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Ultrasound of the head presentation of the fetus. Cephalic presentation of the fetus: a fine line between norm and pathology

Cephalic presentation of the fetus - the location of the child in the uterine cavity, in which he turned his head towards the vaginal outlet. This presentation occurs most often and is considered the most favorable way for natural childbirth. But complications may require surgery or artificial extraction of the baby with obstetric forceps.

Views

Cephalic presentation of the fetus during physiological childbirth is observed in 95–96% of women in labor, the remaining 4–5% are in breech presentation, which is considered abnormal and unsafe. Depending on which area of ​​the baby's head is directed towards the exit, several types of presentation are distinguished:

  • Facial. The infant will walk forward along the birth canal. The baby lies with his chin forward, the head overturns and moves backward with the back of the head. Spontaneous childbirth is allowed only with a small fetus, but most often such an arrangement is considered a direct indication for surgical intervention.
  • Occipital. The most favorable option, which is observed in 95% of births. When the child comes out, the neck of the child is bent, the fetus moves forward with the back of the head. This position gives the best predictions for childbirth, it allows you to give birth without rupture and eliminate the risk of various injuries to the baby.
  • Frontal. The rarest and most dangerous option, which occurs in 5% of cases. The leading point of movement through the birth canal is the infant's forehead. It is located below the rest of the child's head. A woman is delivered artificially by cesarean section. Vaginal childbirth is prohibited as it can be dangerous for the child's vitality.
  • Anterior cephalic (anterior parietal). With such a head presentation of the fetus at 20 or 30 weeks, the probability of natural childbirth is 50% (only in the absence of hypoxia and other pathologies). With spontaneous childbirth, the risk of rupture increases as the fetus exits the vagina with the parietal part forward. Preliminary diagnosis is of particular importance in order to avoid possible complications.

The intrauterine position of the child is also determined by the following positions of the cephalic presentation:

  • Position 1. The baby lies with his back to the left uterine wall. This situation is observed in 97% of cases and is considered the safest for the mother and baby.
  • Position 2. The child is turned with his back to the right uterine wall.

The fetus can lie with its back to the back or to the front wall, this position is also considered normal.

The embryo is located in the uterus longitudinally or transversely (that is, along or across the uterine axis). Longitudinal cephalic presentation of the fetus is the only normal condition in which the baby is turned head down (the position of the legs down is considered incorrect and dangerous for the baby). In this case, the embryo lies along the axis of the uterus, and there are no contraindications for independent childbirth.

The transverse cephalic presentation is considered pathological after the 30th week of gestation, and a cesarean section is always indicated in this state.

Until the 20th week, the embryo can change its position in the uterine cavity several times a day, but after 30 weeks, in 90% of cases, the child takes a normal longitudinal position with the head forward.

An intermediate position is an oblique presentation, in which the longitudinal axis is at an angle to the uterine axis. This condition cannot be considered a pathology, since the fetus almost always eventually takes the correct position.

For the successful course of pregnancy, it also matters how close the fetus is to the exit of the birth canal. With the normal development of pregnancy, the fetus goes down at the 38th week. In some patients, prolapse is observed between the 20th and 36th weeks. This pathological condition is called low cephalic presentation. In this case, there is a high risk of bleeding, placental abruption and premature delivery. If the child sank into the uterus before the due date, the patient is prescribed a special bandage, refusal of physical activity and good rest.

The reasons for any kind of incorrect position of the embryo can be the following factors:

  • a narrow or too wide pelvis of a woman;
  • anomalies in the structure of the uterus;
  • increased fetal activity due to polyhydramnios;
  • reduced mobility due to lack of water;
  • myoma;
  • low contractility of the uterus, weak muscles of the anterior wall of the peritoneum;
  • full or partial placenta previa;
  • hereditary predisposition.

Diagnostics

Head presentation can be detected at home. To do this, a woman needs to take a horizontal position and bend her knees. If you put your palm on the lower abdomen, slightly pressing, and feel the baby's head, you can talk about the head longitudinal position. But the type of presentation (frontal, facial, etc.) can only be determined by a doctor.

Note! After 36 weeks of gestation, the size of the embryo reaches almost maximum, and the uterus stops growing. There is very little room for active movement, the unstable position of the child turns into a permanent one. The fetus assumes its final position in the womb and remains in it until the very birth.

The doctor begins to observe the cephalic presentation from the 28th week of pregnancy, examines the child with the open right hand above the symphysis (transitional connection between the bones of the skeleton), palpating the presenting area. In a normal course with a cephalic presentation, the gynecologist gropes for the baby's head, placed above the entrance to the vagina. The baby's head is movable in the intrauterine waters, so doctors additionally conduct a vaginal examination.

Ultrasound at this time allows you to find out the exact position of the embryo in the uterus and articulation. It is revealed which part of the child will move along the birth canal, and the birth scenario is determined.

When examining a patient, not only presentation is important, but also the location of the placenta, which ensures the viability of the child in the womb. In the normal course of the placenta is located near the uterine fundus. In rare cases, it forms on the anterior wall, completely or partially covering the entrance to the uterus.


Features of childbirth

The most optimal option for natural childbirth is the head occipital position with an anterior position. This position of the fetus provides an ideal relationship between the size of the torso, the shape of the head and the woman's pelvis. When moving through the birth canal, the baby's head bends towards the breast, thereby reducing the size of the presenting area and making it easier for the fetus to exit. When passing through the vagina, the fetus is turned to face the coccyx. After leaving the birth canal, the head unbends, the shoulders unfold in the womb in such a way that the face turns to the inner side of the woman's thigh. After the exit of the shoulder part, the body and legs of the baby pass without problems.

If the fetus is located head down, has a posterior occipital position, it means that during childbirth it moves with the back of the head to the sacral part of the mother. The advancement of the child in this case may be delayed, in some cases this leads to a weakening of the contractility of the uterus or to oxygen starvation of the baby. In case of complications, labor is stimulated or forceps are used.

With a frontal presentation, natural childbirth is not shown, since the baby's exit takes a long time. If the patient gives birth on her own, there is a threat of complications. Injuries to the perineum and genitals often occur, vaginal fistulas form, and the risk of fetal asphyxia and death increases.

If a frontal presentation is suspected, the obstetrician can rotate the baby. If this is not possible, artificial delivery by cesarean section is done. If during natural childbirth serious complications have occurred with a risk to the woman's life, a craniotomy (fruit-destroying operation) is performed.


With facial presentation, independent childbirth is possible only in the following cases:

  • wide pelvis of a woman in labor;
  • small fruit;
  • good labor activity.

Delivery should be expectant and accompanied by constant monitoring of labor and the patient's health. The baby's heart rate is checked with a cardiotocograph or phonocardiograph. A facial presentation with a posterior position (chin up) is considered a clear indication for a caesarean section.

The course of labor in the anterior-head position of the child is delayed, increasing the threat of hypoxic disorders of the fetus and genital trauma.

Prevention of complications

Cephalic presentation of the fetus during pregnancy with a pathological position identified after the 32nd week requires immediate hospitalization of the woman to form the birth scenario.

If the baby is not properly positioned in the womb, the following complications are possible:

  • birth trauma of a woman in labor (ruptures, hematomas of the genitals, vagina);
  • trauma to an infant with a threat to his life and health (hematomas, head trauma, hypoxia, asphyxia);
  • abnormalities of labor (weakness of the woman in labor, impaired coordination of movements).

If the doctor has determined that the fetus is lying incorrectly, a cesarean section is most often prescribed. Such an operation gives favorable prognosis for the mother and the newborn.

A natural birth process is possible only in the absence of other pathologies. Childbirth lasts a long time, therefore, requires intensive labor. If signs of hypoxia appear, vacuum extraction is prescribed (extraction of the fetus by the head).

Experts have developed a set of exercises that must be performed from the 32nd week. They stimulate the infant's activity and increase the chances of correct positioning of the cephalic presentation.

  • Lie sideways on a flat surface and stay in this position for at least 10 minutes, then lie on the other side. This procedure is recommended to be performed three times a day.
  • Get on your knees and lean on your elbows. In this position, you must stand for 15 minutes at least 2 times a day.
  • Doctors also recommend swimming to stimulate the fetus to turn head down and to generally improve the health of the mother.

Summarizing

The cephalic presentation of the child in the intrauterine space is the most common and desirable option for the location of the fetus.

For successful gestation and subsequent natural delivery, it matters which part of the baby's head comes out of the birth canal. In the occipital position, the forecasts are the most favorable. With the frontal, frontal and anterocephalic position, in most cases, a cesarean section is prescribed.

Many pregnant women get scared when gynecologists say incomprehensible and difficult medical terms during the examination. In the process of ultrasound monitoring, young mothers sometimes hear about the head presentation of the fetus. What does it mean? Is this a norm or a pathological condition that causes serious damage to the baby in the womb? There is no need to panic: the attending physician tells about the cephalic presentation in all details.

What is cephalic presentation of the fetus?

Pregnant women often hear this wording from gynecologists during examinations from the 30th week of gestation. Not all expectant mothers understand this complex medical phrase, so they begin to worry about the condition of the baby developing in the stomach. What is fetal presentation, is the head position a norm or a dangerous pathology?

When the doctor talks about presentation, he means the position of the child's torso from the back of the head to the sacrum in relation to the uterus. That is, the cephalic presentation of the fetus is the longitudinal position of the fetus with the placement of the head in the pelvic area. This position of the baby is correct, observed in 97% of mothers preparing for childbirth. In about 3% of women, the crumbs sit with their bottom on their mother's small pelvis, or they can generally lie down horizontally. In such a situation, childbirth is complex and pathological.

What is the head presentation of the fetus?

Gynecologists distinguish four types of head position of the child:

  1. Occipital. Obstetricians find this position to be the most comfortable and safe. When the baby moves along the birth canal during childbirth, his neck is bent. The nape of the baby is the first to emerge from the mother's vagina. More than 95% of births take place as described above. In occipital presentation, most babies are born without injury, and mothers are usually not diagnosed with tears.
  2. Facial. In this position, the child's head is strongly tilted back. In the process of childbirth, the baby's face is shown first from the mother's genital tract. Usually, with facial placement of the fetus, doctors send patients for a cesarean section to prevent complications. Although many women successfully give birth in a natural way.
  3. Frontal. This type of presentation is extremely rare. During childbirth, the baby's forehead is the first to emerge from the mother's vagina. With this position of the fetus, surgical intervention is necessarily prescribed, natural childbirth is not allowed.
  4. Forehead. This type of presentation is also called anteroparietal. The first from the vagina is the fontanelle of the child, located on the top of the head. With the anterior-head placement of the fetus, it is possible to give birth both by caesarean section, and in a natural way. But with natural childbirth, the baby is very likely to get injured. There is also a high risk of hypoxia in the baby during the process of coming out into the world.

The position of the baby in the womb is also determined by two positions. When the baby is in the first position, his back is adjacent to the left side of the uterus. Most babies develop in this position. If the child leans back against the right side of the uterus, then he is in the second position. Sometimes babies press their backs against the front or back mucous surfaces of the uterus.

What to do with a low head presentation of the fetus?

Usually, doctors inform women about a low cephalic presentation of the fetus at 20 weeks of gestation. This is too early; normally, a child, preparing for birth, should descend into the pelvic bowl at 38 weeks. Due to the low cephalic presentation of the fetus at 20 weeks, there is a high risk of premature birth. But there is no need to worry: gynecologists closely monitor the condition of patients with an unfavorable diagnosis. Young mothers who have a low cephalic presentation of the fetus in the womb should listen to all the advice of medical specialists, move with extreme caution. Doctors recommend for women with low child placement:

  • wear special supporting bandages;
  • exclude intense physical activity;
  • resting often while lying down;
  • do not run, do not make sudden and rapid movements.

In the overwhelming majority of cases, childbirth with a low position of the baby takes place within a normal period, without complications.

What are the reasons for the wrong location of the fetus?

Sometimes gynecologists diagnose in pregnant women not cephalic presentation of the fetus, but pelvic presentation. That is, the baby is not placed upside down in the uterus, but sits down in the bowl of the mother’s small pelvis with his legs or bottom. The following factors provoke the incorrect position of the child:

  1. narrow hips in the mother;
  2. myoma;
  3. polyhydramnios, which increases the activity of the fetus;
  4. lack of water that interferes with the baby's mobility;
  5. placenta previa;
  6. abnormal structure of the uterine walls;
  7. low contractility of the muscles of the uterus;
  8. genetic predisposition;
  9. constant squeezing of the abdomen during daytime rest and night sleep;
  10. wearing uncomfortable and slimming clothes.

With a pelvic or transverse position of the child, the gynecologist decides which method to carry out obstetric aid. With the pelvic placement of the fetus, both normal childbirth and surgery are allowed. Obstetricians perform a caesarean section if the woman in labor has too narrow hips, or if the baby is large. With a transverse presentation, when the baby is located in the uterus horizontally, obstetrics is carried out exclusively by the method of cesarean section. Natural childbirth is contraindicated.

How is cephalic presentation of the fetus diagnosed?

How is cephalic presentation of the fetus detected during pregnancy? At about 30 weeks of gestation, the expectant mother will learn from the gynecologist detailed information about the location of the baby in the uterine cavity. Diagnosis of presentation is usually done through a routine pelvic examination. The gynecologist plunges his fingers into the patient's vagina, gropes the crown of the fetal head over the pelvic bowl. With a pelvic position, the doctor's fingers bump into the legs or bottom of the crumbs. To confirm the diagnosis, the patient is referred for ultrasound monitoring.

The medical specialist is able to determine the cephalic presentation of the fetus as early as 20 weeks. But it is not advisable to carry out diagnostics earlier than 30 weeks, since before this time the baby does not yet occupy the entire space of the uterus, therefore it is able to turn over several times. Mom herself at home can find out the location of the child in the womb. To do this, she must lie on her back, spread her legs not wide apart, bend her knees, lower her palm to the lower abdomen. Slightly pressing her hand on her stomach, the woman gropes for a hard and rounded object in the longitudinal head presentation of the fetus. This is the baby's head. To calm down too anxious and confused young mothers who have little understanding of anatomy, some gynecologists show them a cephalic presentation of the fetus in a photo or schematic illustrations. After all, women who understand the physiological characteristics of childbirth worry little.

How is childbirth carried out with different types of cephalic presentation of the fetus?

Safe obstetricians call childbirth in which there is a longitudinal occipital position of the fetus, cephalic presentation of the fetus. When the baby walks outward along the vagina, he tilts his head, his chin is pressed against his neck. The head, pushing forward, makes a turn. The child's face turns to the maternal sacrum, and the occiput to the pubic symphysis. When the head finally emerges from the vagina, it unbends, then the baby's shoulders are straightened, and the face turns to the mother's thigh. The shoulders and head come out the hardest, the torso and limbs leave the birth canal without difficulty.

With an occipital location, childbirth is often complicated. The baby's head turns in the birth canal incorrectly: the face looks at the pubic symphysis, and the back of the head looks at the maternal sacrum. As a result, the exit of the head to the outside is delayed. There is also a risk of weakening of labor, which is very dangerous for a baby being born. In this situation, obstetricians are forced to subject the woman to stimulation. The use of obstetric forceps is indicated when an infant develops asphyxia due to prolonged exposure to the genital tract.

With the frontal position, natural childbirth is allowed only if the woman has wide enough hips, the fetus is medium-sized, labor is intense. During childbirth, obstetricians closely monitor the physical condition and well-being of the woman in labor, using cardiotocography, they calculate the heart rate of a newborn baby.

With the frontal position of the fetus, natural childbirth is allowed in extremely rare cases, since they are almost always accompanied by severe complications: ruptures of the vagina and cervix, the formation of vaginal fistulas and even the death of an unborn baby. To correct the position of the head, the obstetrician can gently turn the baby around. If the reversal cannot be carried out, then the doctor decides to carry out the operation.

With the anterior head position, childbirth is often carried out in a natural way. But if the obstetrician realizes that the health of the mother and the life of the child are in danger, then he prescribes a cesarean section.

The difficulty of giving birth very much depends on the location of the baby in the womb.

Depending on how the fetus is located in the uterus, there are three types of presentation:

    Breech presentation - when the fetus in the uterus is located with the pelvis and legs to the pharynx of the uterus. With this arrangement, they resort to caesarean section, but there are times when it is recommended to give birth naturally.

    Oblique or transverse presentation. This presentation very much depends on the activity of the baby and on the body structure of the expectant mother. It often happens that this type of position of the baby changes to the head position at the time of birth, but in order not to risk it again, doctors perform a cesarean section. In some cases, doctors try to turn the baby around, but more often than not, this leads to injuries.

    Cephalic presentation of the fetus is the most common location of the baby. It can be found in 95 cases out of 100. Cephalic presentation of the fetus is the most optimal position of the baby for natural birth. With this presentation, the baby's head is located at the pharynx of the uterus. Cephalic presentation of the fetus allows childbirth without significant complications.

In order to find out how the fetus is located, it is necessary to be examined by a doctor. The most accurate data can be obtained if an examination is carried out at 35 weeks; before this date, the fetus may change its location several times. For example, a cephalic presentation of the fetus at 21 weeks may change to a breech presentation at 35 weeks.

Types of presentation

There are different types of cephalic presentation. The type of cephalic presentation depends on how the baby's head is located and can be antero-cephalic, occipital, facial and frontal. Among all types of cephalic presentation, the occipital one is the most optimal, so in this case the fetus will move along the birth canal with a fontanel forward. In the case of the occipital position of the baby, at the moment of passing through the birth canal, the baby's neck bends so that the back of the head is shown first. This is how more than ninety percent of all natural childbirth takes place. However, the cephalic presentation anterior view has a variety of options for the location of the head:

    The first version of the anterior cephalic presentation is called the anteroparietal presentation. In such a situation, a large fontanelle serves as the point of the baby's wire. This type of position makes it possible to carry out natural childbirth, but there is a small likelihood of birth trauma to the woman in labor and the baby. In such childbirth, as a rule, a protracted course, therefore, it is necessary to carry out prevention of hypoxia of the baby.

    the second variant of the anterior cephalic presentation is the frontal presentation. This type is characterized by the fact that the forehead is the conductive point of the child through the birth canal, which is lowered below the rest of the head. This version of the head presentation of the fetus 21 weeks is characterized by the impossibility of natural childbirth, therefore, a cesarean section is used.

    the third option is facial presentation. This extreme degree, in which case the chin is the leading point, and the child is born with the back of the head back. In this case, independent childbirth is possible in the case of the small size of the baby and the sufficient width of the mother's pelvis. But in most cases, such a head presentation of the fetus for 21 weeks is an indication for a cesarean section.

Diagnosis of the type of presentation is carried out by a doctor. An accurate diagnosis can be made towards the end of pregnancy. To determine the type of presentation, the doctor, with the help of an open palm, covers the part of the fetus that is located at the pharynx of the uterus, most often the head is groped, which means head presentation. Another way to determine the position of the fetus is to listen to the heartbeat. If it is heard under the navel, then the child is placed head down, in addition, the type of presentation can be determined using ultrasound.

Exercises useful for cephalic presentation

There are exercises for cephalic presentation. They are recommended to be performed from 32 weeks:

    The first exercise for cephalic presentation You need to lie sideways on a flat sofa and lie in this position for 10 minutes, then lie on the other side for the same amount of time. This simple exercise does not require any physical effort. It must be done three times a day. Sleeping is best on the side to which the head of the fetus is displaced.

    The second exercise is for cephalic presentation. Lie on your back, while placing a pillow under your lower back and pelvis so that your legs are thirty centimeters above shoulder level. In this position, you need to lie for fifteen minutes. Do the exercise 2 times a day.

These exercises should not be done if there are scars on the uterus, placenta previa, late toxicosis or uterine swelling. Before starting to take, you should definitely consult a gynecologist. A visit to the pool can be of great benefit. Warm water is great for relaxing muscles and increasing the baby's room for movement. In addition, the suspended state of the child while swimming has a positive effect on his health. Correct births are those that are carried out when the child is positioned with the back of the head.

"What does head presentation mean?" - you ask. So, it helps to create the optimal relationship between the parameters of the pelvis and the head of the child. In this case, passing through the small pelvis, the head sags and the chin approaches the baby's chest. Flexion of the baby's head significantly reduces the size of the presenting part of the fetus, so the head passes through the pelvis much more easily. Moving forward, the head makes a turn, and the back of the head turns to the bosom of the articulation. When leaving, the head is unbent and the shoulders are turned and the child comes out turned to the hip of his mother.

In women who are at risk, in whom the gestation process is associated with manifestations of various anomalies, which means head presentation requires surgical intervention. These women should wait for childbirth in the hospital of the maternity hospital and, after consulting with specialists, work out the necessary tactics for childbirth. When carrying out a timely diagnosis of the non-standard location of the child, the most correct solution is to prescribe an operation.

Cephalic presentation of the fetus is a special position of the child in the uterus, when he turns his head in the direction of the small pelvis. This presentation is normal and acceptable. A head-down position is a guarantee that a natural birth will go well. The risk of developing complications is very low. Many are worried about the very fact of such a position of the child in the womb, but there is no reason for concern.

About the types of head location of the fetus

During pregnancy, the fetus can be positioned in several different cephalic presentation. Moreover, the location at 20 and 30 weeks of gestation differs significantly from each other.

Presentation is as follows:

  • Facial view.

This type of presentation means that the child will come out of the birth canal with the front part, while his head is strongly unbent. In some cases, a cesarean section is required here, but the possibility of natural childbirth is not excluded.

  • Occipital view.

As for the occipital presentation, this position is characterized by the most optimistic forecasts. The fetus leaves the birth canal with the occipital part, with the head bent. Such childbirth takes place without problems, both for the mother and for the child.

  • Forehead view.

This presentation at 20 or 30 weeks means that the baby has an equal chance of being born naturally or by caesarean section. This will depend on whether hypoxia is found on ultrasound. The need for preliminary diagnosis of possible complications comes to the fore.

  • Frontal view.

Frontal presentation means that it is imperative to deliver a woman by cesarean section, since natural childbirth can harm the child. This species can be especially dangerous.

In addition, distinguish between the anterior and posterior views of the cephalic presentation:

  • Anterior - the back of the child faces the posterior uterine wall.
  • Rear - the back is turned towards the front wall of the uterus.

Fetal position in head presentation

Doctors are used to dividing the position of the baby in the uterus in the cephalic presentation into two positions:

  • Position 1 - this means that the baby is turned with his back to the left wall of the uterus. This position is the most common and safest.
  • Position 2 is the type of position where the child's back is in contact with the right uterine wall.

In any of the positions, the fetus can be in a longitudinal or transverse position. Longitudinal is the normal position of the baby in the womb. Transverse - is a pathology after. Up to 20 weeks, this situation is considered a variant of the norm. In the transverse position, birth through the vaginal birth canal is impossible.

In 90% of cases, after 30 weeks of pregnancy, the fetus takes the correct longitudinal position.

Up to 20 weeks, the child can change its position several times a day or constantly be in both longitudinal and transverse positions.

Low cephalic presentation may also occur, especially in twin pregnancies. This can be seen on an ultrasound scan at 20 weeks gestation. With a low position of the head, the placenta also takes a low position. This poses a danger to the further course of pregnancy, there is a risk of premature placental abruption, bleeding and early delivery. But, most often, by about 30 weeks, the placenta and fetus take a higher position. It is related to the placental growth and development of the baby.

With a low head position, the following recommendations must be observed:

  • do not run or walk fast;
  • for the period of pregnancy, give up even minor physical exertion;
  • use special support bandages for pregnant women.

Following these simple rules will help your pregnancy to be comfortable and safe. Compliance with these recommendations is especially important if twins develop.

Reasons for incorrect presentation

Among the main reasons for incorrect placement of a child in the uterus, especially in the presence of twins, the following are worth highlighting:

  • the presence of uterine fibroids;
  • anatomically narrow pelvis;
  • placenta previa;
  • the influence of hereditary factors;
  • external factors - uncomfortable tight clothing, improper body position during sleep.

Diagnosis of the location of the fetus

An experienced gynecologist can determine this or that head presentation of the fetus as early as 20 weeks. For a more accurate diagnosis, it is necessary to undergo a full ultrasound examination. During this examination, already at 30 weeks, it will become clear how it is located in the uterus. You can determine what part of it will be born during natural childbirth. Until the very term of delivery, the situation with presentation may change several times. Changes can be both minor and very significant.

The safest and safest are childbirth, as a result of which the child is born in a longitudinal position with the occipital part. It is the longitudinal position that allows him to easily leave the birth canal in a natural way, bypassing the injuries of the musculoskeletal system and the nervous system. It is necessary to follow the recommendations of a qualified doctor who monitors the course of pregnancy. In this case, childbirth, regardless of the position of the fetus, will take place without complications.

The position of the fetus is the ratio of its axis (which passes through the head and buttocks) to the longitudinal axis of the uterus. The position of the fetus can be longitudinal (when the axes of the fetus and the uterus coincide), transverse (when the axis of the fetus is perpendicular to the axis of the uterus), as well as oblique (the middle between the longitudinal and transverse).

The presentation of the fetus is determined depending on that part of it, which is located in the region of the internal os of the cervix, that is, at the place where the uterus passes into the cervix (the presenting part). The presenting part may be the head or the pelvic end of the fetus; in the transverse position, the presenting part is not defined.

Head presentation

The cephalic presentation is determined in about 95-97% of cases. The most optimal is the occipital presentation, when the fetal head is bent (the chin is pressed against the chest), and the back of the head goes forward at the birth of the baby. The leading point (the one that goes through the birth canal first) is the small fontanel, located at the junction of the parietal and occipital bones. If the occiput of the fetus is facing anteriorly, and the face is posteriorly, this is the anterior view of the occipital projection (in this position, more than 90% of childbirth occurs), if vice versa, then the posterior. In the posterior form of the occipital presentation, childbirth is more difficult, during childbirth, the baby can turn around, but childbirth is usually longer.

With a head presentation, the pelvic end of the fetus can deviate to the right or left, it depends on which side the fetal back is facing.

Extension types of cephalic presentation are also distinguished, when the head is unbent to one degree or another. With a slight extension, when the leading point is the large fontanelle (it is located at the junction of the frontal and parietal bones), they speak of an antero-cephalic presentation. Childbirth through the vaginal birth canal is possible, but they proceed longer and more difficult than in the occipital presentation, since the head is inserted into the small pelvis with a large size.

Therefore, the anterior-cephalic presentation is a relative indication for a caesarean section. The next degree of extension is the frontal presentation (it is rare, in 0.04-0.05% of cases). With the normal size of the fetus, birth through the vaginal birth canal is impossible, prompt delivery is required. And finally, the maximum extension of the head is the facial presentation, when the face of the fetus is born first (it occurs in 0.25% of births). Vaginal birth is possible (while the birth tumor is located in the lower half of the face, in the lips and chin), but they are quite traumatic for the mother and fetus, so the issue is often decided in favor of a cesarean section.

Diagnosis of extensor presentations is carried out with a vaginal examination during childbirth.

Breech presentation of the fetus

Breech presentation occurs in 3-5% of cases and is divided into leg presentation, when the legs of the fetus are presented, and gluteal presentation, when the baby seems to be squatting, and his buttocks are presented. more favorable.

Breech delivery is considered pathological due to the large number of complications in the mother and the fetus, since a less voluminous pelvic end is born first and difficulties arise when the head is removed. With a foot presentation, the doctor with his hand delays the birth of the child until he squats to prevent the prolapse of the leg, after such an allowance, the buttocks are the first to be born.

Breech presentation is not an absolute indication for a cesarean section. The question of the method of delivery is decided depending on the following factors:

  • the size of the fetus (with a breech presentation, the fetus is considered large over 3500 g, while in normal childbirth - more than 4000 g);
  • the size of the mother's pelvis;
  • type of breech presentation (leg or ligature);
  • the sex of the fetus (for a girl, giving birth in a breech position is associated with less risk than for a boy, since a boy may have damage to the genitals);
  • the age of the woman;
  • course and outcome of previous pregnancies and childbirth.

Transverse and oblique position of the fetus

The transverse and oblique position of the fetus is an absolute indication for a cesarean section; vaginal delivery is not possible. The presenting part is not specified. Such a situation is determined in 0.2-0.4% of cases. The previously used turns for the leg during childbirth are now not used due to the great trauma for the mother and baby. Occasionally, a similar turn can be used with twins, when, after the birth of the first fetus, the second took a lateral position.

The transverse position may be due to tumors in the uterus (for example,), which interfere with taking a normal position, in multiparous women due to overstretching of the uterus, with a large fetus, with a short umbilical cord or entwining it around the neck.

In the absence of reasons that prevent the fetus from turning to the head, you can perform the same exercises as in the breech presentation. In an oblique position, you need to lie more on the side where the back is mainly facing.

Fetal position with twins

With twins, birth through the vaginal birth canal is possible if both fetuses are in a cephalic presentation, or if the first (which is closer to the exit from the uterus and will be born first) is in the cephalic presentation, and the second in the pelvic presentation. If, on the contrary, the first is in the breech presentation, and the second in the head, the situation is unfavorable, since after the birth of the pelvic end of the first fetus, babies can catch on with their heads.

When determining the transverse position of one of the fetuses, the issue is decided in favor of the caesarean section.

Even with a favorable location of the fetuses, the question of the method of delivery for twins is decided not only based on the position, but also depending on many other factors.

Comment on the article "Fetal position and presentation"

bandage - fetal position. Personal impressions. Pregnancy and childbirth. bandage - fetal position. the doctor with my back advised me to buy and wear a bandage. but I have a child I know that in the later stages they do not recommend a bandage for breech presentation to give the child ...

Discussion

The doctor told me that the bandage does not fix the child's position. He is in the water, and there is still a lot of things around the child.
To really somehow "squeeze" the child, you need to pull off the bandage with some incredible force, this is simply unrealistic.

I didn’t understand at all whether everyone needs a bandage and when should I start wearing it? And does it depend on the abdominal muscles, that someone is holding their tummy, but someone needs support in the form of a bandage?

Pregnancy, childbirth and breech presentation of the fetus. How to fix? Is natural childbirth possible with breech presentation of the baby? Ever since we were told at 30 weeks that we were lying upside down, I managed to redo a bunch of different exercises and get worried about ...

Discussion

I have a boy, also a pelvic one, but they said that he would turn over, I also really don't want a cop, but if the baby doesn't turn around, I won't injure, it's better a cop than a baby's suffering. and find out the floor, of course.

I have a girl friend 14 years ago gave birth to a daughter in the pelvic. The doctors refused to do the KS: "second birth, you yourself will give birth." Result: the child has severe cerebral palsy.

Abnormal presentation of the fetus. The ideal position of the baby in the uterus is longitudinal with an occipital presentation, that is, head down, with the chin tightly pressed to the chest. But it is important to understand that the wrong position of the child is a feature of the flow ...

low fetal position. Girls, the baby lay very low, and now only 33 weeks old. I wear and remove the bandage only at night. With a cephalic presentation (when the child is head down), the heartbeat is clearly heard below the navel on the right or ...

Discussion

I went from 35 weeks with a child at -1 ... that's bad. that the ligaments on which the uterus rests are strongly stretched.


It was like that in Israel. They don't do anything here, just watch. They even talked about it as a fact, not a pathology. Anyway, I didn't have any particular problems with this. Child, yes, I felt very low all the time. She gave birth quickly after two days of relatively irregular contractions. Whether this was due to the low location or simply the fact that the birth was second, I do not know.

05/01/2007 17:00:06, Miri

Breech presentation. By the way, they offered to give birth herself, but the risk for both the child and the mother was very great. I also had a breech presentation. I tried to do the necessary exercises, but for a long time I did not have enough. Although my stomach was big, but the fetus was large ...

Discussion

Okay :) It will roll over ten more times. Mine was up to 32 weeks in the pelvic, and then turned over :) So do not worry, everything will be fine with you.

You don't need to worry. The main thing is to talk to your child every day that you love and expect him and you will be glad to him. It can still roll over. Exercise, wear a Bandage. Go to the doctor, give birth in a good maternity hospital. Don't worry in advance. Naturopath

On her head in terms of ingenuity, the shape has not yet affected in any way (mmm). What little head is now - you can see in the reg. Before you get scared, look at your own or dad's head. Does anyone have a narrow forehead? BPD, as far as I remember, it is between the temporal bones.

Discussion

Oh, thank you very much! .. I looked at Pashka more closely - this is her husband and future dad - and came to the conclusion that it may well be hereditary. :-) And his quick wits are just fine. Thank you, this is all my pregnant suspiciousness. Now I have calmed down. :-)

We, we were! Dolichocephalic - "cucumber-headed", in other words. Also because of this, there were disagreements on the issue of the deadline, they moved it back three times, only then they thought of the size of the thigh to pay attention to. It's okay, although at first I was scared too, for me everything related to the skull is a sore subject. The doctor, on the contrary, reassured her - she says that it is easier to give birth to such people, they need less space to pass the head. I don’t know, I haven’t had to give birth yet, but the birth went quite easily and without breaks, I gave birth to Masha in 3-4 attempts. On her head in terms of ingenuity, the shape has not yet affected in any way (mmm). What little head is now - you can see in the reg. I was told that this shape of the fetal head is most likely hereditary. Perhaps. I, essno, did not see my mother's exchange card, but in our family everyone gave birth to me very quickly before me - mei bi, just the shape of the head contributed to this. This is what I'm getting at? Do not worry!


Now the story is again the same - the size of the head is again the same. And I also come to the conclusion that I had ovulation later. for a couple of weeks. I think your situation is similar. Do not worry! Firstly, 2 weeks difference is not a "little head" yet. Or maybe the baby is just long-legged? 08.24.2002 23:37:11, Chizh

I copy the archive: Breech presentation of the fetus At the beginning of pregnancy, while your unborn child is still very small, he freely moves inside the uterus, changing his position. Over time, as the fetus grows, it becomes tighter and tighter.

Discussion

I had a transverse up to 33 weeks (and it lay across almost the entire pregnancy). In the consultation, they recommended a circular abdominal massage and persuasion, but about the technique "stand in the pose of a cat - lie on the right side - lie on the left side - repeat all actions from the beginning" I read on the internet (unfortunately, I do not remember which site. At 34 weeks I did an ultrasound scan - we were lying upside down (though in profile). They even took a photo of us :)

Personal experience. True, not pelvic, but also head up. At the 38th week, they made an external coup, the whole procedure - 5 minutes, however, then it lay on the monitors for an hour, absolutely not painful. if not turned over, then they would have put on a planned cesarean at 39 weeks.

04/17/2001 08:05:15, Irina