Preparations 

The presentation of the fetus is pelvic: purely gluteal, foot and mixed. Why does breech presentation occur?

Breech presentation of the fetus - the placement of the child along the uterine cavity, while the legs and buttocks are directed to the small pelvis. Some women do various exercises with the breech presentation of the fetus, but such activities are not recommended without the advice of the attending physician.

At about 20 weeks, the baby in the womb turns over, that is, it assumes a head-down position, its back is turned to the left. This placement of the fetus is correct, called head presentation. In this position, all children are born, with the exception of 10%.

Etiology

There are various reasons for the formation of a breech presentation of the fetus. The following factors can prevent the correct position of the fetus in the uterus:

  • the presence of fibroids in the lower part of the uterus;
  • irregular shape of the pelvis (especially if the pelvis is narrow);
  • the presence of neoplasms of the internal organs of the pelvis;
  • diseases: cephalocele, and others;
  • low position and .

Too high muscle tone of the lower uterus and low in the upper segment. In this situation, the head turns away from the pelvis and turns to the top of the uterus. Such a contraction of the muscles of the uterus, especially in the third trimester, occurs due to an improperly developed organ. This can happen due to its inflammation, frequent curettage, a large number of births, difficult births.

A negative effect on the tone of the muscles of the uterus has a scar formed after a cesarean. There is another reason that affects this situation - a large activity of the fetus, which can begin with:

  • large volume of amniotic fluid;
  • delayed physical development;
  • prematurity.

Low mobility occurs under such conditions:

  • change in the shape of the organ during the development of anomalies;
  • a small amount of amniotic fluid;
  • entanglement of the fetus with the umbilical cord, any part of the body can suffer;
  • too short umbilical cord.

Scientists have made some observations, during which the following fact was established: if a woman was born in a breech presentation, then during the period of gestation the fetus will take the same position. This suggests that one of the reasons is a genetic predisposition. Today, scientists have not yet fully studied this issue.

If a subsequent pregnancy in a woman proceeds against the background of the same negative factors as the previous one, then the risk of recurrence of the pathology is very high.

In some cases, it can be difficult to establish the cause of this position of the baby, in addition, the factors can be combined.

But still, the main causes of breech presentation are called:

  • narrow pelvis of a woman in labor, having an irregular shape;
  • pathological changes in the organ, for example, a formed scar, developmental pathology, inflammation;
  • the presence of neoplasms;
  • diseases in which failures occur in the autonomic nervous system;
  • frequent curettage, numerous and complex childbirth;
  • absence or excess of amniotic fluid, delayed physical development of the fetus, oxygen starvation.

Despite this, the child still tries to take the most comfortable position for himself, in addition, the instinct of self-preservation "prompts" him to the chosen position.

Classification

Breech presentation in obstetrics is divided into gluteal and foot:

  1. Gluteal. Only the gluteal, that is, incomplete - this means that only the baby's buttocks are directed towards the pelvis, the legs will be extended along the body. This position - pelvic longitudinal presentation of the fetus, is observed in seventy percent of cases.
  2. Mixed gluteal. It means that not only the buttocks are deployed to the entrance to the pelvis, but also the legs, which are bent at the knees and pelvis. This position of the fetus occurs in twenty-three percent of women in labor.

Foot (observed in ten percent of pregnant women) are divided into the following subspecies:

  • complete, when both legs are turned to the pelvis;
  • incomplete - only one leg;
  • knee - the baby's knees are directed to the pelvis (such a presentation occurs in 0.3 percent of cases).

The classification is carried out on the basis of the features that caused the biomechanism of the onset of labor.

If the fetus has a breech presentation, the pelvis of the woman in labor is not narrow, then the woman can give birth on her own, without complications. When the presentation of the fetus is foot or mixed, it is necessary to resort to a caesarean section, because in this case the prognosis for the health and life of the child is unfavorable.

Foot presentation is the most unfavorable, because serious complications can appear.

Symptoms

Breech presentation in comparison with the head presentation is more dangerous, because it can happen:

  • spontaneous abortion;
  • will occur, that is, there will be a malfunction in the work of the kidneys, blood vessels and brain of a pregnant woman;

The above conditions can affect the development of the nervous, endocrine and other systems of the baby. Breech presentation, which was diagnosed at 32 weeks of pregnancy, begins to slow down the development of the medulla oblongata. As a result, pericellular and perivascular edema occurs, one of the layers of the adrenal glands is depleted, and the protective reactions of the fetus are reduced.

With breech presentation, the fetus develops defects:

  • hearts;
  • central nervous system;
  • gastrointestinal tract;
  • musculoskeletal system.

If there are violations of the placenta in terms of blood flow, then the fetus appears:

  • oxygen starvation;
  • cardiopalmus;
  • reduced motor activity.

When labor begins with a breech presentation of the fetus, the intensity of the labor process often decreases in a woman. With mixed breech or foot presentation, more complex changes appear.

Diagnostics

If the pregnancy proceeds normally, without complications, then by the twenty-fourth week the fetus turns head down. However, in a period of three months, the situation may change repeatedly. At this time, multidirectional contractions of the uterus, that is, its individual sections, occur. Such contractions maintain proper blood flow in the uterus and placenta. The change in the posture of the fetus can take place several times a day. The baby takes its final position by the thirty-fifth week. If this is a breech presentation, then it is necessary to prepare for labor with such a pathology.

Based on the foregoing, we can conclude that the diagnosis of "breech presentation of the fetus" at the thirty-fifth week will be correct. If it is placed at earlier stages of pregnancy, then the conclusion of the doctor is erroneous. To diagnose breech presentation, two types of research are used:

  • external obstetric examination;
  • vaginal examination.

With breech presentation, the bottom of the uterus is high above the pubis, and this is not typical for a certain period of pregnancy.

During an external examination, the doctor determines the large, round, hard and moving part - this is the baby's head. With breech presentation during a vaginal examination, the doctor palpates the soft volumetric part, the inguinal fold, coccyx and sacrum are clearly felt on it. The doctor should not determine the sex of the baby during palpation, because the genitals can be damaged.

If the presentation is foot or mixed-buttock, then you can feel the feet. They can be distinguished from the child's hand by the fact that the calcaneal tubercle and short fingers, which are located on the same line, are easily determined.

Foot presentations are the easiest to recognize. Most often there are problems with the definition of the gluteal, which can be confused with the facial or frontal.

To correctly determine the presentation, it is necessary to conduct an ultrasound examination. As additional diagnostics are used:

  • echography;
  • dopplerography;
  • cardiotocogram;
  • computer cardiointervalography.

Ultrasound will help to make the correct diagnosis. Sonography will determine the presentation of the fetus and its variety. For this, it is better to use three-dimensional echography.

Treatment

A pregnant woman with a breech presentation of the fetus is determined in a hospital. Basically, this happens as early as the thirty-ninth week. Specialists of the hospital will conduct the necessary examinations and select the method of delivery. The choice of method takes place only on an individual basis, because it depends on many reasons:

  • the number of previous pregnancies and births;
  • the age of the woman in labor;
  • gestational age;
  • readiness of the body for childbirth;
  • the size of a woman's pelvis and much more.

It cannot be said unequivocally that a caesarean section is necessary with a breech presentation of the baby. But if it is combined with complicating reasons, then only surgery is prescribed.

A caesarean section will be scheduled if:

  • a woman over thirty years old, and this is the first birth;
  • the patient suffers from nephropathy;
  • extragenital pathology;
  • violation of fat metabolism;
  • narrow pelvis;
  • large fruit, more than four kilograms;
  • violation of blood flow;
  • Rhesus incompatibility of the blood of the fetus and the pregnant woman;
  • breech presentation and foot presentation.

Natural childbirth is possible with a diagnosed breech presentation, if there are no health complications in the mother and unborn child. The baby should be full-term, medium-sized.

It is necessary that with breech presentation the mechanism of childbirth be spontaneous. In the first period of labor, the pregnant woman should not get out of bed and lie only on her side when the fetal spine is determined - this will help reduce the risk of complications. The fetal heartbeat and uterine contraction during this period must be strictly controlled. In the second period, medical personnel provide benefits. The baby is born within five to ten minutes. If necessary, a perineal incision is made.

The birth of a baby in a natural way, if a foot presentation is diagnosed, is possible only in women who have given birth earlier, with a full-term pregnancy, a small fetus. In addition, a written refusal of the woman in labor from a caesarean is required.

After the birth of babies with a breech presentation, they need special attention. Oxygen starvation, which newborns suffered, can give complications to the nervous system. But if the doctors provided qualified assistance, the further development of such children will not differ from others.

Possible Complications

A child who was born in a breech presentation often suffers from complications:

  • intracranial injury;
  • spinal pathology;
  • hip disorder.

If the baby's neck was wrapped around the umbilical cord or the baby swallowed amniotic fluid, resuscitation is necessary. Immediately after the birth of such children, they should be examined by a neurologist.

As for the woman in labor, after delivery, the woman has such complications:

  • rupture or forced incision of the perineum;
  • rupture of the cervix;
  • vaginal rupture;
  • pelvic bone injuries.

How to avoid possible complications, the attending physician will tell you.

Prevention

Preventive measures that contribute to normal delivery are as follows:

  • it is necessary to identify the reasons why the pelvic position of the fetus may occur;
  • adhere to the physiological course of pregnancy;
  • drug prevention and timely identification of causes threatening miscarriage;
  • warning of a large fetus;
  • gymnastics with pelvic presentation of the fetus;
  • inform the woman in advance about the caesarean section;
  • proper preparation of a woman for the upcoming birth;
  • professionally performed childbirth;
  • special attention to the baby after childbirth.

All preventive actions are aimed at correcting disorders that occur during pregnancy and childbirth, both in the mother and in the child.

Throughout the entire pregnancy, the baby has enough space in the uterus to change its position. But by 36 weeks, the baby begins to prepare for his birth, so he lies down, basically, head down. This position is the most natural and safe for both the child and the woman.

What is breech presentation?

But in a small number of cases (there are about 4 percent of them), the child does not change his position and lies down with his buttocks down, this position is called breech presentation. There are three types of such presentation:

  1. Pure breech presentation. In this position, the baby's buttocks are born first. His feet are near his head, and his legs are along the body. This is the most common type of breech presentation.
  2. Foot (incomplete) breech presentation. In this position, the feet are born first, as the buttocks are higher than the baby's feet.
  3. Full breech presentation. In this position, the baby's buttocks are at the bottom next to the birth canal. The child is in a sitting position, the legs are crossed and the feet are close to the buttocks.

What causes breech presentation during pregnancy?

In most cases, when the child has not taken the desired position, the reasons that caused the breech presentation remain unknown. In some cases, such a presentation is attributed to reasons such as:

  • multiple pregnancy: for several fetuses, most often, there is not enough space to turn upside down;
  • early labor activity (up to 37 weeks): the child is born before the time when he should have taken the right position;
  • malformation of the fetus: for example, heart disease, brain (dropsy, encephalitis, Down's syndrome, anomaly in the development of the food system, etc.).
  • the problem of the uterus: it contains benign tumors or it is irregular in shape.

Signs of a breech presentation

It is impossible to determine the position of the child symptomatically. However, if you are at a period of 36 weeks, and you understand that the baby’s head is not located below, then you should definitely consult with your doctor.

Symptoms of breech presentation

A pregnant woman does not have to feel that the fetus is in the wrong, breech presentation. Often this position becomes known during the birth itself or with the onset of labor.

If you're less than 36 weeks pregnant, you probably won't feel when your baby moves up and down easily. Even with a period of more than 36 weeks, it is not always clear what position the child is in. However, a pregnant woman can feel the baby's insistent movements of the legs at the top of the abdomen, or distinguish the head below.

Diagnosis of breech presentation

The gynecologist will examine the upper and lower abdomen, examine the signs of breech presentation on the cervix. However, only an ultrasound can determine the exact position of your baby.

Most likely, if your baby has a breech presentation, you will find out about it at a scheduled visit to the doctor in the last trimester of pregnancy. The doctor learns about presentation:

  • gently feeling different parts of your abdomen. Presentation is determined by the location of the head - it can be determined due to the fact that this is the hardest part of the child's body;
  • examining the cervix, by feeling either the smooth, round head of the baby, or the soft, uneven buttocks of the baby.

If the doctor suspects a breech presentation, then an ultrasound of the fetus is done to confirm the assumption.

If the doctor will do an external coup of the child with his head down, then you need:

  • do ultrasound diagnostics before, after, and, most likely, during this manipulation, to determine the position and heart rate of the fetus;
  • do electronic monitoring of the baby's heartbeat before and after this procedure.

An increasing fetal heart rate during a coup is considered the norm, but if the heart rhythm is disturbed, then the procedure must be stopped.

How to safely give birth to a baby with a breech presentation?

Sometimes the gynecologist turns the baby upside down, this procedure is called the external flip of the baby upside down. Experts recommend that such manipulation be carried out whenever possible. After all, the position of the child is not so important, each birth and labor activity occur individually. You should consult with a specialist on the safest way to deliver a fetus in a breech presentation.

There are cases when women with a breech presentation have given birth to a child in a natural way, but in many cases, a woman who is pregnant with a baby with a breech presentation has a caesarean section, this is the safest way to give birth to a child. Unfortunately, very few doctors are experienced in vaginal delivery, with breech presentation. You can work with your doctor to develop a plan for childbirth, but you need to remember that there are very high chances of surprises that can lead to a quick decision by the doctor in order to protect your baby and you.

Treatment Overview

For many women, by 36 weeks of pregnancy, the baby is in the correct position during natural childbirth - head down. If, in the later stages, the child lies with his buttocks down, then the gynecologist will most likely advise you to do a caesarean section. If, however, it turns out to turn the fetus upside down, before the onset of labor, then the woman in labor may try to give birth on her own.

Unfolding of the fetus with breech presentation

Attempting to perform an external reversal of the child increases the likelihood of natural childbirth. At home, a woman can try to occupy various positions that favorably affect the turn of the child. Although this method has not yet been thoroughly studied, it is considered quite effective and safe. External turning of the fetus head down is carried out only in medical institutions that have equipment for continuous monitoring of the baby's heartbeat. You should also do ultrasound diagnostics before and after this procedure. Before turning around, the doctor will give you a medication that relaxes the abdominal muscles. This procedure can be carried out several times if it fails the first time.

At home, you can independently take various body postures, for example, carefully raise the pelvis above the head, this exercise should be done for several weeks, several times a day. If, however, the doctor’s attempt to carry out an external turn of the fetus with the head down is successful, then it is necessary to periodically, until the very beginning of childbirth, check the presentation of the fetus. If the child lies head down, then there is no indication for a caesarean section. Whether the birth will take place in a natural way or with the help of the intervention of surgeons depends on how labor activity will take place. According to statistics, a woman who has given birth earlier is less likely to undergo a caesarean section than a primiparous woman.

Childbirth with breech presentation

Most often, with a breech presentation, a caesarean section is done, for the safety of the child. If, just before the birth, the child is still in this position or abruptly changes its presentation to the pelvic one, then the doctor will prescribe an operation - a caesarean section. But in some cases, this operation is not possible or has contraindications. For example, with rapid childbirth, the child appears only naturally; with multiple pregnancy, when the second or more child has a breech presentation, it is better to give birth in a natural way. Childbirth with breech presentation can take: an obstetrician, a perinatologist, a family doctor who has the necessary qualifications. A pediatrician or family doctor should be present in case the child needs help after delivery.

How to make the right decision?

In the absence or presence of data on the breech presentation of the child, you can help the baby be born healthy. For this you need:

  • Regularly consult a gynecologist during pregnancy, it is during such consultations that breech presentation is most often detected. This information may prevent complications from occurring.
  • Eat in a balanced way.
  • Give up bad habits that have a negative impact on the child (alcohol, drugs, smoking).

How to give birth to a baby with a breech presentation?

If your child has taken a breech presentation, then it is worth consulting with a gynecologist about the possibility of you adopting various body positions that stimulate the fetus to roll over into the correct position. Scientists have not found that this method helps in the coup of the child, but there is also no proven harm. Having learned about the incorrect position of the fetus, you will naturally begin to worry about the child - you should not do this. If something is bothering you, it is best to talk to your doctor. In most cases, babies with breech presentation are born healthy. If, however, you still gave birth by caesarean section, the first weeks after the operation you will need help around the house. After the operation, after a few days, you will be able to walk, but it will still be impossible to lift heavy things.

Expectant mothers, having learned from the doctor that their baby is head up in the tummy, begin to worry, because this position of the fetus is considered incorrect. It is called breech presentation. The baby should be head down in the uterus as it is the widest part of the fetus.

It is best if the head appears first during childbirth, and then the rest of the body. However, in 3-5% of women, childbirth occurs with a breech presentation of the fetus, which is fraught with complications.

The location of the child in the uterine cavity is classified as follows:

  1. foot- both hips are unbent or only one of them, and one leg is located at the exit from the uterus. This type of presentation is observed in 10-30% of pregnant women (most often in multiparous women).
  2. Gluteal- the legs of the fetus in the hip joints are bent, and the knees are pressed to the tummy and straightened. This presentation occurs in 50-70% of women in position (most often in primiparas).
  3. mixed(gluteal-leg) - knees and hips are bent. This type of presentation occurs in 5-10% of cases.

Causes of breech presentation of the fetus

Up to 32 weeks, the fetus can take various positions in the mother's tummy. The presence of free space in the uterus allows it to move. As the child grows, he tends to lie head down.

For the following reasons, the breech presentation of the fetus may persist until delivery:

  • oligohydramnios or;
  • placental pathology: location in the area of ​​tubal corners,;
  • pathology of the uterus: violation of tone, fibroids;
  • fetal pathology: anencephaly, hydrocephalus;
  • multiple pregnancy;
  • consequence of a caesarean section.

Signs of breech presentation of the fetus

Many women are concerned about the question of what the breech presentation of the fetus means, and by what signs it can be determined. Pregnant women do not feel at all that their baby is lying incorrectly in the uterus. There is no discharge or pain. Breech presentation can only be determined by a doctor during an examination.

Experts note that when the baby is positioned head up, there is a higher standing above the pubis of the uterine fundus, which does not correspond to the gestational age. In the region of the navel, the heartbeat of the fetus is more clearly audible.

With a vaginal examination, the doctor may identify signs of a breech presentation of the fetus. With a mixed and foot position of the child, his feet are probed, and with the gluteal position, the sacrum, inguinal fold, soft bulk part, coccyx are felt. Despite all the signs, the exact diagnosis is determined only by ultrasound.

Delivery with pelvic presentation of the fetus

A child can be born in a breech presentation naturally or as a result of a caesarean section.

The choice of a particular method of delivery depends on the following factors:

  • the age of the pregnant woman;
  • duration of pregnancy;
  • history data;
  • existing diseases;
  • the size of the pelvis;
  • type of breech presentation;
  • sex and weight of the fetus, the degree of extension of his head.

Childbirth with a breech presentation of the fetus can take place naturally if: the gestational age is more than 37 weeks; the average estimated weight of the fetus is 2500-3500 g; the size of the mother's pelvis is normal; it is known that a girl will be born, not a boy; presentation is breech or breech.

If the above conditions are not met, then it is required. Besides, operation is necessary in the event that: childbirth is premature; fetal weight is less than 2500 or more than 3500 g; male fetus; breech presentation is foot, ultrasound revealed hyperextension of the fetal head.

The doctor, having begun to take birth in a natural way, may decide to perform a caesarean section. It will be called an emergency. Indications for immediate surgery may include:

  • weak generic activity;
  • prolapse of the baby's legs, arms or umbilical cord;
  • discoordination of labor activity (contractions are observed, and the cervix does not open).

Possible complications during childbirth with a breech presentation of the fetus

Breech presentation of the fetus in the longitudinal position absolutely does not affect the course of pregnancy. Complications may occur during childbirth.

First, labor activity can be weak. This is due to the fact that the pelvic end of the fetus is smaller than the head in volume. It weakly presses on the uterus, and as a result, it contracts worse, its neck opens more slowly.

Secondly, during childbirth, the baby's head may tilt back. Her appearance will be difficult. There is a risk that the child will be injured.

Thirdly, often with a breech presentation of the fetus, the umbilical cord is clamped between the wall of the birth canal and the head. Because of this, the flow of oxygen will be difficult. The fetus will go into hypoxia.

Fourthly, during childbirth, throwing back of the handles is possible. It is also fraught with various injuries.

Can breech presentation be corrected?

Many new mothers start to panic too early when they find out that their baby is in the wrong position in the tummy. For example, some women find out on ultrasound about the breech presentation of the fetus at 20, 21 or 22 weeks and are already starting to look for ways to correct his position. However, it is still too early to think about this. In most pregnant women, the baby takes the correct position by 32 weeks or even later.

If at 32 weeks, an ultrasound scan showed that the fetus did not roll over and remained in the head-up position, then special exercises can be started. They are effective, and in most cases, thanks to them, the breech presentation of the crumbs is replaced by the head.

Exercises can be started with a breech presentation of the fetus from 33 weeks. You should first consult with your doctor. In a pregnancy with complications, you may have to give up exercise altogether so as not to harm the baby. Only a doctor will tell you whether it is possible to perform physical exercises, and whether they will negatively affect the condition of the expectant mother and fetus.

All classes are recommended to start with a warm-up. Within a few minutes, a pregnant woman can walk with a normal step, and then on her toes and heels. Hand movements (rotation, raising and lowering), raising the knees to the side of the abdomen will not be superfluous. Below are some examples of simple exercises that can be done after 32 weeks with a breech presentation.

Exercise 1

Stand up with your back straight and legs apart. The arms should hang freely along the body. Then you should stand on your toes and spread your arms to the sides, bend your back, take a breath. After that, exhale and take the starting position. Do the exercise 4-5 times.

Exercise 2

Pillows are required for this. They are necessary in order to raise the pelvis. The pregnant woman should lie on the floor with a few pillows. The pelvis as a result of this should rise above the level of the shoulders by 30-40 cm. The pelvis, knees and shoulders should form a straight line. This exercise is recommended to be performed a couple of times a day for 5-10 minutes, but not on a full stomach.

Exercise 3

Get on all fours with your head down. While inhaling, round your back. Then return to the starting position. Exhale, bending in the lumbar and raising your head up.

Exercise 4

It is necessary to lie on your back, spreading your legs shoulder-width apart and bending them. The feet should rest on the floor. Hands need to be relaxed and stretched along the body. When inhaling, you should raise your back and pelvis, resting on your shoulders and feet, and when exhaling, take your starting position. Then you need to straighten your legs, take a breath, drawing in your stomach. The muscles of the perineum and buttocks should be tense. When exhaling, return to the starting position. This exercise is recommended to be repeated 6-7 times.

If you want to start exercising early (for example, at 30 weeks with a breech presentation of the fetus), then you should definitely consult a doctor.

Not only exercise can affect the position of the fetus. Great importance is played by proper nutrition, walks in the fresh air.

It is advisable for pregnant women to sit on chairs with a firm and straight back and a hard seat. When sitting on upholstered furniture, it is recommended to spread your legs a little so that your stomach lies freely. If possible, you should buy a fitball and perform special exercises on it that can affect the position of the child in the mother's tummy.

Thus, you should not panic if you learn from a doctor about a breech presentation of the fetus before 27 weeks. The baby can change its position several times before giving birth. If desired, from 30-32 weeks in the absence of contraindications, you can begin to perform special physical exercises.

If they do not affect the position of the fetus, then the doctor will select the best delivery option (caesarean section or natural childbirth), which will not harm either the woman herself or her child.

Answers

During its development, the baby, which is in the mother's tummy, rolls over several times. And after 22-23 weeks of pregnancy, the baby, as a rule, assumes a head-down position - and this is the location of the fetus that is considered optimal for subsequent births. The head of the fetus is the largest part of its body in diameter, and therefore it is with its passage during delivery that the greatest difficulties are associated. After the baby's head passes through the birth canal, the rest of his body "by inertia" follows almost imperceptibly. If the baby is located vertically in the mother's tummy, that is, head down, in most cases this position does not bring any difficulties. But it also happens that the fetus occupies a transverse position in the womb: legs or buttocks down. In this case, we are talking about breech presentation during pregnancy, which is diagnosed, as a rule, by the 28th week during the next visit to the antenatal clinic. It should also be mentioned that the breech presentation detected at this time will not necessarily remain until the birth - the baby can change position up to 36 weeks. In addition, there are a number of measures that can help "turn" the fetus, thereby giving it a head position.

Causes of breech presentation of the fetus

Breech presentation of the fetus during pregnancy can be due to several factors. One of the main reasons doctors call a decrease in the tone and excitability of the uterus. Also, the causes of breech presentation are called, and abnormalities in the development of the uterus, placenta previa, some malformations of the fetus. Breech presentation can be breech, foot, mixed, knee - each of them is easily diagnosed by the doctor during a routine examination, after which ultrasound confirmation will be necessary. Breech presentation is considered not quite a normal position for both the baby and the mother - although it does not carry direct big threats.

Although natural childbirth with a breech presentation of the fetus is possible, caesarean section often becomes an indication for delivery. If the birth proceeds in a natural way, then constant and enhanced control of the doctor is necessary - childbirth from a breech presentation is much more often accompanied by complications.

Signs of breech presentation of the fetus

Physically, if there is a breech presentation of the fetus, the woman does not feel this pathology in any way. She is not disturbed by any pain symptoms or discomfort, which can clearly signal the "wrong" location of the baby in the uterus.

Breech presentation can only be determined through examinations. So, with breech presentation, experts note a higher standing of the uterine fundus above the pubis, which does not correspond to the gestational age. The fetal heartbeat is heard more clearly in the umbilical region or slightly above it on the right or left (depending on the position of the fetus).

Also, signs of breech presentation of the fetus reveal themselves during a vaginal examination. For example, with a breech presentation, a soft volumetric part, an inguinal fold, a coccyx and a sacrum are probed. With adjacent breech and foot presentation, you can determine the baby's feet with a calcaneal tubercle and short fingers (other than fingers on the hands) located on the same line. To clarify the diagnosis, however, ultrasound will also be required.

Exercises for breech presentation of the fetus

You can “give” the baby a head position in the tummy with the help of special gymnastic exercises. You can use them starting from 32-34 weeks of pregnancy - after consultation with your doctor. Gymnastic exercises involve turning the future mother in a prone position from one side to the other: 3-4 times approximately every 7-10 minutes. This exercise is performed 2-3 times a day. You can also carry out an exercise that involves lifting the pelvis: lying on your back, you should put some kind of roller under your lower back (you can use ordinary pillows) so that the pelvis is 20-30 centimeters higher than the head. In this position, you need to stay from 5 to 15 minutes, but no more. The exercise is performed 2-3 times a day on an empty stomach. Contraindications for performing such gymnastics are scars on the uterus from any operations, late toxicosis. He offers his methods for breech presentation and alternative medicine, for example, acupuncture, homeopathy,.

If the above methods have not brought the desired results, the expectant mother may be offered an external rotation of the fetus. This procedure is carried out at about 34-37 weeks of pregnancy, always in a hospital with monitoring, ultrasound monitoring and using special preparations that relax the uterus. A successful external coup will make it possible later to carry out childbirth in a natural way, but since this procedure is rather difficult, and also has many contraindications (a scar on the uterus, obesity, the age of the primipara is more than 30 years old, gestosis,), it is not suitable for every pregnant woman and they produce it quite rare.

Childbirth with breech presentation of the fetus

If the breech presentation could not be eliminated by any of the methods, this should not become a reason for the disorder. In this case, the pregnant woman will be advised to go to the obstetric hospital earlier: here, after all the necessary examinations, the method of delivery will be chosen.

Without any serious contraindications, childbirth can proceed naturally - under the constant supervision of a doctor. If it is not possible, a caesarean section will be required. Indications for caesarean section with breech presentation are (more than 3.5 kilograms), the presence of a scar on the uterus, a narrow pelvis in a pregnant woman, placenta previa, presentation in a foot or mixed position.

Especially for- Tatyana Argamakova

About 6% of pregnant women during the next ultrasound hear an alarming conclusion - "breech presentation". It is obvious to everyone that nature has provided for the crumbs in the womb a more natural position of the body - head down. Head forward it is easier to move along the birth canal, to be born into this world, it is the head presentation that does not threaten complications.

But what about those who have kids who decide to settle down differently? Is breech presentation always an indication for a caesarean section? Why is it dangerous and is it possible to force a child to change the position of the body? We will try to answer all these questions as fully as possible in this material.


What it is?

Breech presentation is called the abnormal location of the fetus in the uterine cavity, in which not the head of the fetus, but the priest or lower limbs, is facing the exit to the pelvic area. The head is located at the bottom of the uterus. The baby is actually sitting.

Breech presentation refers to the pathological conditions of pregnancy, childbirth during it is also considered pathological. There is nothing natural in this arrangement of the fetus. However, about 4-6% of all pregnancies occur against the background of a breech presentation of the fetus.


For obstetricians, each such case is a real test of professionalism. Pregnancy management in the pelvic location of the baby, as well as childbirth in this location of the crumbs, require a lot of experience and knowledge from the medical staff.

In modern obstetrics, more and more often they offer a woman whose baby is located booty down to do a caesarean section. But you should know that there is an alternative to the operation - natural childbirth. With a breech presentation, the risks of complications in childbirth are higher, but an experienced and well-trained doctor may well conduct the birth process successfully. The baby will be born, of course, legs forward.


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Kinds

The concept of "breech presentation" is wider than it seems to expectant mothers. It is not enough for an experienced doctor to know where the baby's head is, he needs to clarify which part of the lower half of the baby's body is located in relation to the small pelvis. Therefore, all breech presentations have a fairly clear and understandable classification.


Gluteal

The buttocks are adjacent to the exit from the small pelvis in this position of the baby. The breech presentation may be incomplete, while only the buttocks are adjacent to the exit from the uterus, and the legs are bent at the hip joints and extended along the body so that the heels are at the very face of the child. Also, the breech presentation can be mixed (combined) or complete, in which the butt fits along with the legs, the baby seems to be squatting.

Incomplete (exclusively breech presentation) occurs in 75% of cases of all breech presentations. Every fifth case refers to a complete or combined (mixed) breech presentation.


foot

This concept means the location of the legs of the fetus towards the exit from the uterus. Foot presentation is much less common than breech presentation. With a full foot position, both legs are adjacent to the exit to the small pelvis, slightly bent at the knees. But such a picture is rather rare. Usually there is an incomplete foot presentation, in which one leg is pressed against the exit from the uterus, and the other is bent at the knee and hip joint and is significantly higher in level than the first.

There are also such resourceful kids who are located at the exit to the small pelvis with their knees. This is also a variant of foot presentation - knee. With it, the baby does not bend the legs at the hip joint, but bends them at the knee joints, it looks as if the baby is kneeling in the mother's womb and both knees are pressed to the exit to the small pelvis.

Foot presentation options are considered the most dangerous in terms of the development of complications during childbirth.


Dangers and risks

Breech presentation in childbirth is dangerous for the development of severe complications. The waters can pour out prematurely, along with them the prolapse of the umbilical cord, its parts and even parts of the body of the fetus is not excluded. Often, women develop weakness of the birth forces, when contractions do not lead to the opening of the cervix. Often, the birth of a child with the pelvis and legs forward leads to acute hypoxia, the death of the baby, and irreversible changes in its central nervous system.

During childbirth, the baby can throw back the arms, chin. The latter is most dangerous by the development of a disabling birth injury associated with fractures, displacement of the cervical vertebrae, brain and spinal cord. For the mother, such childbirth is dangerous with ruptures of the cervix, vagina, and the occurrence of severe bleeding.

For a child, the consequences of breech presentation can be quite unpleasant - this is a congenital dislocation of the hip, pathologies of the gastrointestinal tract, kidneys and urinary system, trauma, development of cerebral palsy.


However, dangers lurk not only in childbirth, but also during pregnancy. In the first half of the gestation period, the breech presentation of the fetus increases the likelihood of miscarriage, hypoxia, and the risks of developing early preeclampsia are also considered elevated. In the second half of pregnancy, a woman whose baby is head up is threatened with premature birth, preeclampsia, including severe, premature placental abruption.

Women with a breech presentation of the fetus have a 60% increased risk of developing placental insufficiency and subsequent fetal hypotrophy. In a state of lack of nutrients, vitamins and oxygen, the baby's nervous and digestive systems do not develop well and quickly, there are problems with the endocrine system and the work of the heart and blood vessels.


From the 34-35th week of pregnancy, if the child does not roll over into the head position, the rate of development of the structures of the medulla oblongata slows down, which leads to disruption of the pituitary gland, the adrenal cortex. Negative changes in a child who occupies an incorrect position in space also occur in the genital area - edema and hemorrhage occur, subsequently the girl may develop exhausted ovary syndrome, and the boy may have oligozoospermia or azoospermia. Among children with congenital heart defects, there are many who spent all nine months head up and booty down.

Among congenital cases of pathologies of the musculoskeletal system, about 40% are due to such a cause as breech presentation of the fetus during pregnancy.


Causes

Physicians and scientists do not fully understand the mechanisms for the development of pathology, it is rather difficult to explain why a baby, who is supposed to be head down by nature, occupies a different position, which is not convenient for him or his mother. Therefore, it is not customary to talk about the reasons as such, rather, we are talking about the prerequisites for breech presentation. And they can be very different.

Pathologies of the uterus and pelvis

This premise is considered the most common. Tumors, uterine fibroids, a narrow pelvis, as well as the presence of postoperative scars on the uterus can prevent the baby from taking the correct head position. Quite often, the prerequisites are the anatomical features of a particular woman - a bicornuate or saddle uterus. The increased tone of the uterine muscles also creates a risk that the baby will take the wrong position of the body.

Often, women who have given birth many times face breech presentation - from the uterine muscles are weakened, "stretched", it cannot provide reliable fixation of the fetus. Often with a breech presentation of a baby, women who have had many abortions before are often subjected to curettage of the uterine cavity. The baby instinctively tries to take a position in which his head will be in that part of the uterus, where spasms occur less frequently. For women who have had several abortions, such a section is the fundus of the uterus. Its lower segment is tense.



Fetal pathologies

Quite often in the breech presentation there are children who have gross chromosomal anomalies and malformations. So, according to statistics, up to 90% of babies with microcephaly (reduced brain volume), anencephaly (absence of the brain) and hydrocephalus (hydrocephalus) in the mother's womb are head up.

Breech presentation is often characteristic of one of the twins if the pregnancy is multiple, in which case the position of the child in the uterus may not be associated with any of its pathologies.

Sometimes the incorrect position of the body relative to the exit to the small pelvis is an indirect sign of problems with the vestibular apparatus in a child.


Amount of amniotic fluid

With polyhydramnios, the fetus has more room for coups, somersaults and somersaults. And this sometimes affects the fact that the baby takes the wrong position of the body inside the space of the uterus. With oligohydramnios, the movements of the child, on the contrary, are difficult, and it is difficult to roll over into the correct position.

The umbilical cord and placenta

A short umbilical cord limits the movements of the baby, and too long is often combined not only with the breech presentation of the fetus, but also with entanglement around the neck or limbs. The pathological location of the placenta is also a prerequisite for breech presentation - we are talking about placenta previa or its low location.


Heredity

Obstetricians have long noticed that most often the baby's breech presentation develops in pregnant women who themselves were born in a breech presentation or the mother's entire pregnancy was in this position.

In fairness, it should be noted that the above premises do not always explain this fact. Sometimes a breech presentation is fixed in a baby who does not have any of these prerequisites. Not all cases of breech or oblique breech presentation can be explained, just as it is not always possible to understand why a baby who was head-up, just a few hours before birth, suddenly does the impossible and rolls over into head presentation. This is rare, but there are plenty of examples in obstetrics and gynecology.


Diagnostics

Until the third planned screening ultrasound, or rather, up to 32-34 weeks of pregnancy, the position of the fetus does not play a big diagnostic role, because the baby still has free space inside the uterus to change the position of the body spontaneously. Therefore, breech presentation at an earlier date is not considered a diagnosis, this is just a statement of fact. The doctor describes the position of the fetus in which he was "caught" during the ultrasound.

After 34 weeks, the chances of a coup are reduced to negligible values. It is at 32-34 weeks that breech presentation already sounds like a diagnosis. The tactics of monitoring a pregnant woman is changing, the question of the method of delivery is decided in advance.


The pelvic position of the baby is first determined by the obstetrician. To do this, he uses the so-called Leopold method. The height of the fundus of the uterus exceeds the norm, probing with the hands of a physician through the anterior abdominal wall of the expectant mother determines a rounded element, quite mobile, slightly shifted to the right or left of the midline passing through the navel. This is the baby's head. To eliminate the error, the obstetrician uses auxiliary methods: the presenting part is palpated in the lower abdomen, if it is a priest, then it is not capable of mobility. The baby's heartbeat is also heard. A tiny heart in the pelvic position usually knocks above the mother's navel, slightly to the right or slightly to the left of it.

By the location of the heartbeat, a woman can determine the presentation of her baby on her own, using a phonendoscope. The points and kicks of the baby, which is head up, are felt more painfully and more tangibly in the lower abdomen, almost above the pubis.

With a vaginal examination, the presumptive diagnosis is specified. Through the anterior fornix of the vagina, the doctor determines the softer presenting part. The head, if the position of the fetus is head, is firmer and more dense to the touch.


After examining the gynecologist, the woman will be offered to undergo an ultrasound examination, which should put everything in its place. Ultrasound will determine not only the position of the baby, but also the nuances that are important for delivery - whether his head is unbent, whether there is an entanglement with the umbilical cord, what is the estimated body weight of the baby, whether he has developmental pathologies, where exactly the placenta is located, what is the degree of its maturity.

The angle of extension of the head in this case is of the greatest importance. If it is unbent and the child seems to be looking up, then there can be no talk of independent childbirth, because the risks are too great that when passing through the genital tract, the baby will receive serious injuries to the spine.

When establishing on ultrasound the fact that the baby is lying incorrectly, it is imperative to conduct an ultrasound with a Doppler, as well as CTG, in order to have all the data on possible disorders in the baby’s condition caused by hypoxia.

Only at the end of the examination, the doctor will be able to give an exhaustive answer about the prospects for further pregnancy management and the desired method of delivery.


Natural fetal turnover

Until 28-30 weeks, absolutely nothing is required from a woman. Doctors take an observant position and strongly recommend that the expectant mother sleep more, rest, eat normally, take vitamins and drugs to reduce uterine tone in order to prevent fetal hypotrophy and reduce the risks of placental insufficiency. From the 30th week, the doctor may recommend that the woman do corrective exercises.

Exercises according to Dikan, Shuleshova, Grishchenko are aimed at relaxing the muscles of the uterus and pelvis as much as possible, allowing the child to take the correct position while it is still possible. The effectiveness of gymnastic exercises in combination with breathing exercises is estimated at about 75%. In most cases, if the gymnastics has helped, the child rolls over naturally, without coercion, within the first week after the start of classes.



Gymnastics for the coup of the fetus is contraindicated in women with diseases of the cardiovascular system, liver and kidneys. Classes are undesirable for women who have scars on the uterus from surgical operations or a history of caesarean section, for expectant mothers with signs of preeclampsia, the threat of premature birth. With the appearance of discharge from the vagina (watery, bloody) that is atypical for the gestational age, gymnastics is contraindicated.

In a natural way, babies can take the head position in 70% of multiparous women and in about a third of pregnant women with first-borns. To achieve the result, they use not only gymnastics, but also swimming in the pool, as well as psychological impact. According to most obstetricians, the child may well "listen" to the persuasion of his mother and roll over. If he does not do this before 35-36 weeks, then with a probability of 99% the baby will remain in the breech presentation until the very birth.

It is not worth relying on 1% of his coup already during fights or shortly before them.

See below for fetal flip exercises.

obstetrical inversion

If gymnastics, swimming, proper breathing and adherence to clinical recommendations up to 35 weeks did not have any effect on the baby, a forced obstetric coup can be performed. It is also called a coup by the Arkhangelsky method. An external coup is carried out exclusively in a hospital setting. Previously, doctors tried to practice it at 32-34 weeks, now it is considered the most reasonable to turn the baby by hand for a period of 35-36 or 36-37 weeks.

A woman should have a sufficient amount of amniotic fluid, the coup takes place under the constant control of ultrasound. Doctors monitor the baby's heart activity by means of CTG both before the turn and for some time after it. The essence of the method lies in the smooth, careful simultaneous movement of the head and buttocks of the fetus clockwise or counterclockwise (depending on the position of the back). It is not always possible to turn the baby, no one can guarantee that the Arkhangelsky method will give the expected result.

An obstetric coup is contraindicated in women who are at risk of preterm labor, if her pelvis is very narrow, if she is over 30 years old at the time of her first birth. Doctors will not forcibly turn the baby over if there is not enough mobility, if the woman has preeclampsia.

The Arkhangelsky method is not used in cases of multiple pregnancy, in the presence of scars on the uterus, as well as in the absence of amniotic fluid (oligohydramnios) or their excess (polyhydramnios).

If the breech presentation of the baby is due to anatomical malformations of the uterus, a manual overturn is also not carried out. Recently, more and more obstetricians refuse manual coup in principle. It is believed that it increases the likelihood of placental abruption, entanglement and asphyxia of the fetus, violation of the integrity of the membranes. Medicine knows cases when an obstetric coup ended in premature birth, rupture of the uterus and trauma to the fetus.

Considering that there may be no effect, and there may be side effects, many obstetricians continue observational tactics until the 37-38th week of pregnancy, after which they routinely hospitalize the expectant mother in the maternity hospital and choose the method of delivery.

Caesarean section or natural childbirth?

This is the main question that torments a pregnant woman and haunts her doctor. It is he who has to be solved even before the 38th week of pregnancy. The opinion that you will have to give birth with a breech presentation exclusively through a caesarean section is erroneous. A baby who sits head up in the uterus can be born in different ways:

  • natural childbirth that began spontaneously;
  • natural childbirth, stimulated in the DA, a little earlier or a little later than this date;
  • planned caesarean section.


To choose the appropriate delivery tactics, doctors use a special birth safety scale. If the total score exceeds 16, it is considered that a woman can give birth on her own with a breech presentation. Points are awarded as follows:

  • gestational age - 37-38 weeks - 0 points;
  • gestational age more than 41 weeks - 0 points;
  • gestational age 40-41 weeks - 1 point;
  • gestational age 38-39 weeks - 2 points;
  • large fruit (from 4 kilograms) - 0 points;
  • fetal weight 3500 -3900 grams - 1 point;
  • baby weight from 2500 to 3400 grams - 2 points;
  • foot presentation - 0 points;
  • combined (mixed) presentation - 1 point;
  • gluteal - 2 points;
  • strongly extended fetal head - 0 points;
  • moderately extended head - 1 point;
  • bent head - 2 points;
  • immature cervix - 0 points;
  • insufficiently mature neck - 1 point;
  • mature cervix - 2 points.


Also, from 0 to 12 points is given for the size of the pelvis - the wider it is, the more points the woman will receive. And only the sum of the points shows whether it is possible to risk and give birth on your own, or is it better to trust the experience and qualifications of the surgical team and give birth by caesarean section.

It should be noted that the statements of many pregnant women that they will not consent to the operation, which are often heard in women's forums on pregnancy and childbirth, are of no particular importance. A caesarean section, if the score is less than 16, is performed for medical reasons and only when there is a high risk of injuring the child during natural childbirth.

The decision on a planned caesarean section in breech presentation should always be weighed.

If it seems to a woman that she was sent for surgery simply because the doctor did not want to “mess around” with problematic pathological childbirth, you need to contact the head of the antenatal clinic and ask for the appointment of a medical expert commission that will once again calculate the risk scores and give their opinion.


For a woman in respect of whom a decision has been made about a possible natural birth, it is important to go to the hospital in a timely manner. You can't wait until contractions start at home. Even the very initial, the first period of the birth process should proceed under the vigilant supervision of a qualified doctor.

At this stage, it is important to prevent premature rupture of the fetal bladder, outpouring of water, especially their rapid outpouring, because along with the waters, loops of the umbilical cord and even parts of the baby’s body can fall out.


As soon as the contractions become regular, and the cervix opens by 3-4 centimeters, the woman is injected with antispasmodic drugs and painkillers to prevent too rapid labor activity. At this stage, the CTG device is connected, the entire process of childbirth will be accompanied by constant monitoring of the state of the fetal cardiac activity. To prevent hypoxia, a woman is given chimes, cocarboxylase, sigetin and halocorbin in injection solutions.

As soon as the waters break, the doctor will carefully assess the baby's condition by CTG, and also conduct an intravaginal examination for prolapse of the umbilical cords or parts of the baby's body. If the loops fall out, they will try to tuck them back, but in case of failure at this stage, the woman will be urgently sent to the operating room for a caesarean section.

By the way, about 30% of natural births with breech presentation end with a caesarean section. And both the woman herself and her relatives should be morally prepared for it.

No one can predict the course of childbirth if the baby goes legs or butt forward.


In the second stage of labor, if everything goes well, the woman begins to inject oxytocin, stimulating contraction and faster opening of the cervix. As soon as it opens enough to let the baby's buttocks through, the medical team performs an episiotomy - a surgical incision in the perineum and posterior wall of the vagina. This will help protect the woman from spontaneous ruptures and facilitate the passage of the baby.


It is considered a favorable sign if the birth of the head occurs no later than 5 minutes after the birth of the baby's torso. In the process of the birth of a baby, an obstetrician can use different techniques. With one, the buttocks are supported manually without trying to stretch them or somehow speed up the process, with the other, the baby is carefully removed by one or both legs, by the inguinal fold. There are many options in the third stage of childbirth, it all depends on how the birth proceeds, how the baby himself will be born.

Procrastination or inattentive attitude of the staff towards such a woman in labor can lead to acute hypoxia, death of the fetus, and severe injuries to the child, which will forever make the child disabled.

That is why a woman who is about to give birth in a breech presentation should approach the choice of an obstetric institution, a doctor with great responsibility, once again weigh all the risks.

postpartum period

The postpartum period after such childbirth is not much different from the same period in non-pathological childbirth. A woman should not be afraid that she will spend more time in bed or not be able to take care of a newborn. If there are no complications, bleeding does not open, then the newly-made mother is transferred from the delivery room to the ward where she can rest, and the child is sent to the children's department, where he will be treated with special care.

All babies who were born legs or booty forward, even if there were no visible complications in childbirth, are more closely monitored by neurologists, because some of the consequences of pathological childbirth can be quite remote. It is possible that such a baby will be brought to feed later than other children, often babies after birth with the lower body forward require resuscitation support.

Memo for moms

Pregnancy against the background of breech presentation has its own characteristics, and a woman needs to remember that:

    Antenatal bandage, if the baby is positioned head up, can only be worn until the 30th week of pregnancy. If then the baby retains an incorrect position of the body in space, it is impossible to wear a bandage.

    Before childbirth or shortly before them, the pregnant woman's stomach drops - the head of the fetus in cephalic presentation is pressed against the exit to the small pelvis. With a breech presentation, the prolapse of the abdomen does not occur until the very birth.