is constantly moving and can repeatedly change position. The forecast of the situation is possible from the 28th week.

Correction of the situation before childbirth

Diagnosing a breech presentation is not a final verdict. At the stage of 32-34 weeks, you can perform special exercises that can provoke the fetus to turn over. This is a tilt of the pelvis, carried out on an empty stomach, specific exercises performed in the knee-elbow position. In the latter case, the pelvis should be above the level of the head. It is recommended to stay in this position for no more than 20 minutes several times a day.

It is also possible to use the force of gravity. Swimming in the pool helps a lot. Here, the pressure decreases, which makes it much easier for the fetus to roll over on its own.

The effectiveness of the described methods in their regular use varies between 65 - 75%. However, we must not forget that there are contraindications for the gymnastics mentioned above:

• narrow pelvis;
• risk of preterm birth;
• malformation of the fetus;
• an unsuccessful pregnancy that ended in a miscarriage in the past;
• too much or too little amniotic fluid;
• pathology of the development of the uterus;
• multiple pregnancy;
• placenta previa;
• preeclampsia;
• row concomitant diseases at which such loads are contraindicated.

In the last few years, the use of acupuncture, homeopathic influences, has become more widespread. Sometimes suggestion, the use of light, special music helps. However, the degree of effectiveness of these methods has not been fixed by science.

Obstetric coup: pros and cons

With a breech presentation of a child from the 36th or 37th week of pregnancy, it is allowed to perform obstetric coup. We are talking about the implementation of a certain manipulation, in which the doctor can mechanical action make the child take desired position(head down). Performed exclusively in medical institution, in the absence of contraindications, under strict supervision. During the process itself, control is carried out by ultrasonic equipment. Pain relief is usually not required.

Before performing an obstetric coup, appropriate preparation is required. A pregnant woman should not eat anything from the evening before (empty intestines are important), emptying Bladder occurs immediately before the start of the procedure itself. Also, the expectant mother is given special preparations that help to relax the internal muscles and uterus. This is intended to facilitate the process of the coup.

The procedure can take from 2 to 3 hours. In total, no more than 3 attempts are made.

The degree of effectiveness does not exceed more than 60%, the fetus may not succumb to manipulation. The child is also able, after the coup, to soon take the same position. Precisely according to last reason many countries began to abandon the practice of obstetric coup.

What you need to know

There are contraindications to this procedure:

• oligohydramnios, in this case, any impact of this kind can damage the fetus;
• extensor position of the head in a child;
• multiple pregnancy;
• the presence of contraindications in a pregnant woman to drugs that promote relaxation;
• individual features of the structure or development of the fetus or uterus.

In most of the cases listed above, an obstetric coup is not possible. Therefore, if the child has not changed position (which is checked by ultrasound, including control - by preoperative ultrasound), a caesarean section is prescribed.

Cesarean section with breech presentation of the fetus

Cesarean section in breech presentation is recommended to minimize the risks to the baby. Especially often it is prescribed if the pregnant woman's pelvis is too narrow, and the baby's head is large. Also doctors great attention pays to how exactly the fetus lies, what kind of pelvic proposal is in question. In male babies, this operation is designed to help prevent problems with the genitals. The latter can be damaged during natural childbirth.

Operative delivery is also indicated if the position of the fetus is complicated by other nuances.

Attention! It is considered especially dangerous foot presentation, in this case, there is a high probability of asphyxia and too much trauma to the newborn.

In some cases, there is even a threat of death of the baby. To avoid similar situations doctors ordered a caesarean section.

Types of breech presentation

The incorrect position of the fetus can be different, which affects the decision on how exactly the birth will proceed. The gluteal version is considered a classic. In this case, the child rests on the mother's pelvis with the buttocks. Moreover, the legs can be either bent at the knee joint or extended along the body. In a bent position, the presentation is called mixed. It is determined strictly according to the indications of ultrasound. Visual medical examination is not enough here.

A more complex and rare case is foot presentation (feet facing the entrance). It can be complete, here we are talking about both legs or incomplete, when one is bent and the other is extended. In some cases, the presentation is knee-length, the fetus facing the birth canal with knees bent at the joints. Sometimes the child is turned sideways, obliquely. In the latter case, operative delivery is recommended.

What is the danger of childbirth with such a presentation

The birth process in breech presentation, even in the absence of additional negative factors will be complicated. The reason is simple: the butt of a newborn is smaller than the head. And the fetus will press with less force on the bottom of the uterus, which causes weaker contractions. This leads to a delay in childbirth, the appearance of a specific weakness. Which is fraught with excessive blood loss, fetal asphyxia, and other unpleasant consequences.

During childbirth, the baby's head may tilt back, which is fraught with injury to the newborn (neck or skull). The process of birth becomes difficult, slows down. There is also a high probability of pinching the umbilical cord between the fetal head and the birth canal.

This causes a weakening of the blood flow to the body of the newborn, sometimes hypoxia develops. Boys are at particular risk. During childbirth with gluteal diligence, significant pressure is placed on the scrotum. Due to compression, injury to this part of the body is possible. That is why, with a breech presentation of male babies in Europe, it is strongly recommended to perform a caesarean section.

What else you need to know about the management of pregnancy and childbirth in this situation

Despite the obvious risks, natural delivery is entirely possible if the woman feels well, clinical pathology uterus or fetal developmental disorders were not found. light weight child also contributes normal course childbirth.

Therefore, it cannot be unequivocally said that the incorrect location of the fetus is a "sentence". However, for the best resolution of the situation for a pregnant woman, special medical supervision is needed. A week or two before approximate date childbirth future mother may be put in storage. After all, this presentation is fraught with premature birth. This risk cannot be ignored.

Before certain period the baby in the womb is in constant motion and can change its position several times. The most favorable for childbirth is considered cephalic presentation when the fetus is vertically head down. In this case, childbirth takes place without complications.

In about 5% of cases, the fetus is in a breech presentation, in which it is head up. If the birth goes naturally, the legs and pelvis are born first, and the head is born last. Pathological is the longitudinal-transverse position, in which childbirth cannot occur on its own.

To avoid negative consequences a pregnant woman may be advised to have a caesarean section. But also surgical intervention many mothers-to-be are regarded as highly undesirable. How Alternative option in breech presentation, an external obstetric turn, once proposed by Arkhangelsky, can be used.

Reasons for the formation of presentation

All the reasons that can provoke an incorrect position can be divided into two groups. The first is caused by the characteristics or pathologies of the mother. These include:

• abnormalities in the structure of the uterus;
• violation of the volume of amniotic fluid (oligohydramnios or polyhydramnios);
• entanglement with the umbilical cord, which prevents the child from turning his head down;
• pregnancy with twins (triplets);
• uterine fibroma large sizes, which creates mechanical obstacles to the normal position;
• malformations and anomalies in the structure of the mother's pelvic bones;
• anomalies in the development of the placenta;
• a slight break between pregnancies, especially if there was a caesarean section in the previous one;
• decrease in uterine tone - more common in multiple births or in those who have undergone multiple abortions, curettage, caesarean section or other operations on the uterus;
• hereditary factor.

Breech presentation presents certain risks for the baby. Mortality during childbirth in this case is 9 times higher than with the usual head presentation. 80% of pregnancies with this indicator end in a caesarean section. During natural childbirth, the woman in labor increases the risk of rupture of the internal genital organs, and the child may develop asphyxia, hypoxia, and hematomas may appear. Childbirth is often complicated by the weakness of labor activity.

Until the 36th week, the fetus can change its position. If the mother had a breech presentation before this period, this does not mean that it will continue until the very birth. In this case, they take a wait-and-see attitude. After the 36th week, the chances of natural improvement conditions are minimal. In this case, medical attention is needed.

Misposition Diagnosis

Presentation is determined no earlier than the 22nd week of gestation. The phenomenon is more common in multiparous women. The course of pregnancy with pelvic or transverse presentation does not have any specific features.

Diagnosis of pathology is not difficult. During an external examination, attention is paid to the discrepancy between the height of the fundus of the uterus and the circumference of the abdomen, the presence of large parts of the fetus in the lateral sections, listening to the heartbeat in the navel.

The most informative diagnostic method is this. With its help, they not only establish the wrong position, but also determine the location of the placenta, the approximate weight of the unborn child, the amount of amniotic fluid, the presence of tumors or nodes in the body of the uterus, disorders prenatal development.

When is an external obstetric turn performed?

If an abnormal position of the fetus was found on the ultrasound, there are a number of measures that can transfer it to the head presentation without medical intervention. Pregnant women are recommended to perform special gymnastics, fitball exercises, swimming or water aerobics. Complete physical activity stimulates the child to take a favorable position for childbirth.

Among the recommended exercises, one can single out being in the knee-elbow position for 15 minutes several times a day and quick flips from side to side at intervals of 10 minutes. However, as practice shows, such exercises are not very effective.

Contraindications to corrective gymnastics should be taken into account - the threat of premature birth, low attachment placenta, narrow pelvis, high blood pressure.

Corrective gymnastics for pelvic presentation of the fetus

If the presentation by the 34-35th week has remained unchanged, one of the ways out in this situation is the use of an external obstetric turn. This technique known for a long time, but for many years it was used quite rarely, because, not wanting to take risks, many doctors preferred to perform a caesarean section. Modern equipment has made it possible to control and monitor the condition of the mother and fetus during the rotation, which has caused doctors to increasingly return to this method and refuse to undergo surgery.

External obstetric rotation should be carried out by a doctor in a hospital.

The procedure can be carried out only if the following conditions are met:

• one fruit weighing no more than 3700 g;
• the integrity of the fetal bladder;
• normal amount of amniotic fluid;
• lack of increased or decreased tone of the uterus;
• the size of the woman's pelvis is normal;
• a satisfactory condition of the woman and the absence of anomalies of intrauterine development of the fetus.

The procedure is carried out only if the operating room is equipped with ultrasound equipment and if it is possible to provide an emergency medical care in case of unforeseen circumstances.

Contraindications

External obstetric rotation is not performed if the anamnesis was diagnosed habitual miscarriage pregnancy and premature birth. Symptoms late toxicosis, such as high blood pressure, heart rhythm disturbances, edema as a result of poor kidney function, are also a contraindication.

Other contraindications include:

• pregnancy with twins, triplets;
• fetus weighing over 4 kg;
• cord entanglement;
• violation of the integrity of the fetal bladder and leakage of water;
• the presence of large uterine fibroids or multiple myoma nodes;
• expressed;
• risk of bleeding and placental abruption;
• previous births by caesarean section;
• previous operations on the uterus.

Relative contraindications include excess weight pregnant.

Approximately 15% of women have Rh negative blood. Before carrying out the manipulation, the presence or absence in the blood is taken into account. anti-rhesus antibodies. Obstetric rotation is not possible in the presence of antibodies, which usually occurs with repeated pregnancies. If antibodies are not present, negative Rh factor is not a contraindication.

How is the procedure carried out?

The rotation procedure takes place in several stages:

1. Hospitalization of a woman at the 35-36th week of pregnancy and full informing the expectant mother about the upcoming manipulation, her moral preparation.
2. Conducting ultrasound and CTG to assess the condition of the pregnant woman, determine the location of the placenta, assess readiness female body for the upcoming birth.
3. General preparation for the procedure, including bowel and bladder emptying.
4. Carrying out - the introduction of tocolytics, drugs that inhibit the contractile activity of the uterus.
5. Conducting external obstetric rotation.
6. Control ultrasound and CTG to assess the condition of the fetus and prevent complications.

The probability of maintaining head presentation until delivery is about 60-70%. If the turn is made at a later date, the effectiveness of the procedure is reduced.

How painful is the manipulation?

During it, the pregnant woman experiences some discomfort, which is still not a reason for the introduction of anesthesia. Multiparous people tolerate obstetric rotation more easily. AT individual cases epidural anesthesia is indicated.

The patient should lie on her back on the couch, and the doctor should take a position next to her, facing her. One hand of the doctor is on the pelvic area, and the second - on the head of the fetus. With careful, but rhythmic and persistent movements, the buttocks are displaced towards the back, and the back towards the head. The head is displaced towards the abdominal wall of the fetus.

The obstetrical rotation technique allows its implementation both along and counterclockwise, depending on the position of the fetus. In the transverse position, the fetus is first transferred to the pelvic, and then to the head position.

Control ultrasound allows you to make sure that all procedures were performed correctly. AT without fail monitor the fetal heartbeat and. But often the successful outcome of the turn does not guarantee that the child will keep the head presentation until the very birth. Perhaps his return to the pelvic position.

What measures should be taken to reduce the risk of pelvic position recurrence?

To fix the position of the child favorable for childbirth, a special bandage is used. It is a ribbon 10 cm wide, which is fixed at the level of the navel. Such fixation excludes the return of the fetus to the transverse or pelvic position. The bandage must be worn for 2 weeks, that is, almost until the very birth.

Is external obstetric rotation dangerous?

There is an opinion that it is prohibited due to heightened danger for the fetus.

Indeed, turning has certain risks, but caesarean section and even natural childbirth with pelvic position no less dangerous.

It is almost impossible to injure a child, since it is reliably protected by amniotic fluid. The procedure lasts only a few minutes, and in total a woman spends about three hours in a medical institution (the time for preliminary and control ultrasound and preparation is taken into account).

As a rule, a second visit to the doctor is scheduled after 1-2 days in order to assess the success of the rotation. If everything went well, wait natural childbirth. Otherwise, the patient is preparing for a caesarean section.

The failure rate is about 30%. As a rule, they are associated with the contraindications indicated above. If the turn could not be carried out, the patient must be provided with complete rest in order to prevent damage to the fetal bladder and not provoke.

Sometimes manipulation can provoke premature birth. This is not critical, since the rotation is carried out no earlier than the 35th week, when the fetus is already quite viable.

Possible Complications

External obstetric rotation is carried out only in a specialized institution, so the risk of complications is no more than 1%. In some cases, the following negative consequences are possible:

• premature detachment of the placenta;
• fetal distress;
• premature rupture of the fetal bladder;
• the appearance of heavy bleeding;
• uterine rupture;
• infectious complications in the postpartum period.

Bleeding and severe cramping pains, aggravated by palpation, testify to premature detachment of the placenta. With a small loss of blood, no signs of hypoxia in the fetus and a satisfactory condition of the pregnant woman, a decision is made to maintain gestation. If the detachment progresses, an urgent caesarean section is necessary to prevent hypoxia (lack of oxygen) of the fetus. Insufficient oxygen supply leads to the development of neurological problems and the child's lag in physical and mental development.

fetal distress ( intrauterine asphyxia) also has a detrimental effect on the condition of the child. Due to the lack of oxygen, hemorrhage occurs in the brain, heart, liver, kidneys. main feature asphyxia of a newborn is a respiratory disorder that negatively affects the baby's cardiac activity and the functioning of its nervous system.

In the future, children who have had birth asphyxia develop hyperexcitability syndrome, hydrocephalus, a tendency to convulsions and other neurological problems.

Uterine rupture is a very rare occurrence, in most cases occurs in the presence of scars left over from a previous caesarean section or surgery. To eliminate the gaps, the organ is sutured, followed by the appointment of antibiotics and drugs that prevent thrombosis.

To agree to an external obstetric turn or rely on, the woman herself decides after weighing all the pros and cons, as well as after consulting a doctor. Even if there are certain risks during the procedure, one should not forget that natural childbirth is always preferable to surgical intervention.

Obstetrician-gynecologists have been using external obstetric rotation to change the presentation of the fetus for several decades. However, not all future mothers who are preparing for the birth of a baby know that the breech presentation, which is considered not the most favorable for natural childbirth, can be changed to a more physiological head one, and this can be done without consequences for the health of the unborn child and the ongoing pregnancy.

Why is an external obstetric turn performed?

The main reason for using external obstetric rotation to change from breech to cephalic presentation is to enable the woman to give birth on her own. After all, breech presentation is almost always a reason for operative delivery.

According to world and Russian statistics, confirmed by the work and doctors of the Yekaterinburg Clinical perinatal center, in nulliparous women, external obstetric rotation is successful in 40% of attempts, in multiparous women - in 60%. According to the doctors themselves, the success or failure of the external obstetric rotation depends on the number of births a woman has in the past, her body weight, gestational age, the size of the fetus and the amount of fluid surrounding it, and the location of the placenta. And, importantly, from the experience of the doctor.

Timing of external obstetric rotation

It makes no sense to perform an obstetric rotation in early pregnancy, when future baby still relatively freely moves in the uterine cavity. Optimal time pregnancy for external obstetric rotation - from 36 weeks for nulliparous and from 37 weeks for those who have this is not the first pregnancy. There is no upper time limit, and the rotation can be performed already at the onset of labor, but provided that amniotic sac still intact.

Contraindications

As with most medical manipulations, they are divided into absolute and relative.

Absolute contraindications when breech presentation before childbirth cannot or is not practical to correct by rotation:

If a caesarean section is indicated to a woman for reasons other than presentation,

If a pregnant woman during last week there were bleeding

If there are changes in cardiotocography,

If there are abnormalities in the development of the uterus,

If happened premature passage amniotic fluid,

If there is multiple pregnancy.

Relative contraindications, which the doctor considers along with all other factors of pregnancy, and only after that makes a decision:

If there is a delay in fetal development and impaired placental blood flow,

If a pregnant woman has signs of preeclampsia (preeclampsia is a severe toxicosis of pregnancy with edema, increased blood pressure, changes in urinalysis),

If oligohydramnios is diagnosed,

If there are fetal abnormalities,

If the fetus in the uterine cavity is still in an unstable position,

If there are scars on the uterus (except for the transverse scar in the lower part of the uterus).

Training

Preparation for external obstetric rotation includes: ultrasound, removal of cardiotocography for 20 minutes, as well as tocolysis (that is, inhibition of possible uterine contractions with the help of medications). Immediately before the rotation, talc or a special oil is applied to the belly of a pregnant woman.

How is an external obstetric rotation performed?

The pregnant woman is laid on her side. With the help of smooth movements with his hands, the doctor lifts the baby from the pelvic cavity and tries to turn it around so as to direct the head of the child towards the pelvis of the mother, and place his gluteal region higher.

The procedure itself without preparation takes no more than 5 minutes. For the expectant mother, the main thing at this time is to relax, breathe deeply and be sure to inform the doctor about any signs of discomfort. When pain or if the baby's heartbeat slows down, which is recorded by doctors, the rotation procedure will be suspended or stopped altogether. It is not scary if the baby could not be deployed on the first attempt, in one procedure the doctor can make up to 3 attempts to externally rotate.

At the end, a control ultrasound is performed and a cardiotocogram is also recorded for at least 20 minutes. If the woman is not bothered by anything, the turn was successful, and there is still time before the birth, then she can go home from the hospital on the same day.

Today, obstetricians and gynecologists do not consider it necessary to fix the position of the baby in the uterus after turning, because bandaging the abdomen of a pregnant woman with various fixing bandages, as time has shown, does not affect the results of the procedure. In other words, if the child is destined to turn around to its original position, he will do it anyway.

What does the baby feel and is the procedure dangerous for him?

Answering this question, it is worth paying attention to the fact that the external obstetric turn itself is primarily carried out for the baby - so that he avoids a caesarean section or childbirth in a non-physiological breech presentation.

During the external obstetric rotation, the child may have a slow heart rate (bradycardia) - in this case, the doctors will interrupt the procedure. In extremely rare cases other not entirely pleasant phenomena can occur - for example, the outflow of amniotic fluid or placental abruption. Then a caesarean section will be performed immediately - which is why the external obstetric turn is considered an exclusively stationary procedure, so that the operating room is always ready nearby.

And when in doubt expectant mother It's important to think about this:

frequency of emergency caesarean sections after external obstetric rotation is not more than 0.5%,

An external obstetric rotation is carried out in those terms of pregnancy, when the child is already born full-term in any case,

External obstetric rotation in certain cases is the only way for the baby to be born in the most physiological way and reduce the risk of birth or surgical complications, which after childbirth will have to be compensated for many months and sometimes even years.