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Breech presentation of the fetus provokes a miscarriage. How to turn a baby over. There are several types of breech presentation

During pregnancy, the child changes position several times. By the end of the last trimester, there is less space left, he turns upside down, closer to the exit. In every fifth case, a breech presentation of the fetus is detected. This causes concern for the woman, as it requires the experience of an obstetrician and surgical intervention during childbirth.

After examination, a diagnosis of breech presentation is made, most often of the gluteal type. There is no clinical picture. The obstetrician confirms the position during a vaginal examination, on a planned ultrasound. Before birth, they try to turn the fetus head down. When choosing a method of delivery, the age of the patient, the repetition of the process, the existing obstetric, genital and extragenital pathologies are taken into account.

What does breech presentation mean? The embryo is located in the lower part of the uterus near the tube. Pose with the buttocks forward, where the head should be. Occurs at 25 weeks of gestation.

There are several types of embryo location:

  1. gluteal;
  2. mixed;
  3. foot.

More than 65% is purely breech presentation of the fetus. It differs from the head in the initial exit of the buttocks. The legs are located along the body. Most often occurs during the first birth. A caesarean section is recommended, as the likelihood of prolapse of umbilical loops, asphyxia, and severe injuries increases. Mom has tears and injuries.

What to do with breech presentation of the fetus:

  • to do exercises;
  • follow a diet;
  • swim in swimming pool;
  • resort to obstetric turning.

The breech-leg presentation of the fetus is distinguished by a complete and incomplete view. Closer to the exit are the feet or one leg is straight and the other is pressed to the body. In almost all cases, a caesarean section is performed. The legs quickly go out, and for the head such an opening is not enough.

Mixed breech presentation of the fetus occurs in 20% of cases. The entry is made into the pelvis with the buttocks and legs bent at the knees. Happens in multiparous children. In the case of an oblique and transverse view, a caesarean section is performed.

After the onset of labor, one type of location may be replaced by another. Longitudinal breech presentation of the fetus means that the line of the uterus runs parallel to the body of the child.

The reasons

The causes of breech presentation of the fetus are divided into several groups. It depends on which side the predisposing factors influence. These include polyhydramnios, structural features of a woman's body, a short umbilical cord, a tumor in the uterus, and postoperative scars.

Prematurity. This is the main cause of breech presentation of the fetus. Occurs with excessive mobility of the embryo. The baby has a low weight and length.

Multiple pregnancy. It has an effect in 10% of cases. The development of multiple embryos reduces the possibility of rotation due to the small space. As a result, polyhydramnios and hypotrophy are noted.

Number of births. The fetus is in the gluteal position if the mother has more than three children. The abdominal muscles are weakened, the myometrium is not able to withstand the load, which leads to anatomical and neurotrophic changes.

The shape of the pelvis. Affects the location of the fetus in 2% of cases. The mobility of the embryo is limited with a narrow pelvis or its abnormal shape. By 36 weeks, it does not take a head position that is safe for childbirth.

Anomalies of the reproductive organs. The possibility of a physiological turn is affected by the abnormal structure of the uterus: bicornuity, saddle shape, the presence of nodes and neoplasms. Occurs with a large number of abortions and curettage, if previous births were with complications.

Fetal defects. The embryo occupies the wrong position with hydrocephalus, Down syndrome, diseases of the digestive system and the heart. The fetus increases in size, mobility decreases.

Pathology of the placenta. Presentation interferes with the fixation of the head at the entrance to the uterus. With oligohydramnios, mobility is limited, with polyhydramnios it is increased, so the baby turns over and does not return to the head position.

Symptoms and Diagnosis

Determine the position of the fetus on ultrasound, when visiting a gynecologist for a routine examination. A woman can feel the head closer to the stomach, and tremors in the lower part of the uterus, intense stirring. For confirmation, instrumental and physical research methods are used.

Primary diagnosis includes ultrasound screening. In the second trimester, using the technique, the longitudinal or transverse position, presentation is determined. By the third screening, the indicators change. If breech presentation persists, additional methods are used.

External inspection. Allows you to determine the height of the fundus of the uterus. In what position is the head and gluteal part. The baby's heart beats at or above the navel.

Vaginal examination. Through the uterus, soft tissues, the sacrum and genitals of the fetus are probed. If the presentation is mixed, the buttocks and feet are groped, when it is clean - the inguinal fold. On palpation of the soft volumetric part, the coccyx and sacrum are clearly felt. Do not determine the sex of the baby, so as not to damage the genitals.

Ultrasound of the uterus. It helps to find out the location of the child, to choose medical tactics for successful delivery, to indicate how bent the head is, how the umbilical cord and legs are located. The mass of the baby is specified, the absence of congenital malformations.

CTG and ECG. Detects hypoxia, entanglement, pressing the loops of the umbilical cord. Assess the condition of the fetus, the presence of impaired placental blood flow, heart defects. Will show amnionitis - inflammation of the membranes, anemia.

How to flip

Until the 30th week, the gynecologist monitors the condition of the pregnant woman. Required proper rest, proper nutrition, so as not to gain extra pounds, taking vitamins. Means are prescribed to reduce the tone of the uterus to minimize the risk of malnutrition and placental insufficiency. Do corrective exercises.

Gymnastics with breech presentation of the fetus helps to relax the muscles of the uterus and pelvis as much as possible. The child will be able to independently take the head position. Combined with breathing, the efficiency is 75%, it turns over in the first week of classes.

Exercises are contraindicated in the breech presentation of the fetus, if there are diseases of the heart, blood vessels, kidneys and liver. Physical activity is not recommended for scars on the uterus, caesarean section in history, with the threat of premature birth. Gymnastics is contraindicated when a watery or bloody liquid is released from the vagina.

How to turn the fetus over in breech presentation:

  1. gymnastics;
  2. swimming in the pool;
  3. obstetric turning;
  4. psychological impact.

In a natural way, children take the position in 70% of multiparous and in 30% of pregnant women for the first time. If before 35–36 weeks the baby has not turned his head towards the exit, this means that the breech presentation of the fetus will remain until delivery.

Classes begin with a warm-up. For several minutes they walk at a normal pace, on heels and toes. Perform rotations, raise, lower hands, knees to the side of the abdomen.

Exercise 1. Stand straight, arms along the body. They inhale, rise on their toes and spread their arms, bending their backs. Exhale, take the original position. Perform 5 times slowly.

Exercise 2. Lying on the floor, relax. Make sure that the knees, pelvis and shoulders are at the same level. Place a few pillows under your body. Remain in this position for 30-40 seconds. Perform on an empty stomach.

Exercise 3. Kneeling on a soft rug, tilt your head down. Arch your back, breathe slowly. On exhalation, return to the starting position. Bend at the waist, head up.

Exercise 4. Take a position on the floor on your back. The legs are spread and stand close to the body. Hands are relaxed, lie along the body. While inhaling, lift your back and pelvis. Return to starting position. Straighten your legs, inhale and draw in your stomach. Return to original position. Perform slowly 5-7 times.

With the permission of the gynecologist, classes begin at 30 weeks. Combine with proper nutrition, walks. Physical activity can be carried out in the absence of a threat of termination of pregnancy.

If before the 35th week such funds did not help, an obstetric turning will be needed. It is called the Arkhangelsky method. The external method is used exclusively in the hospital. Check the sufficiency of the amount of amniotic fluid. The procedure is carried out using ultrasound.

The baby's cardiac activity is monitored before and after the process with the help of CTG. The basis of the method is the smooth simultaneous careful movement of the head and buttocks of the fetus. The expected result is obtained in 6 cases out of 10. The method is contraindicated in case of a threatened miscarriage, if a woman has a narrow pelvis, the first birth occurs after 30 years.

This includes late preeclampsia and low mobility of the embryo. You can not use the method for anatomical defects. The risk of placental abruption, entanglement, asphyxia increases. Uterine rupture and injury to the baby may occur.

Pregnancy

In 5% of women, pregnancy occurs with a breech presentation of the fetus, which changes to a head one by 24 weeks. The position remains unstable until 35 weeks. There is no cause for concern if a non-head position of the child was diagnosed at 20–21 weeks of gestation. For prevention, antispasmodics are selected, a diet when the fetus is large. Fears arise with an abnormality of the pelvis, a tumor or myoma.

At the 24th week of pregnancy, 10% of women have a baby in a head-down position. They follow a diet so that the baby is not too large, they do gymnastics. At 27–28 weeks of gestation, presentation is not considered a pathology, since the baby can roll over several more times before delivery. Follow recommendations for rest, nutrition, and medication.

Breech presentation at 30–32 weeks matters. The gynecologist uses all previously prescribed means to keep the cephalic presentation until delivery. Assign gymnastics according to the methods of Dikan, Fomicheva or Bryukhina. The choice of the complex depends on the tone of the uterus. With an increased rate, the first type is chosen. It is allowed to perform three times a day on an empty stomach, lying on its side. The fetus begins to actively move, a turn is made. After that, they wear a bandage, sleep on the side where the back of the baby is located.

With normal or low uterine tone at 33–34 weeks, a complex according to Fomicheva is performed. First, they do a warm-up, walk on toes. Spend in the evening an hour after eating for 20 minutes.

At 36–37 weeks, a large weight gain occurs, the placenta fades. There is a complication of hypoxia, a decrease in fetal activity. You need a proper daily routine, a balanced diet. Drug therapy will relieve spasms.

At the 39th week of pregnancy, the baby is formed, preparing for the appearance. If the loads did not help, the woman is sent to the hospital for examination. The timing is determined as accurately as possible and the optimal method of delivery is chosen.

natural childbirth

During contractions, the woman is on her side, where the back of the baby is located. Constantly monitor the heartbeat using CTG. The cervix does not open enough. When the butt appears, the obstetrician dissects the perineum to reduce the risk of injury. During natural childbirth with a breech presentation, the child goes to the navel, the risk of squeezing the umbilical cord increases. Enter drugs that stimulate the process.

At the final stage, the placenta comes out. The rest is removed manually. Since childbirth with breech presentation of the fetus is accompanied by injuries and incisions, bleeding is prevented with the help of Oxytocin and Methylergometrine. They help the uterus contract.

The biomechanism of childbirth with a purely breech presentation is different in that the buttocks are first shown in a transverse section above the entrance to the pelvis. The advancement of the fetus usually begins after the outflow of amniotic fluid. Independent childbirth will take place with complications if they began prematurely, the birth of a boy is expected, the weight of the child is too large or very small.

In order for a buttock birth to take place with minimal health risks, the pregnancy must be at full term for at least 37 weeks. The weight of the fetus is from 2500 to 3500 g, and the pelvis is of normal size. Among the favorable factors is the equipment in the maternity hospital to help with complications. Under all conditions, the obstetrician recommends the natural process of the appearance of the baby.

Manual breech presentation is a method based on maintaining the normal position of the embryo in order to prevent complications. Necessary for delayed expulsion of the embryo. According to Tsovyanov, it is supported by pressing the legs to the body so that they are not born prematurely. As soon as the buttocks are cut through, they are grabbed by hands, placing the thumbs on the baby's legs, and the rest along the sacrum.

C-section

The gynecologist recommends childbirth or caesarean after determining the type of gluteal location of the fetus. With breech presentation, CS is indicated to exclude complications if a woman has heart problems, the age of the woman in labor is more than 35 years, there are edema. With the breech presentation of the boy, the risk of damage to the scrotum is reduced.

For women over 35 years of age, CS surgery is elective, especially if the previous birth was difficult. A procedure is needed after IVF, long-term treatment for infertility. Assign with a narrow pelvis, scars and tumors. If the fetus has anomalies, tilting of the head is observed. Mandatory process with placenta previa, foot type of location of the baby. CS should not be abandoned, since the use of epidural anesthesia allows you to remain conscious, and the risk of having a child with pathologies is almost zero.

Anesthesia is selected by the obstetrician. In the absence of contraindications, regional anesthesia is performed with minimal impact on the embryo. The procedure is performed on an empty stomach after preliminary preparation. In the evening and two hours before the COP, an enema is given. The procedure involves cutting the anterior abdominal wall above the pubis. There is a small amount of adipose tissue in this place, so healing is faster. If there is a scar from a previous incision, a longitudinal excision is made.

Breech presentation indicates the need to extract the fetus by the leg or inguinal region. After fixation of the umbilical cord, the placenta is removed. The uterine incision is sutured with self-absorbable sutures. Stitches on the abdominal wall must be removed.

Cesarean planned. After evaluating the possibility of natural childbirth, the risks are determined and a referral to the COP is given. If there are complications during normal childbirth, an emergency operation is performed after contractions have begun. It will be needed with weak labor activity, in the absence of disclosure. They react quickly when the umbilical cord falls out, the placenta exfoliates, and acute hypoxia occurs.

Complications

The consequences for the child of the breech presentation of the fetus are dangerous. Mom does not always bear a baby. There is hypoxia, preeclampsia, varicose veins develop. During childbirth, the uterus does not open enough, the head is clamped. The child suffocates, the flow of nutrients is blocked. Possible damage to the collarbone or spine.

Premature discharge of water, which leads to prolapse of the umbilical cord or parts of the fetus. Due to the weakness of the ancestral forces, the neck does not open. Hypoxia affects irreversible changes in the baby's central nervous system. When throwing the arms and chin, birth injuries develop associated with a fracture, displacement of the cervical vertebrae. The consequences of breech presentation are congenital dislocation of the hip, problems with the digestive tract, kidneys, and the development of cerebral palsy. The woman is bleeding.

Bearing a baby is accompanied by the threat of miscarriage, hypoxia. In the second half, premature birth occurs. The risk of fetal hypotrophy is increased by 60%. Lack of nutrients, vitamins inhibits the development of the nervous, endocrine system, affects the functioning of the heart and blood vessels.

From the 35th week, the rate of maturation of brain structures slows down, problems arise in the work of the pituitary gland, the adrenal cortex. Negative changes occur in the genital area: swelling, hemorrhage. Girls subsequently develop exhausted ovary syndrome, boys develop oligozoospermia. More than 20% are due to problems with the musculoskeletal system.

Despite the issues that arise with breech presentation, the correct approach from the beginning of pregnancy will help the baby to assume a head position. With a preventive direction, a risk group is identified, timely preparation is carried out, and tactics of childbirth are selected.

Purely breech presentation is the position of the child, whose head and legs are directed upwards, and the buttocks are downwards. More often it is mixed - the child "sits" on his own legs or bends one of them under him. An obstetrician can suspect a breech presentation during an examination of a pregnant woman, it is confirmed during an ultrasound scan.

A woman is recommended an individual cycle of exercises, which allows the child to roll over into the correct position. Often the child takes the correct position already at the time of birth or after the uterus descends. In any case, a pregnant woman should not worry, worries about this are much worse for her and the child than a potential caesarean section.

The main causes of breech presentation

The main cause of breech presentation of the fetus is the lack of space in the uterine cavity. This happens with a clinical and pathological narrow pelvis, with a curvature of the spine or pelvic bones. With malformations of the uterus, if a woman managed to conceive, you need to be prepared for the fact that the presentation is likely to be breech. Myomatous nodes in the uterus do not allow the fetus to take the correct position, he is forced to find the most comfortable position, placing himself between the nodes of the fibroids.

The uterus is often compared with for a child, when he is uncomfortable in it, the house is too small or has defects, the child has to settle down, taking into account these factors. Not always correct, but in general, breech presentation is not dangerous. With a low attachment or placenta previa, the child is also buttocks down. The umbilical cord "pulls" him and does not allow him to roll over, he is forced to "sit".

With multiple pregnancies, the correct position of the fetus is extremely rare. One of them is usually in the gluteus, often it turns over into the correct position immediately after the birth of the first child. If there are more than 2 fruits, then the presentation of most of them will not be correct.

When there is too much space in the uterus, the risk that the fetus will take a breech presentation is also great. The uterus, overstretched by previous pregnancies, polyhydramnios, reduced tone of the walls of the uterus give the fetus room for movement, as a result, by the time of delivery, it may turn out to be down not with its head, but with the buttocks.

With severe malformations, often incompatible with life, when the size of the fetal head does not correspond to the size of the woman's pelvis, the fetus also cannot take the correct position. But the percentage of pregnancies with breech presentation due to severe fetal malformations is extremely small. They are very clearly visible on ultrasound and a woman may be offered an abortion for medical reasons.

A woman can give birth to a child on her own, only if there are no absolute indications for a caesarean section, this is a narrow pelvis, pathologies from the skeleton, placenta previa. If the labor activity goes without complications, the cervix opens well and actively, then the baby's legs are born first, followed by the head. The main danger is that the cervix does not begin to contract prematurely, in which case there is a high risk of pinching the head. The obstetrician must prevent prolapse of the umbilical cord and premature birth of the legs. The issue of planned operative delivery is discussed individually, but usually a woman gives birth in the delivery room, which communicates with the operating room, since at any time it may be necessary to resort to a caesarean section.

In this article:

So the months of pregnancy flew by like an instant. For some, they were light and cloudless, while others had to actively fight for the life and health of the baby. In any case, bearing a child is a great joy: the first ultrasound, the first photo of the baby, which is still in the mother's tummy, the first things and toys for the little man. All this makes life brighter, more beautiful and more interesting. Children are the flowers of life, bringing joy to parents and all relatives.

The time of birth is approaching. Some young mothers are worried and afraid of the unknown. Childbirth is not dangerous, almost all women have gone through it. With the advent of the most beautiful creation, all generic sensations fade into the background. A newly-made mother carefully examines her baby, trying to understand who he looks like. No one says that carrying and giving birth to a child is easy. This is a very complex and responsible process. Starting from the 32nd week of pregnancy, women should always carry documents with them, they may suddenly be needed.

Diagnosis of pelvic presentation of the fetus

At 30-32 weeks of gestation, the third planned ultrasound examination (ultrasound) is performed, the purpose of which is to determine the development of the baby at this stage, the correct location of the placenta, whether the baby has taken the correct position. After an ultrasound, women receive a huge amount of information about the fetus, the main of which is the absence of any defects and defects. Such problems begin to be solved after birth, with the help of the latest medical technology and equipment. The position of the fetus in the uterus may change towards the end of pregnancy. It's too early to worry about this. There are cases when the baby itself turned over a few hours before birth. It certainly can be called a miracle, but such things happen. The main thing, young mothers, is to believe in all the best, to think that the birth will go just fine and the baby will appear the healthiest in the world. Do not miss a single opportunity to wish your child well. You will see how this will affect his character, well-being and development. If the ultrasound told you that the fetus is in breech presentation. This is entirely fixable.

What is a breech presentation of the fetus?

Let's try to break into what is a breech presentation of the fetus. This is the location of the fetus in the uterus, in which its pelvic part is at the bottom. It turns out that the baby sits with the pelvis down, and not with the head, as is necessary for the standard birth process. Such childbirth does not happen very often, in 3-5% of cases. Childbirth in the breech presentation of the fetus is considered a pathology, the baby can be injured, complications are possible during labor. The diagnosis can only be established after 32 weeks of pregnancy. The baby is in free swimming in the mother's tummy and turns over as he pleases. Due to the intensive movement and space in the uterus, the baby develops, its muscles and motor apparatus are strengthened.

How does pregnancy proceed with a breech presentation of the fetus

Pregnancy with a breech presentation of the fetus is no different from pregnancy with a head presentation of the fetus. As a preventive measure, special exercises are used. Starting from 32 weeks, you can start a set of exercises developed by professionals and approved by gynecologists. Methods of obstetric coup have been developed - this is a forced way to force the child to take the correct birth position. There are circumstances when the kids again take the breech presentation of the fetus. Hospitalization in breech presentation of the fetus is necessary from 38 weeks for diagnosis and choice of a strategy for conducting labor.

Fetal presentation classification

The baby during the whole pregnancy takes different positions, rolls over, dances with the mother to the music, goes in for sports and swims. At 32-34 weeks, he begins to actively prepare for childbirth, there is already little space in the uterus, since the baby's body weight has increased significantly. In most cases, the fetus occupies the head diligence, which can be occipital, parietal, facial and frontal. The best option for labor is occipital cephalic presentation. But there is a classification of the location of the fetus in the uterine cavity.

With the breech presentation of the fetus, the child's legs are bent at the knees and pressed to the stomach. With a foot - it is the leg directed to the exit from the uterus. In a mixed presentation, both knees and hips are bent. In the latter case, surgery is most often offered. In all other cases, you can give birth on your own, but childbirth will be a little more difficult than with the head position of the fetus. Listen to the advice of doctors. Do not be afraid to give birth is not dangerous. All women must go through this.

What are the causes of breech presentation of the fetus

Breech presentation may be due to the following reasons:

  • oligohydramnios and amniotic fluid,
  • narrow pelvis,
  • placental attachment is very low,
  • cord entanglement (double/triple),
  • short umbilical cord,
  • saddle and bicornuate uterus,
  • uterine defects,
  • decreased tone of the uterus,
  • uterine fibroids,
  • fibroma,
  • the presence of scars

Gymnastics with pelvic presentation of the fetus

Obstetrician-gynecologists have developed special exercises for breech presentation of the fetus, with which you can give the baby a head position. You can use such exercises only after the recommendation of the doctor leading your pregnancy.

Exercise #1

These exercises are performed with the help of coups lying from side to side. You need to do 3-5 approaches after a short period of time, after about 8-10 minutes. You need to do this exercise 3 times a day.

Exercise #2

Lying on your back, place a cushion or pillow under your lower back. The pelvis should be above the head. This position should be held for 10 to 15 minutes. No longer needed.

How to do the exercises correctly

All exercises should be performed on an empty stomach, so as not to provoke heartburn, nausea, vomiting, severe dizziness. Such exercises are forbidden to be performed earlier than 32 weeks of pregnancy and without consulting a doctor, as well as with late toxicosis, scars on the uterus, after any gynecological operations. There are also methods of traditional medicine, aromatherapy, which contribute to a change in the position of the fetus in the breech presentation and increase the possibility of the head position of the child in the mother's uterus. Many fitness clubs and groups for pregnant women offer sets of exercises, including an obstetric coup. You can take advantage of this opportunity, but be sure to ask your gynecologist for permission to do such exercises.

Fitness instructors are specially trained to work with pregnant women. They clearly know what exercises can be performed and which are prohibited. During the entire period of pregnancy, exercises on the abdominal muscles and oblique abdominal muscles are not allowed. Such exercises in the period before conception strengthen the muscles of the abdomen and press, which significantly improves the process of pregnancy and childbirth. But the Kegel exercise will help strengthen the birth canal, make the muscles of the vagina more elastic, which will favorably affect the birth process. Do not experiment with your health and the health of your child, do not perform unknown and difficult exercises for you. If possible, go swimming and spend more time in the air. Don't forget about breathing exercises.

Ultrasound examination and medications

If the methods recommended in the article have not reached the goal, then the pregnant woman may be offered an ultrasound procedure and medical intervention. Usually it is carried out no earlier than at 34 weeks of gestation with the use of special medications. This procedure is not simple, but it is very effective. After passing it, a woman has the opportunity to give birth naturally. This procedure has a number of contraindications: the age of the primiparous woman in labor is more than 30 years, scars on the uterus, preeclampsia, entanglement of the fetus with the umbilical cord, obesity and many other contraindications. This method is not suitable for everyone, so it is rarely used in gynecology and obstetrics.

Childbirth with breech presentation of the fetus

In the process of labor, the child moves through the birth canal, while making a huge number of rotational and translational movements. The baby has to go through a difficult journey, he gets tired in childbirth no less than his mother, and maybe even more. Therefore, a newborn baby sleeps soundly for the first day, sometimes it does not even wake up to eat. He needs rest, he has done his first serious work and now he is resting calmly and preparing to meet his parents. Being born is hard work for mom and baby. Life is not easy and it should be appreciated.

The biomechanism of childbirth in breech presentation of the fetus:

  1. The biomechanism allows you to insert the buttocks into the small pelvis of the woman in labor, then the fetus moves along the birth canal. In the process of contractions, the buttocks of the fetus fall lower and lower. One of the buttocks is the leading one, a birth tumor subsequently appears on it, like a fontanel during head insertion.
  2. With the help of the biomechanism, the buttocks of the fetus are rotated in the pelvic area, the gluteal groove is created in the desired size. One buttock moves towards the womb, the second goes towards the sacrum.
  3. Insertion of the buttocks is then carried out after fixing the point under the pubic arch, around which the buttock is cut. With a full pelvic position, the buttocks are born first, then the torso to the navel, and then the legs. With mixed pelvic diligence, we are born with buttocks and legs. Along with the chest, arms appear, then shoulders and a head.
  4. The head is born in a bent position. The fixation point is fixed under the pubic arch. Then the chin, face and back of the head appear. The head is born last, the birth tumor does not appear on it.
  5. The biomechanism of labor activity with foot presentation is similar to the breech presentation. With insufficient disclosure of the cervix after the outflow of amniotic fluid, the baby's leg may fall into the vagina, which can slightly delay and complicate the process of childbirth.

Prevention of breech presentation

Patients at risk: breech presentation, it is necessary to carry out preventive measures. Pregnant women should follow the regimen, have a full 8-hour sleep at night and rest during the day. Particular attention should be paid to nutrition. It should be balanced, consist of vegetables, fruits, meat, fish, dairy products and cereals. Nutrition should be complete and correct, but do not overeat. A large fetus can complicate labor activity. It is necessary to carry out prevention to stabilize the nervous system. Spend more time outdoors, do what you love. Prevention is also necessary to prevent the disruptive activity of uterine contractions. Starting from week 22, the attending physician may prescribe an antispasmodic course for prevention, which can eliminate the causes of breech presentation of the fetus.

The antenatal clinics run courses for pregnant women, which explain in detail the rules that must be observed. They provide psychotherapeutic preparation for childbirth. Training is provided in breathing exercises during childbirth, recommendations are given to relieve pain, relieve nervous tension, and control the tone of the vaginal muscles.

Pregnancy is a wonderful time for any woman, new life is growing in her. Any difficulties only make us stronger, and the long-awaited baby becomes the most beloved person in the world. Breech presentation of the fetus should not affect your mood. The baby feels all the emotions of the mother and should be happy. Good luck with your birth. Happiness to you and your families!

The midwife's story about childbirth with a breech presentation of the fetus

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

What is a breech presentation of the fetus?

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

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

Types of breech presentation

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

Gynecologists distinguish three types of breech presentations:

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

Causes of breech presentation of the fetus

A woman who has been diagnosed with a breech presentation of the fetus needs increased attention from the doctor. The gynecologist easily determines the breech presentation of the fetus, simply by feeling the mother's stomach or by performing ultrasound diagnostics. And although with such a feature of the uterine development of an infant, pregnancy proceeds as usual, the doctor must carefully monitor the fetus, its health and well-being.

Each embryo actively tosses and turns in the mother's womb until about 22 - 23 weeks of pregnancy. Then he becomes big enough to tumble, or lays down head down, or sits on his legs or bottom, not wanting to change position. If before the 36th week the child has not managed to turn around correctly, then the presentation can no longer be corrected, it remains until the birth. The reasons why the baby behaves so strangely can be very different:

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

Symptoms of breech presentation of the fetus

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

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

Birth in breech presentation

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

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

Emergency surgery is needed if:

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

Complications during childbirth

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

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

Breech exercises

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

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

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

Breech presentation is observed in 6% of pregnant women. With 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 can remain unchanged until the 3rd trimester.

The abnormal position of the fetus is not dangerous until 22 weeks of gestation. During this period, it is likely that the child'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 is the position of the embryo in the lower part of the uterus, near the fallopian tube. During gestation, the child should be head down, but in some situations it is able to change its position, and the buttocks or legs are below. 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.

The incorrect position 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 the pathology by the nature of the baby's movement. Most often, such a deviation causes premature birth or with the help of a caesarean 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 incorrect position of the baby:

  1. Due to polyhydramnios, the mobility of the embryo increases, so there is a possibility that it may take an oblique position.
  2. With polyhydramnios, the baby cannot fully move, and when changing positions, there is a low probability that he will again stand in the right place.
  3. When a woman is carrying twins, there is less space in the womb. It becomes cramped for babies and one of them may look for a more comfortable position and therefore turns head up.
  4. The narrow pelvis of the expectant mother.
  5. Abnormal position of the placenta (along the anterior wall).
  6. Too big baby.
  7. Myoma of the uterus.
  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 polyhydramnios or oligohydramnios in the womb. A decrease in fluid is observed due to previous abortions, diseases of the genital organs, multiple fertilizations, and with problems that arose in a previous pregnancy. In addition, there is a special corrective gymnastics that can help the baby to stand in the correct position.

Diagnostic measures

Two types of diagnostics are used to detect pathology: external obstetrics and vaginal examination. During an external examination, the doctor determines the posture of the child, the soft and inactive part of the placenta by perturbations. In addition, this method reveals an increased standing 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.

Vaginal examination of the patient helps to identify the soft and voluminous part in the gluteal anomaly. In this way, it determines where the sacrum, coccyx and inguinal fold are located in the baby. If the girl has a mixed or foot presentation, then the doctor will detect the movement of the child's foot.

In addition, an ultrasound will help to make an accurate diagnosis of the incorrect position of the baby. It will show the location of the fetus and help determine the type of pathology. During the study period, the doctor also determines the position of the head, since if the presentation is incorrect, birth complications may occur (the cerebellum or cervical region may be damaged in an infant).

How is the pregnancy

The head and pelvic transverse presentation with a mild degree of development does not interfere with the management of pregnancy, it proceeds normally without complications. The girl does not experience discomfort, pain or heaviness either at 10-19 weeks or at a later date. At 33 weeks, 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 the right and left side with an interval of 15 minutes.
  3. Repeat the exercise 4-5 times in each direction.

Charging in a pathological condition is done 3-4 times a day. With the systematic exercise of the exercise, the fetus turns the head downward for 7-9 days, if there are no complications. The purpose of gymnastics is to increase the excitability of the walls of the uterus. Women are also advised to sleep on their side. If by the end of gestation no changes are visible, then the girl is hospitalized 1.5–2 weeks before the birth of the baby. This is a mandatory procedure for all pregnant women in whom ultrasound showed the disease. The pregnant woman is placed for preservation and in order to identify exactly how the baby will be born (naturally or by caesarean section).

How is childbirth with breech presentation

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

Whether a caesarean section will be scheduled depends on the following factors:

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

Most often, problems with childbirth arise due to the immaturity of the vagina, late withdrawal of water, pathologies of the vagina, fibroids and a difficult period of gestation.

If the baby is born naturally, then before the contractions, pain medication is administered to the woman to relieve tension and minimize muscle spasms. It is administered when the cervix dilates 40–50 mm.

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

  • late discharge of water;
  • prolapse of the umbilical cord and particles of the placenta;
  • development of uterine anomalies;
  • childbirth is delayed;
  • the appearance of acute hypoxia;
  • premature detachment of the child'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 waters have broken, doctors examine the vagina to find out if the woman in labor can give birth to the child herself. If the loops fall out, then 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 girl in position to take preventive measures in order to facilitate childbirth.

Is it possible to eliminate the pathological position of the fetus

If the disease has developed 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 gestation, antispasmodic drugs are prescribed. They are taken at half the allowable dose 3-4 times a week.
  2. The state of the muscles of the uterus is controlled. Anti-anxiety drugs may be prescribed.
  3. Gymnastic exercises. A set of movements will help to change the incorrect placement of the embryo. All classes are held in a sitting or lying position for 15-20 minutes. They need to be done half an hour before meals. All actions are performed in compliance with the recommendations of the doctor.
  4. Bandage. The belt will help support the stomach and relieve tension from the back, the muscles will be more relaxed, which will help the embryo to move more actively.
  5. Sometimes an 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).

The real story in this video:

How doctors can help

When making a diagnosis of "oblique breech presentation", doctors can provide a woman with several types of assistance.

Correction of the pathological condition before the birth of the 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 the period of therapy, you need to systematically visit a gynecologist to minimize the risks of developing the disease.

This treatment is contraindicated if a woman has:

  • narrow pelvis;
  • there is a risk of premature birth;
  • had miscarriages or turnovers in a previous pregnancy;
  • a lot / little amniotic fluid;
  • diseases of the uterus;
  • in the womb 2 or 3 fetuses;
  • preeclampsia;
  • diseases that prohibit exercise therapy.

Despite the fact that the method has many contraindications, it is very effective and helps the baby to roll over in the early stages of gestation. But in this case, self-treatment is impossible, it threatens to worsen the situation even more. All activities must be supervised by 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. Such an action can only be performed by a qualified specialist in a medical institution under the control of an ultrasound machine. It helps to control the condition of the child and track his coup.

Before doing the procedure, the girl must undergo certain training. You can not eat the night before the procedure, as it is only done on an empty stomach. In addition, the bladder is emptied, and drugs are injected intramuscularly to relax the muscles. This will reduce the risk of spasms and make the procedure less painful. Obstetric rotation allows only for certain types of disease and in the early stages of pregnancy. If the fetus does not fall into place by the end of pregnancy, then a caesarean section is prescribed.

Cesarean section with breech presentation of the fetus

A cesarean is done to safely remove the baby. It minimizes the risk of complications. Most often, it is done if the girl has a narrow pelvis, and the natural birth of a baby is dangerous for the life of two, or the biomechanism of childbirth is broken.

In addition, the location of the fetus plays an important role. If it is impossible to give birth on its own during its presentation, then a caesarean section is performed. The operation prevents possible problems and protects the uterus from damage. Reviews of doctors indicate that this is the safest option when staging with 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 times when the pathological position of the fetus causes a number of complications and becomes a threat to the life of the mother and child. Therefore, if there are signs of an incorrect location of the baby, you should go to the hospital and undergo a medical examination to prevent undesirable consequences.