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Breech presentation why. Breech presentation of the fetus. Breech breech presentation of the fetus

breech presentation observed in 6% of pregnant women. In the normal course of pregnancy, the baby gets up on right place by 21 weeks of gestation. But due to the presence of a number negative factors can remain unchanged up to the 3rd trimester.

The abnormal position of the fetus is not dangerous until 22 weeks of gestation. During this period, it is likely that the baby's place will turn over several more times in the womb, but if the pathology is observed on later dates This is dangerous for both the baby and the mother.

What does breech presentation mean?

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

The incorrect position of the baby in the womb may be due to diseases of the uterus, a small amount amniotic fluid or weak placenta. You can understand the development of pathology by the nature of the movement of the baby. Most often, such a deviation causes premature or with the help of caesarean section childbirth. The disease is treatable, which means that there is a chance to leave the baby safe and sound.

Possible causes of the problem

Why does such an anomaly occur?

Doctors allocate the following reasons wrong position of the baby:

  1. Due to polyhydramnios, the mobility of the embryo increases, so there is a possibility that it may take an oblique position.
  2. With polyhydramnios, the baby cannot fully move, and when changing positions, there is a low probability that he will again stand in the right place.
  3. When a woman is carrying twins, there is less space in the womb. The kids are getting crowded and one of them may be looking for more comfortable position and therefore turns head up.
  4. The narrow pelvis of the expectant mother.
  5. Abnormal position of the placenta (along the anterior wall).
  6. Too much big size baby.
  7. Myoma of the uterus.
  8. Pathological condition of the ovaries.

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

Diagnostic measures

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

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

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

How is the pregnancy

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

The most commonly prescribed exercise is:

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

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

How is childbirth with breech presentation

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

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

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

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

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

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

  • late discharge of water;
  • prolapse of the umbilical cord and particles of the placenta;
  • development of uterine anomalies;
  • childbirth is delayed;
  • the appearance of acute hypoxia;
  • premature detachment children's place from the walls of the uterus.

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

Most often, childbirth with this diagnosis proceeds normally, but there are big risk formation of complications and problems. Therefore, it is important for a girl in a position to perform preventive actions to make childbirth easier.

Is it possible to eliminate the pathological position of the fetus

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

The main measures that can eliminate the disease include:

  1. In the second trimester of gestation, antispasmodic drugs are prescribed. medicines. They are taken at half the allowable dose 3-4 times a week.
  2. The state of the muscles of the uterus is controlled. Anti-anxiety drugs may be prescribed.
  3. Gymnastic exercises. A set of movements will help to change the incorrect placement of the embryo. All classes are held in a sitting or lying position for 15-20 minutes. They need to be done half an hour before meals. All actions are performed in compliance with the recommendations of the doctor.
  4. Bandage. The belt will help support the stomach and relieve tension from the back, the muscles will be more relaxed, which will help the embryo to move more actively.
  5. Sometimes an external transfer of the child to the head is used. But this method of treatment is quite dangerous, as it can harm the fetus and cause complications (hypoxia, injury to the baby, premature birth).

The real story in this video:

How doctors can help

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

Correction of the pathological condition before the birth of the child

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

This treatment is contraindicated if a woman has:

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

Despite the fact that the method has many contraindications, it is very effective and early dates gestation helps the baby roll over. But self-treatment in this case is impossible, it threatens to further worsen the situation. All activities must be supervised by a specialist.

obstetric turn

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

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

Cesarean section with breech presentation of the fetus

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

Besides, important role plays the location of the fetus. If it is impossible to give birth on its own during its presentation, then a caesarean section is performed. The operation prevents possible problems and protects the uterus from damage. Reviews of doctors indicate that this is the most safe option when staging with such an anomaly.

Conclusion

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

But there are times when pathological position fetus causes a number of complications and becomes a threat to the life of mother and child. Therefore, when symptoms appear wrong location the baby should go to the hospital and undergo medical examination to prevent unwanted consequences.

- longitudinal location of the fetus in the uterus with the legs or buttocks facing the entrance to the small pelvis. Pregnancy with a breech presentation of the fetus often occurs in conditions of threatened abortion, preeclampsia, placental insufficiency, fetal hypoxia, and birth injuries. Diagnosis of breech presentation of the fetus is made using external and vaginal examination, echography, dopplerography, CTG. Treatment of breech presentation includes complexes of corrective gymnastics, prophylactic external rotation of the fetus, early choice of the method of delivery.

Breech presentation can be observed with increased fetal mobility caused by polyhydramnios, malnutrition or prematurity, hypoxia, microcephaly, anencephaly, hydrocephalus and other factors associated with the pathology of the child. On the other hand, the limited mobility of the fetus in the uterine cavity with oligohydramnios, a short umbilical cord or its entanglement also contributes to the formation of an malpresentation.

An obstetric and gynecological history of the mother, aggravated by repeated curettage of the uterus, endometritis, cervicitis, multiple pregnancies, abortions, complicated childbirth, can lead to pelvic presentation of the fetus. These conditions often lead to the development of pathological hypertonicity of the lower segments of the uterus, in which the head tends to take a position in the upper, less spasmodic sections of the uterine cavity. A change in the tone of the myometrium can also be caused by a scar on the uterus, neurocirculatory dystonia, neurosis, overwork of the pregnant woman, stress, etc. Breech presentation of the fetus is often combined with low location or placenta previa.

In numerous observations conducted by obstetrics and gynecology, it is noted that the breech presentation of the fetus develops in those women who themselves were born in a similar situation, therefore, the issue of hereditary conditioning of foot and gluteal presentations is being considered.

Features of the course of pregnancy

With a breech presentation of the fetus, the course of pregnancy, much more often than with a head one, is associated with a threat or spontaneous interruption, the development of preeclampsia and placental insufficiency. These conditions, in turn, negatively affect the maturation of the nervous, endocrine and other systems of the fetus. With breech presentation in the fetus from 33-36 weeks of gestation, the processes of maturation of the structures of the medulla oblongata slow down, which is accompanied by pericellular and perivascular edema. At the same time, the neurosecretory cells of the fetal pituitary gland begin to work with increased activity, leading to premature depletion of the function of the adrenal cortex, and a decrease in the protective and adaptive reactions of the fetus.

Changes in the fetal gonads are represented by hemodynamic disorders (venous stasis, punctate hemorrhages, tissue edema), which can later manifest as gonadal pathology - hypogonadism, ovarian failure syndrome, oligo- or azoospermia, etc. With breech presentation, the frequency of development increases birth defects heart, central nervous system, gastrointestinal tract, musculoskeletal system in the fetus. Uteroplacental blood flow disorders are manifested by hypoxia, high heart rate, decreased motor activity fetus. During childbirth with a breech presentation of the fetus, discoordinated or weak labor activity often develops. The most gross changes are observed in cases of mixed breech or foot presentation.

Diagnosis of pelvic presentation of the fetus

A stable breech presentation of the fetus should be discussed after the 34th-35th week of gestation. Until this time, the location of the presenting part may be variable. The breech presentation of the fetus is determined through external obstetric and vaginal examinations.

The breech presentation of the fetus is characterized by a higher standing of the uterine fundus, which does not correspond to the gestational age. Methods of external research allow you to determine in the area of ​​the womb soft, irregular shape, a sedentary part of the fetus, not capable of balloting. In the region of the fundus of the uterus, on the contrary, it is possible to palpate a large, rounded, hard and mobile part - the head of the fetus. The heartbeat is heard above or at the level of the navel.

Management of pregnancy and childbirth

In patients belonging to the groups increased risk on the formation of breech presentation, during pregnancy, measures are taken to prevent fetoplacental insufficiency, violations of the contractile activity of the uterus, complications from the fetus. It is recommended that a pregnant woman observe a sparing regimen with a full night's sleep and daytime rest, balanced diet for the prevention of fetal hypertrophy.

Psychoprophylactic work is carried out with pregnant women, aimed at teaching techniques muscle relaxation and withdrawals nervous excitability. From the 35th week of gestation, corrective gymnastics is prescribed according to Dikan, Grishchenko and Shuleshova, Caio, which contributes to a change in the tone of the myometrium and muscles abdominal wall, the transfer of the fetus from the breech presentation to the head. In some cases, spasmolytic drugs are prescribed in intermittent courses.

Conducting an external prophylactic rotation of the fetus on the head according to Arkhangelsk in some cases turns out to be ineffective and even dangerous. The risks of such obstetric appointment can serve as the onset of premature detachment of the placenta, rupture membranes, premature birth, uterine rupture, trauma and acute fetal hypoxia. These circumstances in last years limit the use of external obstetric aids in the practice of treating pelvic presentations of the fetus.

A pregnant woman with a breech presentation of the fetus at the 38-39th week of gestation is hospitalized in an obstetric hospital for planning the tactics of childbirth. In an uncomplicated obstetric situation (satisfactory condition of the fetus and the woman in labor, the proportionality of the pelvis and fetus, the biological readiness of the maternal organism, purely breech presentation, etc.), childbirth through the natural birth canal is possible. At the same time, the prevention of premature opening is carried out. amniotic sac, continuous monitoring CTG control of the fetus and uterine contractions, drug prevention of labor anomalies

In children born in breech presentation, often determined intracranial injury, encephalopathy, spinal injury, hip dysplasia. If fetal asphyxia or amniotic fluid aspiration is detected, appropriate resuscitation measures are required. newborns at early neonatal period subject to careful examination by a neurologist. To typical for breech presentation of the fetus birth trauma in women, ruptures of the perineum, cervix, vagina and vulva, damage to the pelvic bones.

The preventive direction provides thorough examination and correction of violations in women planning pregnancy; identification of pregnant risk groups for the development of breech presentation of the fetus and timely and adequate preparation for childbirth; early choice of tactics of childbirth and their management under the continuous supervision of an obstetrician-gynecologist.

Starting around the twentieth week of pregnancy, a woman feels that her baby is pushing. This means that the child does not lie all the time in one place and in one position, he changes these positions.

Starting around the twentieth week of pregnancy, a woman feels that her baby is pushing. This means that the child does not lie all the time in one place and in one position, he changes these positions. On the ultrasound, you can see that the baby first, for example, sat on the ass, then turned and lay down on his side, then stood on his feet. In most cases, starting from 33-34 weeks, the baby turns head down and thus prepares for his birth. This is the normal position of the baby in the abdomen, as safe as possible for childbirth. However, this does not always happen. In about 5% of cases, babies prefer to sit on their ass and not roll over. So it is easier and more convenient for them, so they like it more. This position of the child is called breech presentation fetus.

Breech presentation of the fetus causes

There are many reasons for the breech presentation of the fetus, below we will name the most common:

  1. Features of the uterus. The most convenient form of the uterus for the child is an inverted egg. Any other form of the uterus is less convenient for the child, it is inconvenient for him to swim in the amniotic fluid, any tumors and other growths interfere with the child, respectively, he tries to find the most comfortable position, which often does not coincide with the correct presentation.
  2. Any deviation in the amount of amniotic fluid from the norm - a lot of water or little water - is also one of the reasons for the breech presentation of the fetus in the womb. With polyhydramnios, the child changes position at least every minute, with oligohydramnios, on the contrary, it “gets stuck” in one position in the mother’s tummy.
  3. Diseases of the reproductive system, placenta previa, narrow pelvis, uterine tone.

There are three types of breech presentation of the fetus:

  1. Pure breech presentation- the child just sat down on the ass, legs stretched up along the body to the head, knees are straight.
  2. Mixed breech presentation of the fetus- the child seems to be squatting, knees bent, heels and buttocks pointing down.
  3. Breech breech presentation of the fetus- the child sits on the ass, but only one leg is pulled up to the head, and the second is bent at the knee and pressed to the tummy.

Types of fetal position

In addition to the types of fetal presentation, there are several more types of fetal position.

  1. Longitudinal position of the fetus. This is the norm. This term means that the main axis of the child - the line of the back of the head, spine, tailbone - repeats the lines of the uterus.
  2. Oblique and transverse position of the fetus. Incorrect position of the baby in the uterus. Always an absolute indicator for caesarean section.

So, you have confirmed the diagnosis of breech presentation of the fetus. Can something be fixed? Yes. With a breech longitudinal presentation of the fetus, doctors recommend performing a series of simple exercises that give a fairly high chance of turning the fetus into the correct cephalic presentation immediately before childbirth.

Gymnastics with breech presentation of the fetus: it is prescribed only and exclusively by your doctor, it is better to start doing gymnastics from the 35th week of pregnancy.

Exercise 1. Lie on the floor or any other hard surface. Lie on your left side for 10 minutes, lie on your right side for 10 minutes. Do three times on each side. It should be performed three times a day one and a half hours before meals or one and a half hours after meals.

Exercise 2. Lie down on the floor. Tear off the pelvis from the floor by 30 - 40 cm. You can put pillows under the ass. Knees, buttocks, shoulders should be in one straight line.

Exercise 3"Animal Pose". Get on the floor on all fours, rest on your elbows and knees. Relax the abdomen, chest and perineum. It will be easier for the baby to move around in your belly. Also, with the help of this exercise, the tone of the uterus will decrease.

Swimming in the pool at least three times a week and sleeping on the side, where the back of the child is, help very well.

The main thing is to believe and wait. It often happens that the child rolls over into correct position either before childbirth, or in general during childbirth.

Baby from the buttock longitudinal presentation is it still in the correct position? Put on a special bandage. Fix the correct position.

With an incorrect presentation of the fetus, a woman is placed in the maternity hospital under the supervision of doctors two weeks before the birth. It was then, after an additional examination, that all the details of childbirth are agreed.

Breech presentation of the fetus and childbirth

Have you tried everything, but the baby still did not want to roll over to the correct position? It's OK. The most important thing now is to calm down and find out from the doctor which way is better for you to give birth - whether they will do you a cesarean or you can give birth naturally. After carrying out all the necessary additional surveys the doctor will tell you how you will give birth. If you have a girl, and the structure of the pelvis is quite wide, then you may give birth on your own.

If you are expecting a boy, then the birth will be by caesarean section. This is done to save the life and health of mother and child and due to the peculiarities

It is determined by nature that in utero the child should be in the uterus head down with limbs bent and brought to the body - the classic "fetal position". This position is optimal for normal course pregnancy and, most importantly, childbirth. The head first passes through the birth canal, preparing it for the passage of all other parts.

But by force certain reasons the position of the fetus in the uterus may be incorrect, which significantly increases the risk of complications during pregnancy and at the time of childbirth.

head presentation

95% of all pregnancies and births occur in the normal position of the child - the head. The name speaks for itself - the head is directed to the entrance to the small pelvis. These are the births that proceed with the least traumatism. There are, of course, varieties of cephalic presentation that make the process difficult. normal delivery, increase the likelihood of death of the child and the percentage of injuries, but they are rare, so we will omit their discussion for now.

As already mentioned, breech presentations account for 3-6% of all pregnancies. The fetus with this type of presentation is head up, and the buttocks serve as a wire point during childbirth. Natural childbirth when the fetus is located with the buttocks down is possible, but only in the absence of contraindications from the mother and baby.

Transverse and oblique position

This situation is rare, in no more than 0.5% of all pregnancies. The baby's spine is located almost or completely perpendicular to the mother's spine (the axis of the fetus crosses the axis of the uterus at a right or oblique angle).

Natural childbirth in this position is impossible. Prior to the introduction of caesarean section into practice, most pregnancies with an oblique and transverse position ended in the death of the child, and often, the child and mother.

There are, of course, ways to fix it. transverse position fetus, but they are extremely traumatic and ineffective, therefore, from them in recent times they just refused.

  • Pure gluteal, occurs in more than 65% of breech presentations. The baby is located in the uterus with the letter “V” - only the buttocks of the child are facing the entrance to the mother’s pelvis, the head and feet are at the top.
  • Mixed berry. It accounts for about 20% of all breech pregnancies. The feet and buttocks face the entrance to the pelvis. The legs are fully bent, the baby is in a squatting position.
  • Complete and incomplete foot (10 - 15%). Both or one leg (respectively) are facing the small pelvis. The degree of flexion-extension of the legs in the joints is individual. Incomplete foot presentation is more common.
  • Knee. It occurs in 0.1 - 0.3% of cases.

Incorrect presentation of the fetus during pregnancy may occur due to various reasons. Conventionally, they can be divided into causes from the side of the mother, causes from the side of the fetus, and others.

From mom's side

Pathology of the uterus:

  • saddle, bicornuate uterus or other developmental anomalies;
  • uterine fibroids, especially large ones, which are located mainly in the muscle layer (the nodes located under the serous layer do not affect the location of the fetus in the uterus);
  • operated uterus - cicatricial deformity after surgery on the uterus (caesarean section, myomectomy);
  • change muscle tone uterus, especially its lower segment. Occurs after frequent surgical interventions- abortion, diagnostic curettage;
  • overstretching of muscle fibers after multiple pregnancies, 5 or more.

Pathology of the pelvis:

  • deformation of the pelvic bones - flat, narrow pelvis, flat rachitic, etc.;
  • good and malignant tumors pelvic bones.

  • congenital malformations (hydrocephalus, anencephaly);
  • prematurity;
  • decreased muscle tone and motor activity of the fetus;
  • multiple pregnancy;
  • heredity. Experts note that in women who were born in a breech presentation, more often than in others, babies are also born with their buttocks down. Perhaps this is due to some inherited feature of the vestibular apparatus, but there is no reliable information.

Other reasons

  • problems with the placenta - attaching it to the area of ​​the pipe corners, the bottom or the internal pharynx;
  • a lot or a lack of water;
  • pathology of the umbilical cord - short umbilical cord, knots, tight entanglement around the limbs and neck.

There is a point of view that the immaturity of the vestibular apparatus causes the formation of breech presentations. The number of diagnosed breech presentations decreases as the duration of pregnancy increases - 33% at 21-24 weeks and only 3-5% at full-term pregnancy.

Diagnosis of breech presentations

Diagnosis of malposition and presentation for an experienced specialist is not difficult.

Obstetric appointments

External methods of palpation of the abdomen (Leopold's methods) make it easy to determine what position the baby is in. The exception is cases when the tone of the uterus is increased, and there are problems in the anterior abdominal wall, as well as when multiple pregnancy and in obese women.

Palpation at the bottom of the uterus allows you to feel a dense, rounded, easily displaced head, above the entrance to the small pelvis, a large, soft, non-displaceable pelvic part or small parts - limbs are probed.

Stethoscope the most distinct fetal heartbeat is heard at or slightly above the navel.

Vaginal examination allows you to confirm the diagnosis, through the vaults of the vagina, the gynecologist probes the large soft part (pure gluteal) and / or small parts (mixed gluteal and foot).

Instrumental Methods

To confirm the diagnosis, it is enough to perform Ultrasound research. With its help, it is possible not only to determine the size of the fetus and presentation, but also the type of presentation, the degree of flexion-extension of the head, the position of the limbs, the presence of entanglement of the umbilical cord, its nodes. AT difficult situations to determine the presentation, its type, the position of the fetus, the degree of flexion-extension of the head and the size of the pelvis, they can resort to computed tomography, MRI or X-ray pelviometry.

The course of pregnancy in women with breech presentation

Factors that lead to the formation of breech presentation also increase the risk of complications both during pregnancy and during the development of labor.

Complications occurring before the 20th week:

  • threat of interruption;
  • early gestosis.

Complications that occur after the 20th week of pregnancy:

  • threat of interruption;
  • premature birth;
  • entanglement of the umbilical cord;
  • oligohydramnios;
  • preeclampsia with a different combination of symptoms and varying degrees gravity;
  • three times the risk of placental abruption;
  • placenta previa is seven times more likely to be found.

Management of pregnancy in breech presentation

If breech presentation is detected up to 28 weeks no special measures are required, only dynamic surveillance. In 70% of multi-pregnant women, the baby rolls over on its own, in primigravida this occurs in 30% of cases. Breech presentation, preserved after 29 weeks, requires more attention.

The constant wearing of a bandage up to 30 weeks in pregnant women with a breech presentation is undesirable, as it fixes the child, preventing him from freely moving. After 30 weeks, if there is no threat of termination of pregnancy, it is generally better to refuse a bandage.

In the absence of contraindications in the period of 32 - 37 weeks, a woman is recommended to perform a complex of gymnastic procedures according to the method of Dikan I.F. or according to the method of Shuleshova A.E. and Grishchenko I.I.

In the period 34 - 37 weeks in a hospital setting may be preventive outer turn fruit per head. Despite relatively high efficiency procedures (up to 65%), recently it is practically not performed, because there is a risk of developing severe complications:

  • the onset of labor in preterm pregnancy;
  • injury, oxygen starvation and fetal death
  • uterine rupture;
  • placental abruption, bleeding.

In addition to possible complications, this method has whole line contraindications:

  • operated uterus and anomalies of its development;
  • infertility and miscarriage in history, the onset of pregnancy when using ART;
  • narrow pelvis;
  • anomalies in the location of the placenta and pathology of amniotic fluid;
  • severe somatic diseases.

Given the number of contraindications and possible complications, and also having such an alternative as a caesarean section available, you should think more than once before agreeing to this procedure.

Gymnastic exercises according to the above methods have a fairly high efficiency (up to 75% according to some sources), but, like the external turn, they have a number of contraindications. And this means that they can be performed only after agreement with the attending doctor and preferably under the supervision of an experienced physiotherapy instructor.

Conditions in which corrective gymnastics is prohibited:

  • operated uterus, as well as tumors and anomalies of the uterus, vagina, pelvic bones;
  • Availability spotting from the genital tract;
  • any manifestation of gestosis;
  • the threat of termination of pregnancy;
  • extragenital diseases of the mother (especially diseases of the liver, kidneys, cardiovascular system).

Here Dikan's technique as the simplest, and not requiring special physical effort. It consists in the following - a woman, lying on a couch, changes the position of her body every 10 minutes, performs turns (from side to side). Performed three times a day for a week. The duration of one approach is 30 - 40 minutes.

Childbirth. What to prepare for?

Regardless of which method of delivery is chosen, a pregnant woman with a breech presentation of the fetus is sent to the hospital on a planned basis after 38 weeks without signs of labor.

natural childbirth

There are a number of conditions, the combination of which allows specialists to make a choice in favor of natural delivery in breech presentation:

  • term pregnancy;
  • the size of the pelvis corresponds to the size of the fetus (clinically normal pelvis);
  • mature cervix.

When choosing in favor natural childbirth the woman will be under the supervision of specialists before the onset of labor, which will avoid such formidable conditions that develop with a rapid outflow of amniotic fluid (which is often found in breech presentations), such as prolapse of parts of the fetus and umbilical cord loops.

With cephalic presentation, after opening the fetal bladder, a small amount of waters (front waters), after which the head falls below, bordered on all sides by the soft tissues of the birth canal, and blocks the further outflow of waters. Their final outpouring occurs after the birth of the baby (rear waters).

With breech presentation, there is no division of amniotic fluid into anterior and posterior, because, if you imagine it simply, soft tissues the birth canal cannot tightly cover the buttocks and legs due to their inconvenient shape for this. This means that when the membranes are opened, all the available fluid rushes out at once, taking the umbilical cord and even limbs with it.

Considering all of the above, with a breech presentation, it is more expedient to perform an amniotomy in a hospital, when, after a puncture of the membranes, the doctor, without removing his hand, releases water slowly, preventing the development of unnecessary situations.

The negative consequences are:

  • after a rapid discharge of amniotic fluid, prolapse of umbilical cord loops is possible, which occurs, according to statistics, 5 times more often than with head presentation;
  • after the 36th week of gestation in breech presentation, the percentage of premature and early rupture of amniotic fluid is higher than at the same time in cephalic presentation (25% and 15%, respectively);
  • lengthening of the first and second stages of labor due to the development primary weakness generic activity;
  • violation of microcirculation in the vessels of the uterus and placenta;
  • compression of the umbilical cord when passing through the birth canal of the fetal head and the development of severe hypoxia with all the ensuing consequences;
  • trauma in childbirth;
  • injuries of the soft tissues of the genital organs in the mother;
  • hypotonic bleeding in the postpartum period.

The biomechanism of childbirth in breech presentation complex and depends on the type of presentation and the degree of flexion-extension of the head. The whole process requires the utmost care from medical workers. Since the pelvic end is smaller than the head end, certain complications may occur during childbirth. The work of obstetricians is aimed at their prevention.

One of the main tasks is to prevent the rapid birth lower extremities and buttocks so that the birth canal can prepare for the birth of a larger head. With the rapid birth of a baby to the waist, it is possible to tilt the arms up, which will also complicate the further birth process.

Therefore, up to a certain point, the child is “held”, guided, and after the birth of the lower part, they apply special tricks for bringing down the arms and giving birth to the head. As soon as it is born Bottom part, the process is accelerated as much as possible, because there is a high risk of compression of the umbilical cord between the head of the fetus and the bones of the pelvis of the mother and death as a result of hypoxia.

Upon admission to the hospital for caesarean section, planned hospitalization is needed to prepare the pregnant woman for surgery, correct existing pathological conditions, stabilization chronic diseases, conversations with the anesthesiologist and choice of the method of anesthesia.

Indications for operative delivery in primiparas:

  • delayed pregnancy;
  • full-term pregnancy, but unfinished birth canal;
  • the age of the pregnant woman is over 30;
  • fetal weight more than 3600 and less than 2000 (especially if the fetus is male);
  • premature outflow of water with an unfinished neck;
  • mixed breech or foot presentation;
  • weakness of labor activity.

Indications for operative delivery in multiparous:

  • extended pregnancy + unprepared birth canal;
  • premature discharge of water + unprepared birth canal;
  • fetal weight less than 2000 and more than 3600;
  • foot presentation of the fetus;
  • traumatization or death of the fetus during previous pregnancies and childbirth.

In this article:

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

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

Diagnosis of pelvic presentation of the fetus

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

What is a breech presentation of the fetus?

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

How does pregnancy proceed with a breech presentation of the fetus

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

Fetal presentation classification

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

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

What are the causes of breech presentation of the fetus

Breech presentation may be due to the following reasons:

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

Gymnastics with pelvic presentation of the fetus

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

Exercise #1

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

Exercise #2

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

How to do the exercises correctly

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

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

Ultrasound examination and medications

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

Childbirth with breech presentation of the fetus

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

The biomechanism of childbirth in breech presentation of the fetus:

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

Prevention of breech presentation

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

AT women's consultations there are courses for pregnant women, which tell in detail about the rules that must be observed. They provide psychotherapeutic preparation for childbirth. Training is provided on breathing exercises during childbirth, recommendations are given to relieve pain, relieve nervous tension, control of the tone of the vaginal muscles.

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

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