Consequences of breech presentation. Breech presentation of the fetus: causes, exercises for turning the baby over, features of childbirth

Breech presentation of the fetus refers to the pathological course of labor, and often pregnancy. To prevent possible complications during childbirth and perinatal problems in the fetus, the doctor must have high qualifications and certain skills. Today, the frequency of breech presentation is 3–5% of all births.

What is breech presentation of the fetus?

Normally, the fetus is located in the uterus with its head down, that is, during childbirth it is pressed against the entrance to the pelvis by the largest part, which ensures adequate dilation of the cervix and expansion of the birth canal for the birth of the body, arms and legs of the fetus. If the fetus is with the pelvic end down and the head rests against the fundus of the uterus, then they speak of a breech presentation. The fetus should turn its head downwards up to 32, and according to some authors up to 34 weeks.

Classification (types) of breech presentation

The following types of breech presentation are distinguished:

• breech presentation:
  - pure breech presentation (the child’s buttocks are pressed to the entrance to the pelvis, and the legs are extended along the body);
  - mixed breech presentation (the buttocks and legs are pressed to the entrance to the pelvis, bent at the knee and hip joints, the child seems to be squatting).
• foot presentation:
  - full leg (only both legs are presented);
  - incomplete leg (one leg is present, and the other is extended along the body);
  - knee (the child is kneeling).

The most unfavorable and rare type of breech presentation is considered to be 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

• abnormalities of the uterus (saddle-shaped, bicornuate and others);
• tumors of the uterus that change its shape;
• narrow pelvis and pelvic abnormalities (rachitic, with bone exostoses, etc.);
• decreased and increased tone of the uterus, in particular the lower segment (threat of interruption, many births, abortions and uterine curettages);
• scar on the uterus after cesarean section;

Fruit

• congenital malformations of the fetus (anencephaly, hydrocephalus);
• incorrect positioning of the fetus (extension of the head and/or spine);
• prematurity;
• insufficient muscle tone of the fetus;
• multiple births;
• 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;
• umbilical cord entanglement;
• true umbilical cord nodes;
• the placenta is located in the region 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 miscarriage, with multiple pregnancies, anencephaly, or with a pronounced subcutaneous fat layer of the anterior abdominal wall in obesity.

During an external obstetric examination, it is established that the fundus of the uterus is higher than expected 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 non-ballooning (immobile), soft consistency and the cervical groove is not palpable. A round, dense, voting formation (baby's head) is palpated in the fundus of the uterus.

During an internal vaginal examination, the soft presenting part can be clearly felt through the fornix, and during childbirth, when the cervix is ​​dilated, the inguinal fold, sacrum and coccyx can be palpated. With foot presentation, the fetal feet are identified with a pronounced heel bone and short toes.

Also, for breech presentation, amnioscopy (examination of amniotic fluid) is used, during which the color and volume of amniotic fluid, the presence or absence of umbilical cord presentation are determined.

The most revealing method in diagnosing breech presentation is ultrasound. Using ultrasound, you can determine not only the size and presentation of the fetus, but also obvious malformations, the sex of the fetus (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 choosing the method of delivery. There are 4 degrees of fetal head position:

• the head is bent (angle greater than 110 degrees);
• the head is slightly extended (angle 100 - 110 degrees or “military pose”);
• the head is moderately extended (angle 90 - 100 degrees);
• excessive extension of the head (angle less than 90 degrees or “looking at the stars”).

Tactics of pregnancy and childbirth

In the antenatal clinic, at 32–37 weeks of pregnancy, special gymnastic exercises are prescribed to “turn” the fetus onto its head. It is possible (at present practically not used due to the high risk of complications) to externally rotate the fetus onto its head at 34–36 weeks in the hospital.

Hospitalization of women with breech presentation is carried out at 37–38 weeks. In the hospital, 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.

• complicated obstetric history;
• estimated fetal weight 3.5 kg or more;
• 3 degree of head extension;
• anatomically narrow pelvis;
• chronic intrauterine fetal hypoxia;
• And so on.

With a mature cervix and normal fetal condition, labor occurs through the natural birth canal after its spontaneous onset.

Labor induction is indicated for:

• immunoconflict pregnancy;
• abnormalities of fetal development;
• prenatal rupture of water.

The period of contractions is carried out with monitoring of the fetal condition, timely pain relief and administration of antispasmodics, with a constant assessment of the obstetric situation for a possible emergency cesarean section. The period of pushing is carried out under the protection of antispasmodics and contractants, with an episiotomy at the time of birth of the fetal head and possible extraction of the fetus by the pelvic end according to Moriso-Levre-Lachapelle if it is difficult to remove the head.

Breech presentation is observed in 6% of pregnant women. In a normal pregnancy, the baby gets into the right place by the 21st week of gestation. But due to the presence of a number of negative factors, it may remain unchanged until the 3rd trimester.

Abnormal position of the fetus is not dangerous until 22 weeks of gestation. During this period, there is a possibility that the baby’s place will turn over several more times in the womb, but if the pathology is observed in the later stages, it is dangerous for both the child and the mother.

What does breech presentation mean?

Breech presentation refers to the position of the embryo in the lower part of the uterus, near the fallopian tube. During pregnancy, the baby should be head down, but in some situations it is able to change position, and the buttocks or legs are at the bottom. This pathological condition is most often detected at 25 weeks of embryo development. With a breech presentation of a full-term fetus, the worst prognosis is the death or severe injury of the baby upon birth.

Incorrect placement of the baby in the womb may be due to diseases of the uterus, a small amount of amniotic fluid or a weak placenta. You can understand the development of pathology by the nature of the baby’s movements. Most often, such a deviation causes premature birth or by cesarean section. The disease is treatable, which means that there is a chance to leave the baby safe and sound.

Possible causes of the problem

Why does such an anomaly occur?

Doctors identify the following reasons for the baby’s incorrect position:

1. Due to high water levels, the mobility of the embryo increases, so there is a possibility that it may take an oblique position.
2. With high water levels, the baby cannot fully move and when changing position, there is a low probability that he will return to the correct place.
3. When a woman is pregnant with twins, there is less space in the womb. The kids feel cramped and one of them may look for a more comfortable position and therefore turns his head up.
4. Narrow pelvis of the expectant mother.
5. Abnormal position of the placenta (along the anterior wall).
6. Baby size is too big.
7. Uterine fibroids.
8. Pathological condition of the ovaries.

If a woman does not have uterine diseases, the placenta is healthy and the embryo develops normally, then there is a chance to avoid high or low water levels in the womb. A decrease in fluid is observed due to previous abortions, diseases of the genital organs, multiple fertilizations and problems that arose during a previous pregnancy. In addition, there is special corrective gymnastics that can help the baby get into the correct position.

Diagnostic measures

To identify pathology, two types of diagnostics are used: external obstetrics and vaginal examination. During an external examination, the doctor determines by the movements the baby’s posture, the soft and inactive part of the placenta. In addition, this method reveals an increased position of the uterine fundus, which may not correspond to the trimester of gestation. The doctor determines the baby's mobility and listens to the heartbeat by listening to the baby in the navel area through a stethoscope.

A vaginal examination of the patient helps to identify the soft and bulky part of the gluteal type of anomaly. In this way, it determines where the sacrum, coccyx and inguinal fold of the baby are located. If a girl has a mixed or leg presentation, the doctor will detect movement of the child’s foot.

In addition, an ultrasound will help make an accurate diagnosis of the baby’s abnormal position. It will show the location of the fetus and help determine the type of pathology. During the examination, the doctor also determines the position of the head, since if the presentation is incorrect, complications at birth may occur (the baby may have damage to the cerebellum or cervical spine).

How is pregnancy progressing?

Head and pelvic transverse presentation with a mild degree of development does not interfere with pregnancy management; it proceeds normally without complications. The girl does not experience a feeling of discomfort, pain or heaviness either at 10-19 weeks or at a later date. At week 33, a woman is prescribed a special set of exercises that will help change the position of the fetus and facilitate childbirth.

The most commonly prescribed exercise is:

1. You need to take a lying position on the bed.
2. Turn alternately on your right and left sides with an interval of 15 minutes.
3. Repeat the exercise 4-5 times in each direction.

Exercises in pathological conditions are done 3-4 times a day. When performing the exercise systematically, the fetus turns its head downwards within 7–9 days, if there are no complications. The purpose of gymnastics is to increase the excitability of the walls of the uterus. It is also recommended for women to sleep on their side. If by the end of pregnancy no changes are visible, then the girl is hospitalized 1.5–2 weeks before the baby is born. This is a mandatory procedure for all pregnant women whose ultrasound has shown the disease. The pregnant woman is placed in preservation in order to determine exactly how the baby will be born (naturally or by cesarean section).

How does childbirth occur during breech presentation?

How exactly the birth of the baby will take place is decided by the attending physician.

Whether a cesarean section will be prescribed depends on the following factors:

1. The age of the girl (after 35 years, natural childbirth can provoke a number of complications).
2. Pelvic size.
3. The course of pregnancy and its timing.
4. The child’s body weight and fetus (if it’s a girl, then most likely there will be a cesarean section, a boy will have a natural birth).
5. Vaginal diameter.

Most often, problems with childbirth arise due to vaginal immaturity, late water discharge, vaginal pathologies, fibroids and a difficult gestation period.

If the baby is born naturally, then before contractions the woman is given an anesthetic to relieve tension and minimize muscle spasms. It is administered when the cervix is ​​dilated by 40–50 mm.

Due to the abnormal development of the disease during natural childbirth, the following complications may occur:

• late release of water;
• prolapse of the umbilical cord loop and placenta particles;
• development of uterine abnormalities;
• labor is delayed;
• the appearance of acute hypoxia;
• premature detachment of the baby's place from the walls of the uterus.

Such complications are dangerous for the fetus and mother, so childbirth takes place under the supervision of obstetricians. After the water has broken, doctors examine the vagina to find out whether the woman in labor can give birth to a child herself. If the loops fall out, a caesarean section is performed.

Most often, childbirth with this diagnosis proceeds normally, but there is a high risk of complications and problems. Therefore, it is important for a pregnant woman to take preventive measures to make childbirth easier.

Is it possible to eliminate the pathological position of the fetus?

If the disease develops in the early stages or is mild, there is a chance to eliminate the problem. Preventive gymnastics and drug treatment will come to the rescue.

The main measures that can eliminate the disease include:

1. In the second trimester of pregnancy, antispasmodic medications are prescribed. They are taken at half the permissible dose 3-4 times a week.
2. The condition of the uterine muscles is monitored. Medications may be prescribed to relieve nervous agitation.
3. Gymnastic exercises. A set of movements will help change the incorrect placement of the embryo. All classes take place sitting or lying down for 15–20 minutes. They need to be performed half an hour before meals. All actions are carried out in compliance with the doctor’s recommendations.
4. Bandage. The belt will help support the abdomen and relieve tension from the back; the muscles will be more relaxed, which will help the embryo move more actively.
5. Sometimes external transfer of the child to the head is used. But this method of treatment is quite dangerous, as it can harm the fetus and cause complications (hypoxia, injury to the baby, premature birth).

Real story in this video:

How doctors can help

When diagnosing an “oblique breech presentation,” doctors can provide a woman with several types of assistance.

Correction of a pathological condition before the birth of a child

Identification of pathology is not always negative. There are times when there is a chance to correct the situation. If the disease was detected at 32–34 weeks of gestation, then doctors prescribe a special course of gymnastic exercises for the pregnant woman. Exercises can be performed at home, but during therapy you need to regularly visit a gynecologist to minimize the risks of developing the disease.

This treatment method is contraindicated if a woman has:

• narrow pelvis;
• there is a possibility of premature birth;
• there were miscarriages or turnovers in a previous pregnancy;
• a lot/little amniotic fluid;
• diseases of the uterus;
• 2 or 3 fetuses in the womb;
• gestosis;
• diseases prohibiting exercise therapy.

Despite the fact that the method has many contraindications, it is very effective and helps the baby turn over in the early stages of pregnancy. But in this case, you cannot self-medicate; this threatens to worsen the situation even further. All activities must be carried out under the supervision of a specialist.

Obstetric turn

If the deviation was detected at 6–7 months of pregnancy, then an obstetric turn can be made. The doctor performs certain mechanical manipulations that help the fetus turn head down. This action can only be performed by a qualified specialist in a medical institution under the control of an ultrasound machine. It helps to monitor the child’s condition and track his revolution.

Before performing the procedure, the girl must undergo certain training. You cannot eat the night before the procedure, as it is only done on an empty stomach. In addition, the bladder is emptied and muscle relaxant medications are administered intramuscularly. This will reduce the risk of cramping and make the procedure less painful. An obstetric turn is allowed only for certain types of disease and in the early stages of pregnancy. If the fetus has not settled into place by the end of pregnancy, then a cesarean section is prescribed.

Caesarean section for breech presentation

Caesarean section is done to remove the baby more safely. With it, the risks of complications are minimized. Most often, it is done if the girl has a narrow pelvis, and the natural birth of a baby is dangerous for the lives of two, or the biomechanism of childbirth is disrupted.

In addition, the location of the fetus plays an important role. If it is impossible to give birth on your own when it is presented, then a caesarean section is performed. The operation prevents possible problems and protects the uterus from damage. Reviews from doctors indicate that this is the safest option when staging such an anomaly.

Conclusion

Breech presentation is observed due to many factors that can negatively affect the fetus and the expectant mother. In the early stages of development, the problem can be eliminated, pregnancy and childbirth will proceed normally.

But there are cases when the pathological position of the fetus causes a number of complications and becomes a threat to the life of mother and child. Therefore, if signs of improper positioning of the baby appear, you should go to the hospital and undergo a medical examination to prevent undesirable consequences.

Many mothers, having learned after an ultrasound about the fetal breech presentation, begin to worry about how the birth will go and whether it is worth choosing a caesarean section for such a problem.

You need to know what the baby and mother are risking in this case. But first, we should consider what a foot presentation is. The baby's legs are not located together and at the exit of the uterus, often one of them is directed towards it, and the other in the other direction, while the hips are turned out.

Types of presentation:

1. foot,
2. gluteal or pelvic
3. mixed type (pelvis + legs).

The most common is the pelvic one, in which the baby’s legs are pressed to his tummy, and the buttocks are located at the exit of the uterus. This applies to 50-70% of pregnant women with a similar problem. A foot birth is unsafe and difficult for a natural birth, a mixed birth is a little easier, when the hips and knees are bent and the baby is positioned almost across to the exit, which creates a difficult situation. Statistics show that the number of such births is no more than 10%.

Pelvic-foot presentation, which is called mixed and foot presentation, is more complex than breech presentation. With such problems, doctors and expectant mothers often do not risk giving birth naturally and choose delivery by cesarean section. But it also depends on other factors. There is a high risk of damaging the child’s fragile limbs, and very often you can encounter dislocations.

Factors that determine the mode of birth:

• age of the woman in labor,
• diseases,
• pelvic size,
• gestational age,
• child's weight,
• location and degree of head bending,
• anamnesis data,
• type of presentation.

If the pelvis is normal or wide, the fetus is not very heavy, weighing from 2500 to 3500 grams, and a girl is expected, located inside the womb with the pelvis towards the exit, if the mother wishes, childbirth can take place naturally. Boys with leg presentation and weight more than 3500 g are an indicator for cesarean section.

Causes of fetal breech presentation

As you know, the fetus moves in the womb and can change its position, but the larger it gets, the more difficult it is for it to change position. Already before the 32nd week, the baby usually assumes a head-down position, which is most favorable for childbirth. But in some cases, the baby turns over even after 34 weeks, or even on the eve of birth.

The reasons cannot be 100% established, but doctors include the following:

1. pathology of the uterus,
2. uterine tone,
3. multiple pregnancy,
4. fetal pathologies (hydrocephalus, anecephaly),
5. after cesarean section,
6. polyhydramnios or oligohydramnios,
7. abnormalities with the placenta.

Even without an ultrasound, you can determine whether the fetus is presenting during pregnancy. Experienced doctors notice a high standing above the pubis, and also trace the heartbeat, which in case of a problem is clearly audible near the navel. By palpating the abdomen, presentation and its appearance can be determined, as well as through a gynecological examination. Usually an accurate diagnosis is made by ultrasound.

Consequences

How the birth process will proceed depends on the mood of the woman in labor. If the mother thinks positively without unnecessary fuss, pelvic or breech presentation affects pain to some extent. There may be tears in the perineum or deliberate cuts for the safety of the baby.

Slow labor may also be observed, because if the fetus lies with its head towards the exit, the uterus contracts better and the pressure on it is stronger. It is impossible not to warn about possible injuries to the arms, legs or head. After such a birth, it is necessary to show your child to a good specialist to determine the condition of his limbs, because if you notice the problem in time, it can be easily avoided until the body is stronger.

Many people have probably heard about what a breech presentation, or TPP, is, but what exactly does it mean? In medical practice, there are many cases, some of them occur more often, while others are quite rare. Pregnancy is no exception here - so many unusual births were performed by obstetricians that one could write a whole novel, and in several volumes.

But the topic of our article concerns precisely the position of the child on the eve of childbirth. Let's touch on what it should be and what consequences its incorrect position threatens. We will also analyze the features of the upside down position, what can be done in this case.

General information about breech presentation

Pregnancy is a complex physiological process, the course of which is impossible to predict. Until a certain point in time, the baby is free in the womb and can swim as he pleases. However, as it develops, it grows, and the space becomes less and less. In this regard, it occupies a certain position and remains in this state until childbirth.

In some cases, a child up to 35 weeks may change its position in the uterus several times, which in medical practice is called unstable. However, by a later date he takes a certain position, and in most cases his head is directed downward. This is called cephalic presentation. But sometimes he can take a position with his legs down, which, in turn, is called pelvic (or leg) presentation, which is undesirable. Below, for clarity, there is a photo of a breech presentation.

Specialists in the field of obstetrics and gynecology consider this position of the child to be a pathology, since it complicates the course of not only the pregnancy itself, but also the birth itself. This often becomes one of the main causes of deviations in child development.

There is a theory according to which there is a relationship between the development of the vestibular apparatus of the child and its position in the uterus. Since this organ of balance in the early stages of pregnancy is still only at the stage of development, pathology cannot be diagnosed. It can be detected in a child only after birth.

Until 33-34 weeks, the baby can move actively and unhindered. In this case, the pelvic position is detected in 35% of pregnant women. As for the prenatal period, this kind of pathology occurs in 4% of pregnant women.

Types of pathology

What is typical, like almost every disease, breech presentation has several types, and each of them is further divided into subspecies. Breech presentation includes the following:

• In its pure form - of all cases of pelvic or leg presentation, this subtype is observed in 75% of pregnant women. Only the child’s buttocks are directed towards the small one, while his legs are located along the body.
• Mixed pathology - here the legs of the fetus are bent and, together with the buttocks, are directed towards the exit of the uterus. This position occurs in 20-24% of cases.

Foot presentation has one more subtype:

• Full - both legs of the fetus are facing the female pelvic area.
• Incomplete - in this case, only one leg is in the wrong position.
• Knee - this subspecies holds the record for the number of registered cases - only 0.3%. Here the child’s knees are already turned towards the pelvis.

As many experts note, breech presentation of the fetus at 32 weeks of pregnancy is considered the most dangerous, since it can cause prolapse of the umbilical cord or limbs of the child. Asphyxia during childbirth cannot be ruled out either. If the size of a woman’s pelvis is impressive, then with a simple breech presentation there will be no complications during childbirth.

Causes of uncharacteristic fetal position

Doctors are often unable to find out exactly why the baby is in an undesirable position before birth. Nevertheless, some factors can be identified. From the point of view of modern medicine, these include genetic predisposition. In other words, if the expectant mother herself was born in this position, then her children can be born in the same way. At the same time, this theory has so far been little studied, although many obstetricians have recently also adhered to it.

It is very difficult to establish the exact cause of a baby's breech presentation. There are almost always one or two circumstances leading to this. The exact position the baby takes depends on many factors, both in relation to the fetus and its mother. Let us first consider the so-called maternal reasons, and then we will touch on some features of fetal development.

Problems with the uterus

Among the main reasons for malpresentation of a child in the womb are deviations in the development of the reproductive organ. Characteristic ones include the saddle uterus, bicornuate uterus and duplication of the reproductive organ. In some cases, such pathologies are detected precisely during pregnancy.

Uterine fibroids are also not uncommon. In particular, we are talking about the large size of a benign tumor, which on a purely mechanical level creates an obstacle to turning the child head down. No less serious danger is posed by myomatous nodes that grow into the uterine cavity.

Another reason for a breech presentation of a child is a decrease in the tone of the uterus and its contractility. This condition is typical for those women who have already given birth, more than once, and their anamnesis contains cases of abortion or curettage procedures. Those women who have had a cesarean section (CS) or myomectomy are left with scars. As a result, the contractility of the middle muscular layer of the uterine wall decreases, and it is more difficult for the child to take a “comfortable” position.

Placenta previa also plays an important role. By this we mean which can be complete or partial. Under normal conditions, the pharynx should be free, and the placenta should be located at least 7 cm from the internal pharynx. Its overlap creates a restriction on the stretching of the lower part of the uterus. The child also has little opportunity for the necessary rollover.

"Fault" of the umbilical cord

The cause of breech presentation of the fetus may be the length of the umbilical cord. And if it is short - less than 40 cm, then purely mechanically this also creates problems for the movement of the fetus in the uterine cavity. But if its length is within normal limits, then cases of spontaneous entanglement with the umbilical cord cannot be ruled out. This can often occur between the 23rd and 24th weeks of pregnancy. In this case, the child cannot perform a coup due to the mechanical tension of the umbilical cord loop.

Amniotic fluid

In some cases, the cause of the pelvic position of the fetus may be polyhydramnios or oligohydramnios.

With polyhydramnios, due to an increase in the amount of amniotic fluid, prerequisites are created for multiple changes in the position of the fetus in the cavity of the reproductive organ. During the entire period of pregnancy, the baby runs the risk of adopting an upside down position. But, besides this, there is another equally dangerous risk: the umbilical cord can twist not only around the child’s body, but also around the neck.

With oligohydramnios, the amount of amniotic fluid, on the contrary, is reduced, which also interferes with the free movement of the fetus in the uterine cavity and leads to breech presentation. He simply does not have the opportunity to take the necessary and only correct position - head down.

Here you can consider one interesting case when not one baby is expected to appear, but several. We are talking about multiple pregnancy. With twins, one child is almost always positioned as needed (the head is pointing down), while the other’s pelvis is pointing downwards. The same goes for triplets.

Again, this is due to limited space in the uterine cavity. With the birth of the first baby, the birth canal expands, as a result of which there are no problems with the advancement of the second child.

Bone structure

With anatomical narrowing of the pelvis or deformation of the bones in a woman, it is also quite difficult for the fetus to take the desired position. This feature in a woman’s anatomy can occur as a result of injury or a previous illness. It is often provoked by rickets, bone tuberculosis, or severe scoliosis.

Some features of fetal development

The most important difficulty with breech presentation is a caesarean section; only in some cases it is possible to do without it. But more on this a little later, but for now, as promised, we will touch on those features of the child’s intrauterine development, due to which he cannot take the desired position. First of all, this concerns fetal malformations, and they must be of a pronounced nature.

For example, there is an enlargement of the thyroid gland or cases of hydrocephalus when the child’s head exceeds the permissible size. Fortunately, such an anomaly is quite rare, and it is not difficult to detect it using ultrasound. And this study is known to be highly reliable. And if a similar or any other case with pronounced severity is diagnosed, a decision is made to terminate the pregnancy due to medical indications.

If the size of the fetus is small, then it can freely “flounder” in the womb as it pleases. Usually this may indicate intrauterine growth retardation.

Possible consequences

What complications can an undesirable position of the child lead to? Maybe everything is not as bad as it seems, and breech birth will go smoothly? Here it is immediately worth clarifying that the child’s pose, in which his legs are pointing down, is fraught with serious danger, and more than one. In most cases, it is leg presentation that provokes the threat of premature birth. In addition, gestosis or fetoplacental insufficiency may develop.

As a result, this negatively affects the formation of many body systems, including the nervous and endocrine ones. Also, such conditions often cause a decrease in the amount of amniotic fluid, fetal hypoxia, and disruption of its development.

But this is not all that matters; before birth, with a breech presentation of the fetus, the following cases may occur:

• Towards the end of the gestation period, the medulla oblongata lags behind in development, and the functioning of the pituitary gland is disrupted.
• Depending on the sex of the child, hemorrhage may begin in the testicles or ovaries. In some cases, body tissues swell, causing germ cells to die. As a result, this leads to azoospermia (severe male infertility), hypogonadism (testicular insufficiency due to decreased levels of sex hormones) and other pathologies.
• The supply of the necessary “life-giving” gas to the fetus is significantly limited, up to oxygen starvation.
• The heart begins to work faster.
• A particularly severe case is the development of cerebral palsy.

However, all this can threaten the fetus in the womb. But if the risk of premature birth has passed, then after the birth of the child it becomes very difficult for him to adapt to the environment. Many reviews about breech presentation confirm this. Anti-stress resistance is noticeably reduced.

However, every pregnant woman must take into account that fetal breech presentation at up to 34-35 weeks is not yet a pathology.

Signs of pelvic pathology

It is quite difficult to independently determine the type of TPP, however, there is the only reliable sign - these are tremors that are felt only in the lower abdomen, while in other parts they are less pronounced or absent altogether. Another sign by which you can judge TPP is the baby's heartbeat. With a cephalic presentation, it is clearly heard below the navel, while with a reverse fetal position, the heartbeat is felt at the same level as the navel or above it.

As practice shows, many pregnant women are not even aware of TPP; only during diagnostic studies is a breech presentation of the fetus revealed at week 32 or at another period. In addition, as is now clear, the abnormal position of the child negatively affects him. Therefore, it is necessary to regularly attend an antenatal clinic and not refuse the necessary examination.

Diagnosis of TPP

To determine the exact position of the baby in the uterine cavity, several methods are used:

• external examination (palpation of the abdomen);
• vaginal examination;
• performing an ultrasound.

During an external examination, the doctor feels the expectant mother’s abdomen to determine the displacement of the baby’s head relative to the fundus of the uterus. In this case, it is located above the norm. Other signs of TPP are also identified. However, in some cases, palpation of the abdomen will not produce results. This applies to those women who have a fuller physique or well-developed abdominal muscles. This also includes double pregnancy and increased uterine tone.

During an examination of the vagina, a soft and large formation can be detected directly at the bottom of the reproductive organ, which is the child’s buttocks.

You can finally verify the accuracy of the diagnosis and the need for a cesarean section for breech presentation using ultrasound. In addition to breech presentation, this study will reveal other signs:

• Decreased amniotic fluid.
• The nature of placenta attachment.
• Displaced head position.

In some cases, the doctor may prescribe additional examinations such as Doppler sonography and CHT. This will allow us to establish the child’s functional state.

What should an expectant mother do?

What can a woman do if it is discovered that her child has taken an undesirable position, and there is little time left before giving birth? Is there really no way out?! Don't despair! As you know, the child independently takes the necessary position in preparation for childbirth, which usually occurs with the onset of the 5th month of pregnancy.

But if, during a routine examination at a later date (more than 35 weeks), it is still legs down, action must be taken. Just don’t panic, as stress is not good for either the baby or the mother herself. Besides, there is still time.

In addition to regular visits to the gynecologist and other necessary examinations for breech presentation of the fetus, what else can be done? You should follow a daily routine. In particular, full and restful sleep is necessary, you need to rest more during the day, and avoid stressful situations. As for nutrition, it is necessary to adhere to a fractional diet. That is, eat small portions, but often throughout the day.

Medical support

The peculiarities of TPP are such that if the baby is in an uncharacteristic position in the womb, it is necessary to closely monitor the course of pregnancy. With the arrival of 38-39 weeks, she will be offered hospitalization in a clinic in order to determine the date and method of delivery. The examination itself consists of several planned points:

• The first step is to study the woman’s medical history and her past pregnancies, if any.
• The general condition of the expectant mother is examined, not only physical, but also emotional.
• In case of breech presentation of the fetus in the later weeks of pregnancy, its more precise period is determined based on the obtained ultrasound data and the date of the last menstruation.
• The nature of the pelvic pathology (breech or leg presentation), the degree of readiness of the cervix for childbirth, the condition of the placenta and amniotic sac are determined.
• The dimensions of the woman's pelvis are determined.
• The child's developmental status is assessed. That is, his weight, the amount of amniotic fluid is determined, whether there are any deviations, etc.
• The sex of the child and the degree of head extension are also determined. Typically, boys are the most difficult to cope with the stress of childbirth.

Based on the data obtained during these studies, one or another method of delivery is chosen.

Effective technique

What else can help in a breech situation? How to turn a child over so that there are no dangerous consequences?

There is a whole set of exercises for this:

• "Bridge". For this exercise, you need to choose a flat surface - a bed, a sofa, but the floor is still better. You will need to lie down, then put 2 or 3 pillows under your lower back, with your pelvis 20-30 cm higher than your head. You need to remain in this position for 10-15 minutes. The exercise should be done 2-3 times a day before meals. In this case, the baby's head begins to rest against the fundus of the uterus, as a result of which he experiences a feeling of discomfort, and he begins to turn to eliminate it.
• Breath. You should take the starting position with your feet shoulder-width apart, your arms should be lowered. As you inhale, raise your arms, palms facing down, to shoulder level. At the same time, you need to rise on your toes, slightly bending your lower back forward. After this you can slowly descend. Repeat 4 times per set.
• Gymnastics for breech presentation called “Turn” are no less effective. For this exercise you need a hard surface; again, the floor will help. You need to take a lying position and turn on the side towards which the child’s back is facing. Bend and press your legs towards you and lie like this for 5 minutes. After this, you should take a deep breath, exhale and turn over to the other side through your back. Also lie down for 5 minutes and inhale and exhale. Breathing should be free and even. Depending on the position of the fetus, you need to straighten the leg that is below (for transverse) or the one that is on top (for pelvic). Now, with each inhalation, it should be pressed to the stomach, and straightened as you exhale. The movements should be performed slowly and for 10 minutes.
• "Bridge-2". Take a lying position again, with your feet resting on the floor, your arms should be along your body. As you inhale, lift your pelvis up, hold for a few seconds, and lower it as you exhale. After this, on the next inhalation you should tense the muscles of the perineum, and when you exhale, relax them. Repeat this complex several times.

All these fruits must be performed exactly in the order in which they are given above. In this case, the muscles will smoothly engage in work, which will avoid sudden overload of the body. In the event that the baby has turned as expected, you should continue to perform only the last exercise as a preventive measure until birth. According to many experts, the effectiveness of this method is 75%.

Features of childbirth during TPP

In cases where the situation could not be corrected at the 38th week of pregnancy, the woman is sent to the hospital and, depending on the situation, the optimal method of delivery is selected. This can be a natural birth, which every mother strives for, or surgical intervention (caesarean section).

Both methods differ in their indications. Reasons for caesarean section for breech presentation may include:

• Presentation of the leg or buttock (mixed) nature, given that this is the first birth.
• The weight of the fetus is less than 2 kg or more than 3.5 kg.
• Low location of the placenta.
• Enlarged veins in the genital area.
• Anatomical narrowing of the pelvis.
• Presence of gestosis.
• Uterine fibroids or other abnormalities in its development.
• There is a scar on the reproductive organ.
• Primipara women 30 years of age and older.

Natural childbirth can occur without complications if:

• The size of the pelvis allows the baby to pass unhindered through the birth canal.
• The woman and her child are in satisfactory condition.
• A woman’s body is completely ready for childbirth.
• Breech presentation only.

In the case when the choice of the expectant mother fell on natural childbirth with a breech presentation, the woman needs special preparation. For this purpose, sedatives and restorative drugs, including antispasmodics, are prescribed. In this case, the doctor must monitor the course of drug therapy! The cervix also needs preparation. This is done using special injections and gels that are inserted into the vagina. But if the cervix is ​​still closed, then surgery is performed.

What is wrong in the uterine cavity is not a death sentence - a woman can give birth according to natural laws. However, given the existing threat to both mother and child, there is nothing left to do but resort to CS.

As a conclusion

Pelvic pathology is a case of pregnancy when much depends on the actions of not only the woman herself, but also the medical staff. The task of obstetricians-gynecologists is vigilant and constant monitoring of the patient, prescribing useful and special exercises. The result of such joint actions will be the birth of a healthy child.

Well, and most importantly, do not panic if the doctor makes a disappointing diagnosis - “breech presentation”. A specialist will tell you what to do in this case. Also, every expectant mother should read useful information not only regarding the topic of this article, but also how pregnancy proceeds in general. No wonder there is one good saying: forewarned is forearmed!

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

What is breech presentation of the fetus?

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

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

Types of breech presentation

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

Gynecologists distinguish three types of breech presentations:

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

Causes of breech presentation of the fetus

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

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

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

Symptoms of breech presentation of the fetus

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

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

Birth with breech presentation

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

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

Emergency surgery is necessary if:

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

Complications during childbirth

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

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

Exercises for breech presentation

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

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

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