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The position of the fetus before childbirth. Oblique or transverse presentation of the fetus

Data on the location of the fetus is necessary to determine the tactics of delivery of a woman. The normal course of labor is possible with the correct positions and presentation of the baby.

In the first half of pregnancy, the fetus is small and moves freely in the uterus. Closer to 34-35 weeks, he begins to take a stable position, which in most cases persists until delivery. In this period, the doctor leading the pregnancy can already decide on the method of childbirth: naturally or by cesarean section.

Fetal position

Fetal position Is the ratio of the fetal axis to the longitudinal axis of the uterus. Distinguish three position options:

  1. Longitudinal(the axis of the fetus and the uterus coincide or lie parallel). One of the large parts (head or buttocks) is located at the entrance to the pelvis, the other lies in the area of ​​the bottom of the uterus;
  2. Transverse(the axes of the fetus and uterus intersect at right angles). The head and buttocks of the fetus are located in the lateral parts of the uterus;
  3. Oblique(axes intersect at an acute angle). One of the large parts is located in the upper lateral part of the uterus, the other in the lower part.

Information The longitudinal position is considered correct, in the absence of other contraindications, a woman can give birth naturally.

The main reasons for the appearance of incorrect positions fetus (oblique and transverse) are:

  1. Multiple pregnancy;
  2. Abnormalities in the development of the uterus;
  3. Laxity of the muscles of the anterior abdominal wall;
  4. Tumors of the uterus (fibroids).

Diagnosis of abnormal fetal positions:

  1. Visual inspection... In the wrong positions, the abdomen has a spherical shape, and is not stretched forward;
  2. Measurement of the circumference of the abdomen and the height of the standing of the uterine fundus... Characterized by an excess of the abdominal circumference norm in comparison with normal indicators for a given gestational age and a decrease in the height of the uterine fundus;
  3. External obstetric examination... On palpation of the abdomen, the presenting part is not determined, the head or pelvic part is palpated in the lateral parts of the uterus. The fetal heartbeat is heard in the navel;
  4. fetus.

Incorrect fetal positions can lead to a number of complications during pregnancy and childbirth:

  1. Premature termination of pregnancy;
  2. Loss of small parts: umbilical cord, arm or leg;
  3. Launched transverse position of the fetus during childbirth (the hand together with the shoulder is hammered into the pelvic bones, preventing the head and trunk from passing through the birth canal);
  4. Anomalies of the generic forces;
  5. Fetal hypoxia during labor;

Labor management with incorrect fetal positions

In the transverse position the birth of the fetus cannot be completed spontaneously. A woman needs to be hospitalized at 37 weeks and routinely deliver by cesarean section.

In an oblique position make an attempt to achieve an inversion of the fetus. To do this, a woman is placed on her side, where a large part of the fetus (head or buttocks) is located in the iliac region. Often, when moving into the pelvic cavity, the child takes a longitudinal position. If the position on the side does not correct the situation, then delivery is also carried out operatively.

Fetal presentation

Fetal presentation Is the ratio of the large part (head or buttocks) to the entrance to the pelvis. The presented part they call that part of the fetus that is located at the entrance to the small pelvis and is the first to pass through the birth canal.

Allocate two types of presentation:

Head presentation of the fetus

  • Occipital;
  • Forehead;
  • Frontal;
  • Facial.

Breech presentation of the fetus

  • Pure gluteal;
  • Mixed gluteal;
  • Foot.

additionally A cephalic presentation is considered a correct presentation (the child enters the birth canal with the head tightly pressed to the chin). Incorrect (extensor) insertion of the head complicates the course of labor, and often the birth of a child can occur only by caesarean section.

The main causes of the extensor cephalic presentation:

  1. Narrow pelvis;
  2. Multiple entanglement of the umbilical cord around the fetus's neck;
  3. Small or large head sizes;
  4. Labor activity disorders;
  5. Laxity of the muscles of the anterior abdominal wall;
  6. Decrease.

With an anterior cephalic presentation the chin moves slightly from the chest, the extension of the head is not very pronounced. Labor usually ends spontaneously, but can be protracted. In the first and second stages of labor, prevention of fetal hypoxia is mandatory.

Frontal presentation is the second degree of head extension. Spontaneous childbirth is possible only with a large pelvis, low weight of the child and sufficient strength. However, vaginal delivery can lead to a number of complications (prolonged labor, fetal hypoxia, etc.), so it is preferable to deliver a woman by surgery.

Facial presentation manifested by inserting the head into the pelvis with the front part. This is an extreme degree of extensor presentation. Delivery through natural routes is almost impossible, leading to serious complications, up to the death of the fetus. In this case, it is advisable to carry out an emergency delivery of a woman by cesarean section.

Breech presentation- This is the longitudinal location of the fetus, in which the presenting part is the pelvic end.

Main reasons development of breech presentation:

  1. Abnormalities in the development of the uterus;
  2. Premature pregnancy;
  3. Decreased tone of the uterus.

With a pure breech presentation the buttocks are adjacent to the entrance to the pelvis, while the legs are bent at the hip joints, extended at the knees and close to the body.

With mixed gluteal presentation, the legs are bent at the hip and knee joints and are presented together with the buttocks to the pelvic cavity.

With foot presentation both legs are presented to the pelvis, unbent in the joints (full leg) or one leg, while the second lies higher and bent in the hip joint (incomplete leg).

The course of pregnancy is not much different from the head presentation, however, there are frequent cases of premature rupture of amniotic fluid. A woman should be admitted to a hospital 2-3 weeks before the expected date of birth. First of all, it is necessary to determine the tactics of labor management.

Natural birth management often results in to serious complications:

  1. Birth trauma to the fetus;
  2. Weakness of birth forces;
  3. Fetal hypoxia;
  4. Compression of the umbilical cord leading to asphyxia and fetal death;
  5. Injuries of the birth canal in a woman.

Important Due to the high risk of complications, delivery of the woman by caesarean section is recommended.

Exercises for turning the fetus

There are special gymnastic exercises to help the fetus turn over. The optimal period for such techniques is 30-32 weeks. Exercises can be carried out at a later date, but then the fetus is already large, and the likelihood of its overturn is extremely small.

It is necessary to start exercises only after the permission of the doctor leading the pregnancy, because there are contraindications:

  1. Scars on the uterus after surgery;
  2. Placenta previa;
  3. Tumors of the uterus(myoma);
  4. Serious diseases of other organs and systems in the mother.

The set of exercises must be performed 3-4 times a day for 7-10 days:

  1. Turns... Lying on the bed, turn from one side to the other 3-4 times (on each side you should lie for 7-10 minutes);
  2. Pelvic tilts... It is necessary to lie down on a hard surface and raise the pelvis so that it is 25-30 cm higher than the head. You should stay in this position for 5-10 minutes. The exercise can be repeated for up to 2-3 weeks;
  3. Exercise "Cat". Kneel down and put your hands on the floor. While inhaling, raise your head and tailbone, bend your lower back. On exhalation, lower your head and arch your back. The exercises are repeated up to 10 times;
  4. Knee-elbow position... Get on your elbows and knees, the pelvis should be above the head. You should stay in this position for 15-20 minutes;
  5. Half-bridge. Lie on the floor, put several pillows under the buttocks so that the pelvis is 35-40 cm higher, and raise your legs. Shoulders, knees and pelvis should be at the same level;
  6. Lying on your back. Lie on a hard surface, bend your legs at the knee and hip joints, rest your feet on the floor. While inhaling, raise and hold the pelvis. As you exhale, lower your pelvis and straighten your legs. The exercises should be repeated 6-7 times.

Gym exercises are often effective and result in fetal inversion within the first 7 days.

During pregnancy, babies change their position in the uterus many times. As long as the fetus has enough room to move, it can roll over as it suits it best. But from a certain moment, the presentation and posture of the child is important for doctors, because the prognosis for the upcoming birth depends on it. In this material, we will talk about what the transverse position of the fetus is and what to do if the baby has decided to sit in the mother's womb in this way.

What it is?

They say about the lateral position when the baby is in the uterus across. If you mentally draw a line along the spine of the child, then in oblique presentation it will intersect with the axis of the uterus at a right angle. In this way, the hip and elbow of the baby can be turned to the exit from the uterus. The head will be located in one side, and the butt in the opposite.

There are several options for the lateral position. If the baby is facing the front abdominal wall of the mother, then we are talking about the transverse facial presentation, if the baby is turned forward with the back, then the transverse position of the fetus with the dorsal presentation is diagnosed. In all cases, a transverse or oblique transverse presentation (if the baby's axis does not create a straight, but an acute angle when crossing the central axis of the uterus) is considered a pathology of pregnancy.

This pathology is rare. Less than 1% of pregnant women are faced with a transverse position of the baby in the womb. In 97% of pregnant women, babies are located in the cephalic presentation, in 2 - 2.5% - in the pelvic presentation. And only in 0.5-0.6% of cases, children accept a transverse presentation, unusual from the point of view of the laws of nature.

Most often, this arrangement of the fetus is typical for women who have given birth a lot and often. In the first pregnancy, transverse presentation - isolated cases. Until 34-35 weeks of pregnancy, pathology is out of the question, because the baby has practical and theoretical opportunities for an independent turn in the uterus for childbirth, but after 35 weeks, the turn becomes almost impossible, because there is no more free space for such wide movements in the uterus


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Dangers and risks

This situation does not significantly affect the course of pregnancy itself. However, it should be remembered that any abnormal position of the baby in the uterus is a significant risk factor for premature birth. In the case of the transverse position, this happens in 40% of cases. A child who will be born much earlier than the intended obstetric term may not always adapt to a new environment for himself. So, with the immaturity of the lung tissue, problems with spontaneous breathing may arise, acute respiratory failure may develop, and with a low weight of a child born prematurely, it will be difficult for the baby to keep warm.

In the case of the onset of spontaneous childbirth, small parts of the body and umbilical cord loops may fall out along with the outpouring of water. This is fraught with the death of the child, injuries, deformities, disability, the development of severe complications from acute hypoxia. For a woman, such childbirth is dangerous with injuries to the pelvic bones, ruptures of the perineum, cervix and body of the uterus, vagina, heavy bleeding. In severe cases, everything can end in the death of both the child and the woman in labor.


With rapid spontaneous childbirth, the shoulder of the child is often "hammered" into the small pelvis, this is how the neglected lateral position of the fetus develops, in which the independent birth of the child is impossible. It is when the transverse position is neglected that the traumatic rupture of the uterus most often occurs.

If the position of the child is oblique, then it is considered transitional. Theoretically, even in childbirth, it can change either longitudinal or transverse. Naturally, no one will wait until the crumb turns, the risks are too high.

That is why, with transverse presentation, it is recommended to give birth by surgical intervention - a cesarean section allows you to remove the child from their womb without the risk of severe birth trauma, hypoxia. For the expectant mother, the operation will also guarantee that her small pelvis and perineum will not suffer from ruptures and fractures.


Causes

Most often, babies find themselves in a transverse position, for whom it is easy and free to move in the uterus, even for long periods. Such physical activity is promoted by polyhydramnios. If the amount of amniotic fluid is higher than normal, then the baby may well take this position and "get stuck" in it. Also, active movements for long periods are facilitated by weak and overstretched walls of the uterus. Weakness and some flabbiness of smooth muscles are characteristic of women who give birth a lot and often.

No matter how strange it may sound, the lateral position is also facilitated by low physical activity, or rather, the inability for the child to move. This condition is characteristic of oligohydramnios. Also, large hypertrophied children experience difficulties with movements and coups.

The risk of transverse presentation of one of the children or both at once is in a woman with multiple pregnancies, which is why the position and condition of each of the fetuses is closely monitored throughout the entire multiple pregnancy.


The baby can take a lateral position as the only convenient one if a woman almost constantly has an increased uterine tone during pregnancy, and also has tumors or other neoplasms in the lower uterine segment. The establishment of a normal head presentation therefore becomes unacceptable for the child. In addition, transverse or oblique presentation is often observed during pregnancy in women with congenital abnormalities of the main reproductive organ - a saddle or bicornuate uterus.

Quite often, the placenta interferes with the baby, if it is located low, they have its full or partial presentation. When the entrance to the small pelvis is blocked by something, the baby cannot stand in the correct position - head presentation. A child in a woman with a clinically narrow pelvis can also sit across the womb.

Sometimes the reason for the wrong position of the child lies not in the maternal factors, but in the child itself. So, with hydrocephalus (dropsy of the brain) or anencephaly (absence of the brain), the baby does not take a head position, but remains either sitting in a breech position or lying across the uterine cavity.


Diagnostics

A transverse presentation can be determined by an obstetrician-gynecologist during an external examination of a pregnant woman, as well as during a vaginal examination. Usually, the height of the uterine fundus, which is measured at each planned appointment in consultation, with a transverse position is below normal, and the pregnant tummy itself even visually looks like a torpedo melon. On palpation, the position of the fetus is determined by the location of the head - this is the hardest and most mobile part of the child's body. With a head presentation, it is felt in the lower abdomen, above the pubis, with a pelvic presentation - near the bottom of the uterus (in the upper abdomen), with a transverse presentation, the head is either in the right or in the left side of the expectant mother.

The baby's heartbeat is determined near the belly button of the expectant mother. Vaginal examination allows you to exclude presentation of the head or priests. Then the expectant mother is recommended to undergo an ultrasound scan. Only an ultrasound scan allows you to get the most accurate data about the position in which the child lies, what are the features of his position, which part of the body is located towards the exit to the small pelvis, and also to assume the weight of the baby. All these data are needed so that the doctor can more carefully assess the risks and choose the right delivery tactics, in which neither the mother nor the child will suffer.


What to do?

If a woman has a transverse presentation at 24-25 weeks of pregnancy, as well as earlier or later than this period, there is no need to panic. Up to 35 weeks, the baby has time for a coup. The expectant mother needs to try with all her might to help her child to take the correct position in the uterine cavity.

For this, special gymnastics is recommended, in which each exercise is thought out in such a way as to maximally relax the muscles of the uterus, to give the baby the opportunity to turn. The set of exercises includes the exercise complexes of Dikan, Shuleshova, Grishchenko. There are other complexes developed by gynecologists specifically for women who need help turning their baby around. It should be noted that with a positive attitude and daily exercises, the effectiveness of gymnastics reaches about 70-75%. It is this percentage of babies that nevertheless move from an unstable transverse or oblique arrangement to a head one.

Fetal flip exercises are not recommended for everyone. So, it is forbidden to do exercises for women suffering from diseases of the heart and blood vessels, kidneys, and liver. A scar or several scars on the uterus from a previous cesarean section or other surgical operations are also a contraindication.



If a pregnant woman has edema, signs of preeclampsia, the threat of termination of pregnancy, spotting, presentation or low position of the placenta, gymnastics cannot be done.

It is advisable to do gymnastics for those for whom it is not contraindicated from 30 to 36 weeks of pregnancy. If the baby stubbornly does not want to accept a different position, doctors can offer an obstetric coup according to Arkhangelsk. It is done in a hospital under ultrasound control. The kid is deployed manually. But such an intervention is quite dangerous, it can provoke rupture of the membranes, the outpouring of amniotic fluid, the onset of premature birth, as well as injury to the fetus. That is why doctors themselves rarely decide on an obstetric turn.

Separately, I would like to emphasize the importance of a positive attitude of a pregnant woman. Many experts argue that methods of persuading a baby, gentle persuasion, combined with corrective gymnastics, give amazing results.

If the expectant mother herself is in the mood for the best, will remain calm, harmonious mood, then the chances of her baby for an independent coup closer to childbirth will significantly increase.


With transverse presentation, it is important to prevent premature birth. That is why a woman should be extremely careful - do not lift weights, do not jump, do not make sharp bends of the body.

Care should be taken to have sex, because an orgasm and even the usual sexual arousal in a woman cause short-term spasms of the smooth muscles of the uterus. If, simultaneously with the transverse presentation, a low position or placenta previa is diagnosed, then it is recommended to refuse sex altogether, as well as from masturbation. Stress should be avoided.

Additionally, a woman should wish only on her side, completely repeating the pose of her baby. How to do this correctly, the doctor will tell you after the ultrasound scan, since he will see the exact location of the child's body and body parts.

You can not miss scheduled visits to the doctor in the antenatal clinic. Most likely, the attending doctor will suggest early hospitalization - at 36-37 weeks of pregnancy, and this will be the only reasonable solution to avoid unwanted complications. In no case should you refuse it.


If, despite all the precautions, the woman began to deliver prematurely, regular painful contractions appeared, the water receded, it is important to take a horizontal position in order to prevent the baby's hand from falling out of the genital opening, which is in breech presentation. After that, you need to immediately call an ambulance.

The woman will receive emergency care, with a 99% probability she will undergo an emergency caesarean section immediately after she is delivered to the hospital.

Can I give birth on my own?

Childbirth with a transverse presentation can be dangerous, we talked about this above. With this position of the baby, in 99% of cases, a cesarean section is performed. It is better if it is carried out before the onset of spontaneous labor, which is why early admission to the hospital is recommended.

Absolute indications for surgery are post-term pregnancy in a transverse or oblique presentation, fetal hypoxia, as well as the presence of scars on the uterus. If the pregnant woman was taken to the hospital on an "ambulance" with the discharge of water, the doctors will make sure that the parts of the child's body have not fallen out. If a prolapse is found, it is forbidden to set the handle or umbilical cord back.

If the anhydrous period (the time elapsed from the moment the water leaves) is delayed, then the likelihood of infection of the uterine cavity and the development of fetal hypoxia increases. The critical time is considered to be 12 hours.

If a woman is brought to the ambulance after a long dry period, the caesarean section will be performed in any case, regardless of the degree of cervical dilatation.


Late treatment is life-threatening for women with sepsis. Often in such situations, after a cesarean section, you have to perform another operation - a hysterectomy (complete total removal of the uterus). A woman will never be able to become a mother.

Given the high risks, a planned cesarean section at 37-38 or 38-39 weeks of pregnancy looks like a more reasonable way out of the situation.

And what is presentation, we will talk about this in this article.

Terminology

The interest of expectant mothers in how the baby is located in their tummy is quite understandable. From the first movements of the baby, mother, with a sinking heart, listens to her feelings with the hope of recognizing what these initially barely perceptible waves inside her mean - movement or somersault, anxiety or play with mother. Location has very important for both the health of the child and the mother. It will affect the course of pregnancy, intrauterine and childbirth. It can be:

  1. Longitudinal. If you conventionally draw a line through the baby's pelvis and head, and it will coincide with the axis of the uterus.
  2. Transverse. If the conditional line of the fetus is perpendicular to the uterus.
  3. Oblique. If the baby is in a middle position at an angle to the uterus.

For to determine the position of the fetus, the doctor must conduct an external one using a stethoscope or an obstetric tube, find the baby's heartbeat, and he can also conduct a vaginal examination. As a rule, many expectant mothers can do it on their own, especially if the child does not determine the position of the baby. To do this, they must only listen even more carefully to their feelings and pay attention to:

  • the place where the baby's heartbeat is most noticeable is the upper part of the back;
  • where you can most often feel the blows of the crumbs are its legs;
  • light tickling feelings - handles;
  • the place that sticks out the most is the baby's bottom;
  • the back of the baby is felt smoother and harder.

Developing in the womb, the baby can turn over and somersault many times, however, over time, its size increases, it has less and less space to freely change its location, and it takes a certain position. Correctly, when the child is in the mother's abdomen vertically, all other fetal positions are called incorrect.

The presentation of the fetus indicates which part of the baby's body will come out first at the time of birth. It can be:

1. Head, subdividing, in turn, into:

  • occipital: the chin is at and the back of the head goes forward. There can be an anterior view, the most optimal position at birth, and a posterior view, depending on where the back of the head is turned;
  • antero-head- there is a large fontanelle ahead;
  • frontal extension- the frontal part protrudes forward
  • facial extension- the baby is turned face.

2. Pelvic.

  • foot- legs are in front;
  • gluteal- most favorably when the baby is in a squatting position.

3.

4. Transverse.

Abnormal presentation of the fetus- oblique, transverse, as well as leg, head with frontal and facial extension, as well as relatively antero-cephalic presentation. Having taken this position, it is quite difficult for a baby to be born on his own. It is important to note that these types of presentation are not very common. The doctor decides how the childbirth will take place, taking into account a large number of important factors, and, as a rule, childbirth takes place through

Causes that lead to the transverse and oblique position of the fetus

The baby can take various positions in utero. Some of them allow a woman to give birth on her own, others can lead to complications in the development process and the baby in utero, and then during delivery. The fetus may take an irregular position under the influence of such factors:

  • fetus;
  • flabbiness of the muscles of the abdominal wall.

These conditions allow the baby to be overly active. Conversely, the following restrictions on the ability to move freely can also provoke an abnormal fetal position:

  • multiple pregnancy;
  • large baby;
  • increased uterine tone;
  • threat of spontaneous
  • fibroma of the uterus and anomalies of its structure.
Also to factors affecting which location the baby chooses include the following:
  • anatomical reasons due to which the head cannot take the required place in the narrow pelvis;
  • low
  • the formation of tumors of the lower segment of the uterus and pelvic bones;
  • and anencephaly, anomalies in the development of crumbs.
The oblique position of the fetus during pregnancy may not be permanent, but a temporary, transitional state, and the baby during childbirth can change it either to longitudinal or transverse.

Did you know?The age of children in East Asian countries, for example, in Vietnam, is calculated taking into account their life in the mother's belly. Thus, they become 9 months older than their peers from other countries of the world.

How to determine diagnostic methods

A gynecologist can diagnose how the fetus is located under the mother's heart. based on routine visual inspection. So, in the longitudinal position, the abdomen has a vertical-oval shape, if the position is incorrect, it will have a transverse-oval or oblique-oval shape. The abdominal circumference, as a rule, exceeds the norms corresponding to the gestational age, since the uterus becomes like a ball, and does not acquire an oval shape, and also a low standing of the uterine fundus is noted.

It is impossible to determine the presentation visually; this will require:

  • palpate the lateral parts of the uterus;
  • listen to the fetal heartbeat, either by applying to the abdomen, or with a stethoscope or obstetric tube.
An effective method for determining the position and presentation of the baby is ultrasound.

What are the dangers

The pregnancy process can proceed unattended, but the risk of their occurrence is higher than normal. The dangers that a pregnant woman may face are:

  • premature outpouring and headlong onset
  • in the transverse position c, there is a high probability of a strong
  • with a rapid discharge of water, the child's activity is significantly limited, there is a possibility of its parts falling out, for example, it can be a handle or which leads to a neglected transverse position. This, in turn, can cause complications such as: ascending infection, diffuse peritonitis, sepsis. Being in a waterless space for a long time, the baby may feel a need for air, and he may develop an acute or even a neglected transverse position for a woman may threaten with a rupture of the uterus.

Features of the course of pregnancy

If at 28-32 weeks of gestation, there are signs of non-standard placement of the baby in the womb, the gynecologist may recommend her with the transverse position of the fetus, which can help the baby roll over and take a head presentation. A reversal is possible until the 35th-36th week, since later its size will no longer allow it to be done.

Turning on the leg is also permissible at birth when one of the babies has taken a transverse position.

Features of operative delivery

The operation of a cesarean section is performed on a planned basis, since the danger of natural childbirth in the wrong position is very high both for the child and for the health of the mother. Surgery takes place in accordance with the following plan:

  • The abdominal wall is dissected.
  • An incision is made in the uterus.
  • Removal of the fetus, which is carried out in conjunction with an assistant. The doctor, grasping the child's leg, transfers it to the pelvic position and removes it by the pelvic end. The assistant's job is to help guide the baby's body in the right direction from the outside. If it is difficult to extract, then the incision in the uterus is enlarged. In this procedure, there may be a risk of damage to the vascular bundles.
  • The placenta is removed and the uterine cavity is scraped out.
  • The final step is suturing the uterus, examining the abdominal cavity and restoring the abdominal wall.

Transverse presentation of the fetus is not a pathology, however, pregnancy should take place under the constant supervision of a gynecologist so that there is no threat to the life of the child and the expectant mother.

If we talk about literature, I will remember many examples when women in labor died in childbirth, and often together with an unborn child. One of the reasons for the high mortality in the 17th - 19th centuries and earlier was difficult childbirth caused by the lateral position of the fetus. Currently, this complication of pregnancy, although it remains a danger, both for the life of the woman and for the baby, but the risk of death of both participants in childbirth has significantly decreased. Incorrect fetal positions, including the lateral position, occur in 1 case per 200 births, which is 0.5 - 0.7% as a percentage. Tellingly, situations with an incorrect position of the child in the uterus are more often observed in multiparous (10 times) than in women giving birth for the first time.

Let's define the terminology

Depending on how the fetus is located in the uterus, the tactics of delivering a woman is also determined. To understand the terms, we will define the following concepts:

  • the fetal axis is the longitudinal line connecting the buttocks and the baby's head;
  • the axis of the uterus is the longitudinal line connecting the fundus of the uterus and the cervix, or the longitudinal axis of the uterus.

The position of the fetus is the ratio of the baby's axis to the longitudinal axis of the uterus. Distinguish between correct and incorrect fetal position. The correct position is considered to be longitudinal, when the axes of the uterus and the child coincide, but simply, when the baby and the mother's torso are in the same direction (if the mother is standing, then the child is located vertically with her). In this case, one of the large (head or pelvic end) parts of the baby "looks" at the entrance of the small pelvis, and the other rests against the uterine fundus.

Incorrect positions are considered transverse and oblique positions of the fetus. But it should be remembered that the fetus is very mobile for most of pregnancy and constantly changes its position. Stabilization of his position occurs by 34 weeks, so it does not make much sense to talk about the wrong position before the specified time.

Transverse position

In the case of the transverse position (situs transverses) of the child, it is located not along, but across the uterus, that is, the uterine axis and the axis of the fetus are perpendicular to each other and make up an angle of 90 degrees. Since the baby is located across, accordingly, there is no presenting part - large parts of the fetus are felt on the sides of the uterus on the right and left and are located above the iliac crests.

What is called oblique position

The oblique position of the fetus (situs obliguus) is said when the axis of the fetus is displaced in relation to the longitudinal axis of the uterus, which forms an acute angle (less than 45 degrees). In this case, the head or buttocks are located below the iliac crest. You can also highlight the transverse-oblique position (does not play a big role), when the axes of the fetus and uterus are at an angle, but do not reach 90 degrees, but more than 45 degrees.

It is also worth mentioning the unstable position of the fetus. With significant mobility of the fetus, it periodically changes its position from longitudinal to transverse or oblique and vice versa.

Fetal presentation

Presentation of the fetus is the ratio of its large part (it can be the head or the pelvic end) to the entrance to the pelvis. Accordingly, distinguish between cephalic presentation (at the entrance to the small pelvis there is a head) and pelvic (can be leg, gluteal or mixed).

What contributes to abnormal fetal positions

The reasons for the transverse position of the fetus can be due to either uterine factors (the presence of obstacles in it) or increased or decreased fetal motor activity:

  • Myoma of the uterus

The risk of an incorrect position of the baby increases significantly in the presence of myomatous / fibrous nodes in the uterus. It is especially large when localization of nodes in the neck, isthmus or lower uterine segment, or with large sizes of nodes located in other places, which prevents the child from taking the correct position. The growth of a tumor of the uterus during gestation is not excluded, which also deforms the uterine cavity and the fetus is forced to position itself incorrectly.

  • Congenital malformations of the uterus

Uterine abnormalities also contribute to the transverse position, for example, a septum in the uterus or a saddle or two-horned uterus.

  • Incorrect localization of the placenta

Low placentation or low location of the placenta (5 cm or less from the internal pharynx) or its presentation (when the placenta partially or completely overlaps the internal pharynx) is often the cause of the baby's incorrect position in the uterus.

  • Narrowed pelvis

As a rule, a 1 - 2 degree narrowing of the pelvis does not create obstacles for the development of the fetus or for its birth. But more severe degrees of narrowing of the pelvis, especially asymmetric forms of narrowing (oblique, curved by bone exostoses) serve as a prerequisite for the location of the fetus not along the axis of the uterus, but across or obliquely.

  • Fetal malformations

Some of the developmental defects manifest themselves already in utero. For example, with anencephaly (no brain) or hydrocephalus - dropsy of the brain (the fetal head becomes very large), a transverse / oblique position of the fetus can be observed.

  • Pathology of amniotic fluid

Excess amniotic fluid leads to excessive expansion of the uterine cavity, which in turn provokes excessive motor activity of the baby. He becomes very mobile, does not feel the boundaries of the uterus and "fits" in it across or obliquely. With a lack of amniotic fluid, the situation is the opposite. The tightness of the uterine space and a small amount of amniotic fluid does not allow the child to actively move and take the required longitudinal position.

  • Multiple pregnancy

When there are several fetuses in the uterus, they become cramped, which prevents one or all babies from taking the correct position.

  • Large fruit

The significant size and weight of the fetus (more than 4 kg) reduces its motor activity and provokes an incorrect position of the baby in the uterus.

  • Increased tone of the uterus

In the event of a threat of termination of pregnancy, especially a permanent one, the uterus is almost constantly in hypertonicity and restricts the movement of the fetus.

  • Laxity of the muscles of the anterior abdominal wall

A similar situation is often typical for women who have multiparous (4 - 5 births). The constant elongation of the anterior abdominal wall of the abdomen by the pregnant uterus contributes to the excessive motor activity of the child (the abdominal muscles do not restrain movement), his upturns and somersaults, which ends with the location of the fetus in the uterus transversely.

  • Fetal hypotrophy

Insufficient weight and size of the fetus is also the reason for its constant movement and upturns in the uterus (the baby is small and there is too much space in the uterus for him).

How to determine the lateral position of the fetus

To determine the wrong position of the fetus, a comprehensive examination of the pregnant woman is carried out:

Examination of the abdomen

During examination of the abdomen of a pregnant woman, its irregular shape is revealed. The abdomen is stretched in the transverse size with the transverse position of the fetus or has an obliquely stretched shape in the case of the oblique position of the baby. The uterus takes the form of a ball instead of the laid ovoid-elongated one. When measuring the size of the abdomen, it is established that its circumference significantly exceeds the norm, although the height of the uterine fundus does not coincide with the gestational age (less).

Palpation of the abdomen

During palpation of the abdomen, it is impossible to determine the presenting (large part of the fetus) part at the entrance to the bony ring of the pelvis. In the fundus of the uterus, the head or pelvic end is also not palpable. Large parts of the baby are felt on the right or left side of the midline of the uterus. The position of the fetus is established by the head. If the head is on the left, they talk about the first position, when the head is on the right, about the second. The fetal heartbeat is well heard in the navel, and not on the left or right, as in the longitudinal position. It may be difficult to establish the position and position of the baby in the case of hypertonicity of the uterus (the threat of premature birth) and with an excess of amniotic fluid.

Obstetric ultrasound

Obstetric ultrasound with 100% guarantee determines the position of the fetus at any gestational age. But, as already mentioned, the lateral position of the baby in the period of 20 weeks should not serve as a reason for panic, the fetus will have time to take the "correct" position before the due date of birth.

Vaginal examination

A vaginal examination, which is carried out at the end of pregnancy or when contractions have begun, but the whole fetal bladder, provides little information. The obstetrician can only determine that the presenting part of the fetus at the entrance to the small pelvis is absent. In the case of the outpouring of water and the opening of the uterine pharynx up to 4 cm or more, the vaginal examination is carried out with caution, as it can provoke a prolapse of the handle, fetal leg or umbilical cord loop. When the water is poured out, the doctor can feel the side of the fetus (ribs with intercostal spaces), the scapula or armpit, in some cases the elbow or the hand of the handle.

How are pregnancy and childbirth going?

Pregnancy with the transverse position of the baby, as a rule, proceeds without features. But it was noted that in almost 30% of cases, premature birth begins. Untimely outpouring of amniotic fluid is one of the most frequent complications of this pathology, which can occur both during pregnancy and cause the onset of premature labor, and during labor.

Why labor is complicated in the case of a transverse position of the fetus

It is extremely rare to complete childbirth with a transverse position of the fetus on its own and the birth of a live baby. In such cases, the child spontaneously turns into a longitudinal position and is born with its head or pelvic end. Self-rotation is possible with an insignificant size of the fetus or its prematurity. Basically, the course of childbirth is unfavorable and complicated by the following processes:

  • Untimely discharge of water

With the transverse arrangement of the fetus, an early or premature outpouring of water occurs (in almost 99% of cases). This causes the absence of the presenting part, which is pressed against the entrance to the pelvis and divides the amniotic water into anterior and posterior.

  • Running lateral position

This complication occurs after premature or early drainage of water. In such a case, due to the rapid outpouring of water, the child's mobility is sharply limited and either the shoulder is hammered into the small pelvis, or small parts (arms or legs) fall out. When the umbilical cord loop falls out, it is clamped, blood flow is disturbed in it and the fetus dies.

  • Ruptured uterus

Threatening rupture of the uterus accompanies the neglected lateral position of the fetus. After the water has departed, the shoulder girdle is hammered into the entrance of the small pelvis, and the uterus begins to contract rapidly, which leads to overstretching of the lower segment and the threat of rupture. If a cesarean section is not performed in a timely manner, the uterus ruptures.

  • Chorioamnionitis

Premature discharge of water and a long anhydrous gap contribute to the penetration of infection into the intrauterine cavity and the formation of chorioamnionitis, which leads to the development of peritonitis and sepsis.

  • Fetal hypoxia

A protracted course of labor against the background of a long anhydrous interval provokes the development of fetal hypoxia and the birth of a child in asphyxia.

  • Childbirth with a twin body

Due to intense contractions and poured water, the walls of the uterus are in close contact with the fetus, which leads to its bending in half in the thoracic region. In this case, labor ends spontaneously. First, the chest is born with the neck pressed against it, then the abdomen and the head pressed into it, and then the buttocks and legs. The birth of a live fetus in such a situation is unlikely.

How are childbirth and pregnancy

The tactics of managing a pregnant woman with a transverse position of the fetus includes careful observation of the woman, limiting physical activity and the appointment of corrective gymnastics (in the absence of contraindications). Up to 32 - 34 weeks, the transverse or oblique position of the child is considered unstable, since there is a high probability of the fetus adopting a longitudinal position.

Previously, it was widely practiced external rotation of the fetus in order to bring it into a longitudinal position. The external obstetric turn was performed at 35 - 36 weeks with a satisfactory condition of the pregnant woman and the absence of contraindications. To date, this method of correcting the position of the fetus is considered ineffective and is used very rarely due to the many contraindications and complications that arise. During the procedure, detachment of the placenta and the occurrence of fetal hypoxia are possible, as well as the likelihood of rupture of the uterus.

Corrective gymnastics

Special exercises are prescribed in case of incorrect position of the child in the absence of contraindications:

  • abnormal localization of the placenta (low placentation or presentation);
  • pathology of the umbilical cord vessels;
  • pregnancy with more than one fetus;
  • scar on the uterus;
  • severe somatic pathology of a woman;
  • hypertonicity of the uterus;
  • uterine fibroids;
  • little or polyhydramnios;
  • bleeding from the genital tract.

Dikan gymnastics is successfully used. A woman is recommended to perform simple exercises three times a day: roll over from one side to the other and lie on each side after turning for 15 minutes. Turns are performed up to 3 times.

A set of exercises that provides a rhythmic contraction of the abdominal and trunk muscles and is combined with deep breathing:

Pelvic tilts

The woman lies down on a hard surface and raises her pelvis. The pelvis should be 20-30 cm higher than the head. Stay in a position with a raised pelvis for up to 10 minutes.

Exercise "cat"

In a kneeling position, you should rest your hands on the floor. When you inhale, the head and tailbone rise, and the lower back flexes. When exhaling, lower your head and bend your back. Repeat the exercises 10 times.

Knee-elbow pose

Elbows and knees rest on the floor, while the pelvis should be higher than the head. Be in this position for 20 minutes (you can read a book).

Half bridge

Lie down on a hard surface, and put a couple of pillows under the buttocks. The pelvis rises 40 cm, raise your legs.

Raising the pelvis

Lying on the floor, bend your knees and hip joints and rest your feet on the floor. With each breath, raise the pelvis and hold it in this position. With each exhalation, lower the pelvis and straighten the legs. The exercises are repeated up to 7 times.

As a rule, the performance of corrective gymnastics lasts up to 7-10 days, during which the fetus takes a longitudinal position. Exercise should be done three times a day.

After the fetus takes a longitudinal position in the uterus, the woman is prescribed to wear a bandage with longitudinal rollers. Wearing a bandage fixes the result and is recommended before the onset of labor or pressing the head to the entrance to the pelvis.

Labor management

The optimal method of delivery in the case of a transverse position of the fetus is a planned cesarean section. The pregnant woman is hospitalized at 36 weeks, thoroughly examined, and prepared for surgery. The natural birth of a child is almost impossible, since self-rotation happens extremely rarely. Childbirth is carried out through the natural birth canal, followed by external-internal rotation of the fetus on the pedicle only in two cases:

  1. deeply premature fetus;
  2. childbirth of twins, if the second baby is located transversely.

Scheduled surgical delivery before the onset of contractions is performed in the following cases:

  • true overdue;
  • prenatal effusion;
  • placenta presenting;
  • tumors of the uterus;
  • uterus with postoperative scars;
  • fetal hypoxia.

In rare cases, with the onset of contractions, it is possible for the fetus to move from a transverse position to a longitudinal position and complete labor in an independent way. With an oblique position of the baby, the woman in labor is placed on the side, at the bottom of which a large part of the fetus is determined. The woman is not allowed to stand up and is in a horizontal position.

In the event of a child's arm or leg falling out, they must not be repositioned in any way. Firstly, it is absolutely hopeless, and secondly, it is dangerous. In addition to additional infection of the uterus, the time before the caesarean section is delayed.

When the lateral position of the child is neglected, an immediate cesarean section is performed, regardless of his condition (alive or dead). A number of obstetricians, in the case of a neglected transverse position and fetal death, propose to carry out a fruit-destroying operation. But a fruit-destroying operation is very dangerous, as it can lead to rupture of the uterus. If there are signs of infection (temperature jump, purulent discharge from the uterus), then the caesarean section operation ends with hysterectomy and drainage of the abdominal cavity.

The combined outside-inside turn is carried out under the following conditions:

  • live fetus;
  • the opening of the uterine pharynx is complete;
  • a catheter in the bladder;
  • the consent of the woman;
  • the size of the head corresponds to the size of the mother's pelvis;
  • preserved fetal mobility;
  • deployed operating room;
  • there are no tumors of the uterus and vagina, vaginal strictures;
  • small fruit size (up to 3600 gr.).

Difficulties that may arise when making a combined turn:

  • rigidity (not stretching) of the soft tissues of the birth canal - selection of an adequate dose of narcotic drugs, administration of antispasmodics, episiotomy;
  • rupture of the uterus - immediate surgery;
  • falling out of the handle or removing it instead of the leg - putting on the loop on the handle and moving the handle towards the head of the fetus;
  • loss of the umbilical cord after the end of the turn - mandatory and quick extraction of the fetus by the stem;
  • fetal hypoxia and intrapartum death;
  • development of infectious complications in the postpartum period.

Question answer

Question:
On the second ultrasound, I was determined: Pregnancy 23 - 24 weeks. The transverse position of the fetus. What to do to make the baby "lie down" correctly?

The gestation period is still short, so no measures should be taken. The child will take the final position by 34 - 35 weeks, and until that time he can turn and position himself as he pleases.

Question:
At the last ultrasound, the doctor found that the fetus was lying across (32 weeks). Do I need to do gymnastics so that the baby is positioned correctly?

You should talk about the need for corrective gymnastics with the obstetrician who leads the pregnancy. Only with his permission can special exercises be performed to turn the baby into a longitudinal position, since in some cases their implementation is contraindicated and even dangerous.

Question:
I have twins, 36 weeks. The first child is presented with legs, and the second lies across. Is it mandatory to have a cesarean section?

Yes, in this situation, a cesarean section is the safest and most favorable method of delivery for both mothers and babies. If the first child was in a purely breech presentation, then his independent birth is possible, followed by a combined rotation of the second fetus on the leg. But in this case, during childbirth in a natural way, difficulties will arise already at the stage of birth of the first baby, since the legs can be born before the cervix is ​​fully open, which will complicate the birth of not only the head (the head is the largest part of the fetus), but also the pelvic end.

Pregnancy is a happy period in a woman's life, which is often overshadowed for various reasons. One of these reasons may be the lateral position of the fetus inside the uterus. This can significantly complicate the course of pregnancy and lead to a number of difficulties during delivery.

Transverse position of the fetus

Up to 30-31 weeks, the size of the baby allows him to move freely and change position inside the uterus. But by 32 weeks, the fetus has an increase in muscle mass, and it grows noticeably. After the 32nd week, there is not enough space in the uterus for somersaults, and the baby takes a certain position, which remains until the very birth. Usually, the fetus is positioned with its head towards the exit of the uterus, which is considered the natural position of the baby. In rare cases (less than one percent), a transverse or oblique presentation of the fetus is possible.

The transverse presentation of the fetus means that the child is not located along the axis of the uterus, but perpendicular to it, that is, the head and buttocks rest against the lateral walls of the uterus. With an oblique presentation, it is not a right angle with the axis of the uterus that is formed, but an obtuse or acute one. There is no big difference between the two situations, therefore in medicine they prefer to adhere to the general term - transverse presentation.

Diagnosis of fetal position

It is not difficult to establish the wrong position of the fetus in the mother's body. This can be noticed both by external signs and by internal ones, on examination by a doctor. The following main diagnostic methods are noted:

  1. Visual inspection: the abdomen is in the shape of a ball, but differs in size from the norm - the circumference is larger than the established normal indicators, and the length is less.
  2. Palpation: when palpating the abdomen, the bottom of the uterus is located lower than it should be, and at its base one does not feel a large part (head and buttocks), which can often be felt at the side walls. The baby's pulse is best heard in the mother's navel.
  3. Fetal ultrasound: the most accurate diagnostic method that allows you to see the exact location of the baby in the uterus.

Reasons for incorrect location

There are many reasons that can cause an abnormal presentation of the fetus in the uterus. This may be due to the presence in the uterus of obstacles that prevent the head from dropping to the exit from the uterus, and to factors that cause increased mobility of the child.

Etiology of the transverse position:

  • multiple pregnancies, when children prevent each other from positioning correctly in the uterus;
  • lack of water: insufficient amount of water noticeably restricts the movement of the baby in the uterus;
  • polyhydramnios causes increased fetal mobility;
  • large size of the fetus;
  • flabbiness of the anterior abdominal muscles;
  • pathological shape or location of the uterus;
  • the presence of neoplasms in the abdominal cavity.

The course of pregnancy and childbirth

The abnormal position of the fetus is formed in the third trimester, when, due to the increase in size, it is no longer able to actively change its position in the uterus. Therefore, in the first six months, no deviations and anomalies in the well-being and health of the expectant mother are observed. Increased readiness from the mother and from the gynecologist is required in the third trimester, when some complications may develop:

  • premature onset of labor;
  • premature discharge of water due to the lack of division into anterior and posterior;
  • possible loss of small parts: child's handles, legs, umbilical cord;
  • rupture of the uterus when attempting a natural delivery;
  • fetal hypoxia (oxygen starvation);
  • development of a neglected transverse presentation.

With the transverse arrangement of the fetus in the uterus, childbirth cannot take place naturally, therefore a cesarean section is prescribed. Hospitalization of a pregnant woman is made approximately one week before the planned date of birth of the child for observation, since there is a high risk of premature birth.

With oblique presentation, attempts are initially made to turn the child into the correct position. To do this, the woman in labor is laid on her side on the side where the baby's head is located. There are frequent cases when, when the fetus begins to move to the exit, it takes the correct position. If the location does not change, then the child is removed promptly.

Natural childbirth with the wrong position of the child is carried out if the child is premature, has low weight and if there are contraindications for the operation. In these cases, the obstetrician attempts to manually overturn the child. But even if the coup is successful, there is a high likelihood of the child re-adopting the wrong position.

Therefore, the safest way to give birth to a baby with a transverse position remains a cesarean section. With natural childbirth, many complications are possible in the form of serious injuries to the child, the birth canal of the mother, compression of the umbilical cord and hypoxia of the child.

Gymnastics for turning the fetus

To move the child into the correct position, experts have developed some exercises for pregnant women. They are most effective for a period of 30-32 weeks, when there is still enough space in the uterus to rotate the fetus. For periods over 32-33 weeks, the effectiveness of corrective gymnastics is noticeably reduced due to the lack of space in the uterus for maneuvers in the fetus.

It is important to consult with your doctor before starting exercise, since gymnastics has a number of contraindications:

  • severe acute or chronic diseases of the internal organs of the mother;
  • placenta previa;
  • the presence of scars on the uterus after surgery;
  • the presence of neoplasms in the uterus (fibroids).

You should not make your own decision to engage in corrective exercises, since in late pregnancy, the child can be seriously harmed.

A set of exercises for changing the position of the fetus in the uterus includes:

  1. Exercise "cat": starting position on the knees and hands rest on the floor. Take a deep breath and raise the dog and head, while bending your back. As you exhale, the back arches, and the head and coxus lower. The number of repetitions of this exercise should not exceed ten.
  2. Turns: starting position lying (preferably on the bed). It is necessary to turn from one side to the other several times, lingering on each for 10 minutes.
  3. Stance: kneel down and rest your elbows on the floor. It is important that the position of the pelvis is above the head. This position should be maintained for up to 20 minutes.
  4. Tilting the pelvis: lying on your back, raise your pelvis 30 centimeters above your head. Fix in this position for 10 minutes, and then slowly lower. Repeat the exercise 10 times.

The duration of the exercise usually does not exceed 10 days, 3 times a day. With correct and regular exercise, the child often turns into the correct position on the seventh day of gymnastics.

The transverse position of the fetus is a rather rare and serious phenomenon during pregnancy, therefore, independent attempts to change the position of the child in the womb are categorically contraindicated.

This can lead to serious complications not only for the child, but also for the expectant mother. Any action to change the situation should first be discussed with your doctor.