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What does the expectant mother need to know about fetal presentation? What does the longitudinal position of the fetus mean, how it happens and how it affects childbirth

The position of the fetus is the ratio of its axis to the axis of the uterus. It can be longitudinal, transverse or oblique. Until 34 weeks, the position of the fetus inside changes, but after this period it becomes stable.

Presentation shows which part of the fetus is located above the exit from the uterus. Experts determine this parameter from week 28. In the normal course of pregnancy, the baby is in the occipital presentation.

Fetal position

Incorrect position - a phenomenon when the axis of the fetus does not coincide with the axis of the uterus. Allocate oblique and transverse position. With this placement, the presenting part is absent in the womb. Natural childbirth in this case is impossible, if a woman begins to have contractions, there is a high risk of rupture of amniotic fluid and fetal hypoxia. Incorrect posture occurs in 0.2-0.4% of all pregnancies. This phenomenon can be provoked:

  • Multiple pregnancies.
  • Polyhydramnios.
  • Narrow pelvis.
  • Decreased tone of the uterus.
  • Flabby muscles of the anterior abdominal wall.

With normal development, the fetus should take a longitudinal position in the embryo position - the arms are crossed on the chest, the legs are pulled up to the stomach and pressed. The following types of provisions are distinguished:

  • Longitudinal - the axis of the fetus and the uterus coincide.
  • Oblique - the axis of the uterus and the fetus intersect at an acute angle.
  • Transverse - the axis of the uterus and the fetus intersect at right angles.

With an oblique and transverse position, the child will not be able to be born naturally. When leaving the pelvis, the fetus can receive serious injuries that lead to disability and even death. With a transverse position, a woman at 37 weeks of gestation is hospitalized in a hospital and a cesarean section is performed. When oblique, they try to turn the fetus over for some time. If the child does not take a longitudinal position, surgery is performed.

Fetal presentation

There are two types of presentation: pelvic and cephalic presentation. If a woman is diagnosed with breech presentation, then from 32 weeks she is recommended to perform special exercises or sent to an obstetric coup.

At 38-39 weeks of pregnancy, a woman should go to the hospital. There it is determined how the delivery will take place. The doctor needs to assess in advance the size of the fetus, pelvis, the age of the mother and the readiness of her body for childbirth. Breech presentation is not always an absolute indication for cesarean, however, in the presence of complicating factors, another option for childbirth is not considered.

Breech presentation of the fetus

Breech presentation - the location of the fetus in the womb when its buttocks or legs are above the exit to the small pelvis. Pregnancy with this pathology proceeds in conditions of a constant threat of interruption, during childbirth there is a high risk of fetal hypoxia and serious injury to it. Diagnostics takes place during vaginal and external examination, Doppler ultrasonography, echography and CTG. You can change the position of the fetus with the help of special exercises or an external coup.

Among the causes of breech presentation are:

  • Lots or low water.
  • The mother has a narrow pelvis.
  • Multiple pregnancy.
  • Excessive fetal activity.
  • Placenta previa.
  • Pathology of the uterus.
  • Fetal developmental anomalies.

With a breech presentation, there is a risk of spontaneous interruption. This situation negatively affects the development of the child's endocrine and nervous systems. Starting from 33-36 weeks, the development of the medulla oblongata slows down - this leads to perivascular and pericellular edema. To minimize the negative impact, the child's pituitary gland begins to work more actively, which depletes the adrenal cortex and slows down the development of immunity.

Breech presentation can be breech and foot.

  1. Gluteal - the legs are extended along the body, the head is directed upwards.
  2. Foot - one or two of the child's legs are located above the entrance to the small pelvis.
  3. Glute-leg - both legs and buttocks are located above the bosom.

With gluteal, there are:

  1. Incomplete - the child's buttocks are located above the entrance to the small pelvis, the legs are extended along the body.
  2. Mixed - both legs and buttocks are located above the exit from the uterus.

Leg presentation can also be of several types:

  1. Incomplete - one leg of the child is bent completely, the other is unbent and looks into the mother's pelvis.
  2. Full - legs unbent at the knees are above the bosom.
  3. Knee - The baby's knees are above the entrance to the uterus.

The diagnosis of breech presentation is made after 32 weeks of gestation. Due to the fact that the baby is constantly moving in the womb, he can take the correct position for childbirth. This pathology can be recognized even for 20-22 weeks using ultrasound. Such a study helps the doctor determine the location of the back, sacrum, inter-quarter line of the fetus, and assess the degree of bending of its head.

Breech delivery

Women should be hospitalized for 38-39 weeks. There, a complete examination is carried out, which helps to determine how the birth will take place. Also, the specialist needs to assess the condition of the expectant mother, the duration of her pregnancy, the ratio of the size of the fetus to the pelvis. Natural childbirth is indicated only with normal sizes of the pelvis and fetus, good condition of the birth canal, bent or slightly unbent head of the child, with a mixed or purely breech presentation.

Among the absolute contraindications to natural childbirth, a narrow pelvis, the presence of signs of hypoxia and impaired blood flow, Rh-conflict, lipid metabolism disorders, the age of a woman in labor over 30 years old, unpreparedness of the birth canal, overmaturity, foot presentation of the fetus and multiple pregnancy are distinguished. In each individual case, the attending specialist chooses how the delivery will be carried out, based on the individual characteristics of the mother and child.

Head presentation of the fetus

Cephalic presentation of the fetus is the normal and most common position of the baby in the womb.

With it, the baby's head is right above the entrance to the small pelvis. Cephalic presentation occurs in 97% of all pregnancies. The most optimal for natural childbirth is the occipital, when the chin of the fetus is pressed against the legs. During the exit from the uterus, the back of the head appears first in this case.

With a head presentation, the following types are distinguished:

  1. Occipital - The occiput facing forward is the first to appear during childbirth.
  2. Antero-parietal - the head is born first.
  3. Frontal - during childbirth, the baby's forehead is shown first.
  4. Facial - when the head is first born with the back of the head back.

With frontal presentation, natural childbirth is rarely carried out, because this can provoke complications: rupture of the uterus or perineum, the formation of vaginal fistulas, and fetal death.

With anteroposterior presentation, childbirth can take place both naturally and with the help of a cesarean section. However, in the first case, the risk of injury to the baby is high, it is important to prevent fetal hypoxia. With a facial presentation, the fetus exits the birth canal with the back of the head. This is accompanied by maximum extension of the head. With a facial presentation, a woman can give birth both naturally and with the help of surgery, the doctor will determine the exact method.

Low fetal presentation

At 38 weeks of gestation, the fetus begins to slowly descend. However, sometimes the process starts at 20-36 weeks. Low presentation is not a pathology, it does not affect the condition of the child or the expectant mother. This arrangement of the fetus is an individual feature of the female body. Despite the relative safety, this condition requires increased attention, as it can provoke premature birth. With him, a woman will have to wear a prenatal bandage and completely abandon lifting weights and walking up stairs.

Head longitudinal presentation of the fetus - photo and characteristic features of this position when the head of the unborn child is turned towards the entrance to the small pelvis. You can find out the presentation of the fetus during the examination, using special obstetric techniques, as well as ultrasound. The most common and preferred presentation is cephalic presentation, which guarantees easy spontaneous delivery.

What is the head presentation of the fetus? Photo and description of the situation.

The cephalic presentation is the most favorable position of the fetus in the uterus. This is known to all expectant mothers. However, few people know that even if a child lies with his head down, sometimes he will not be able to come out on his own. The success of childbirth depends on the size of the fetus, on the activity of labor and on some of the nuances of the position of the unborn baby in the uterus.

The longitudinal head presentation includes several variations in the location of the fetal head: anterocephalic, occipital, facial and frontal. The most optimal in obstetrics and gynecology is considered to be the occipital flexion presentation. In this case, the leading point for moving along the birth canal is the small fontanelle. With this variant of presentation, the neck of the child in the process of passing through the birth canal is bent so that at the time of birth, the back of the head is initially born, facing forward. Up to 95 percent of all births proceed in this way.

But in the cephalic presentation, there are also variations of the extensor insertion of the head, which differ from each other.

Interesting on the net:

    The first degree is the anterior head (or anteroparietal) presentation of the fetus.

    A similar head presentation as a wired point during the period of exile uses a large fontanelle... Also, the possibility of spontaneous childbirth is not excluded, but the likelihood of birth trauma of the newborn and the mother is much higher than with the occipital presentation. Childbirth has a protracted course, and therefore, in such a case, prevention of fetal hypoxia should be carried out.

    Second degree: fetal position - longitudinal presentation of the head, frontal.

    In this case, the fetal head also enters the pelvis with its maximum size. The forehead acts as a wired point, which is lowered below the rest of the head. In this variant, independent childbirth is impossible, operative delivery is desirable.

    The third degree is facial presentation.

The extreme degree of head extension is facial presentation. In this version, the chin is used as a leading point, the baby's head comes out of the birth canal with the back of the head. In such a case, the possibility of natural childbirth is not excluded if the woman has a large pelvis or a small fetus. However, a facial presentation is usually an indication for a caesarean section.

The reasons for various non-standard fetal presentations are the small width of the pelvis in a pregnant woman, an abnormal structure of the uterus, uterine fibroids, limiting the space available to the child, placenta previa, polyhydramnios, flabby abdominal wall, heredity, etc.

How to diagnose cephalic presentation of the fetus?

The presentation of the fetus is determined by the obstetrician-gynecologist. This can be done from the 28th week of gestation using an external obstetric examination. To this end, the doctor places his open palm over the symphysis, covering the presenting part of the child. In the case of a cephalic presentation above the entrance to the small pelvis, it is possible to determine the head palpable with a rounded dense part. The data obtained during an external examination must be clarified by a vaginal gynecological examination.

The presentation of the fetus determines the method and method of delivery. To make an accurate diagnosis, it is necessary to conduct an ultrasound scan. An experienced doctor can determine the presentation of the fetus already at the twenty-second week. But before labor begins, this situation may change. Finally, the intrauterine position of the fetus is established at the thirty-sixth week.

Longitudinal is considered the most correct and optimal. It is the most common, and with it the baby's head lies down in the direction of the exit from the uterus. In such a presentation, with qualified medical care, childbirth will be successful and with the least pain.

Labor with longitudinal cephalic presentation in most cases takes place naturally. Except in cases where the fetus is too large (more than 3600 g) or the size of the pelvis of the expectant mother does not allow the baby's head to pass. Such situations can be an indication for a cesarean section.

When defining what a cephalic presentation of the fetus means, it is important not to confuse this concept with the position of the fetus. The longitudinal position of the fetus in the cephalic presentation can have two positions:

  • 1 position of the head presentation - the baby's back lies to the left uterine wall;
  • 2 position of the cephalic presentation - the back of the fetus is facing the right uterine wall.

The types of positions are also distinguished: anterior, in which the back is facing anteriorly, and a posterior view of the cephalic presentation, in which the back is facing posteriorly.

Low head presentation of the fetus

It is possible to determine the low location of the fetus from the twentieth to the thirty-sixth week. Then, as the lowering of the fetus during the normal course of pregnancy occurs at the thirty-eighth week. This diagnosis should not be panic-stricken. This situation can provoke premature birth, but if you follow all the doctor's recommendations, then the birth will take place safely and on time.

If a pregnant woman is diagnosed with a low head presentation of the fetus, it is recommended to wear a special prenatal one, limit physical activity, do not run and rest more often.

In the normal course of labor with a longitudinal cephalic presentation of the fetus, the birth canal first passes the head, and then the whole body slips out. Women who are at risk of childbirth with pathologies are recommended hospitalization, where they will be under the supervision of specialists.

Every expectant mother wants her pregnancy to go well, and the baby develops in the womb according to the accepted norms.

But not all women understand the terminology used by doctors in documents. Therefore, pregnant women often have questions about medical reports. Often they are put on the location of the fetus in the uterus.

What does the longitudinal position of the fetus mean?

When the expectant mother receives the results in her hands, she sees a diagnosis that concerns the location of the baby in the womb. Not everyone understands the meaning of medical terms, conclusions, and even if the doctor says that everything is fine with the child, they are tormented by doubts. So, how does the position of the baby in the mother's belly affect pregnancy and future childbirth?

This question worries primiparous women most of all. What does the longitudinal position of the fetus mean? How is this medical term to be understood? The longitudinal position of the fetus is the most optimal and correct for a healthy delivery. This means that the axis, that is, a straight line running along the spine of the fetus, is strictly along the axis of the uterus.

If the medical report says that the position of the child is longitudinal, which means that everything is fine with you! Your baby lies with its head towards the exit of the uterus, and the birth will be successful, less painful. You should know that the longitudinal position of the child in the uterus is the most common. Such placement of the fetus occurs in 95-97% of cases. But the remaining 3-5% is a breech presentation of the fetus. Childbirth with this presentation is considered pathological.

If the position of the fetus is longitudinal, the baby is not large, the size of the mother's pelvis allows the baby's head to pass, then he will be born naturally. The child will descend along the birth canal and gradually expand them. After the birth of the head, the rest of the body will slip out of the mother's womb.

And if the presentation is pelvic?

This presentation always complicates natural childbirth, although it is rare. Those 3-5% of women in labor who have such a presentation are at risk. Only in extreme cases, with this position of the child, birth is possible in a natural way. In most cases, a cesarean section is still prescribed. In isolated cases, women give birth themselves, but this is a rather difficult childbirth. First, they must be fast to avoid complications. A woman will need it very much, and in such situations, literally every second is precious. Babies born with a breech presentation under one year old should be regularly monitored by an orthopedist in order to monitor the condition and development of the hip spine.

Secondly, breech presentation during labor can lead to bleeding. And uterine bleeding is very dangerous for both the child and the mother.

Change in fetal position before birth

It is impossible to pinpoint the reasons why the baby is in a particular position in the uterus. Until the end of the second trimester of bearing the baby, he is constantly in motion, changes his position ten times a day. This suggests that he is very comfortable in his mother's womb. As the baby grows, it already becomes cramped in the mother's stomach, and therefore it takes a certain position closer to childbirth.

Why is the head in the longitudinal position located at the bottom of the uterus? Doctors say that the head shifts due to the weight of the fetus. But this is only an assumption, and usually the position of the fetus directly depends on the uterus, its contractions and the size of the pelvis of the pregnant woman.

How to correct the position of the baby in the womb?

If the child before childbirth has settled down incorrectly, and there is still time until delivery itself, then everything can be corrected. To do this, the mother must constantly change her position and be in a position that can facilitate the movements of the child. If, for example, the head is displaced to the side and not on a straight axis, then the woman should often lie on her side where the fetus is located. And as soon as the baby takes the desired position, doctors recommend fixing this position by wearing a bandage.

Psychologists advise mothers not to be nervous about the wrong posture of the child. They recommend talking to your baby more often, stroking your belly, and asking your baby. It is necessary to explain to him affectionately and often that it will be better for him this way. Mom's voice works great on the child. He may well roll over before childbirth and take the correct position.

Specially for Elena TOLOCHIK

The longitudinal position of the fetus with a cephalic presentation is considered optimal for normal delivery. Often, after an ultrasound scan, a woman is worried if the baby is located incorrectly. This is not always a problem, so there is no need to be upset in advance, the baby takes the correct presentation before the onset of labor.

Nature provides several options for the intrauterine location of the fetus, so that childbirth is minimally traumatic. Mandatory diagnostic manipulation is used to determine the position. If the baby's head sank into the pelvis, we can say that the woman will give birth in a few days. Sometimes this time is reduced to several hours. Some location options are considered normal, while others lead to the development of complications.

What does cephalic longitudinal presentation mean? This type of placement of the baby in the uterus is considered desirable for natural childbirth. The baby's head is located at the entrance to the pelvis. You can find out about presentation with the help of ultrasound; later, the tactics of the behavior of childbirth are determined. The occipital view is considered ideal, since there are no tears and injuries in the process of the appearance of the baby.

The cephalic longitudinal presentation of the facial type is characterized by throwing the head back. In this case, a caesarean section may be prescribed. But natural delivery is possible if several conditions are present: a wide pelvis in a woman, a small fetus, an active process of contractions has begun.

The longitudinal position of the fetus with a frontal cephalic presentation indicates that a caesarean section is recommended. When the child appears anteriorly, the parietal part moves forward. Childbirth is normal, but there is a risk of hypoxia and injury.

How many days before delivery does the head go down? Most often in 5-7 days. Sometimes this period is 10-14 days. At this time, the woman finds out to which wall of the uterus (right or left) the baby has turned. If the position of the fetus on the left is the first position, the right longitudinal presentation of the head means that the expectant mother has the second position.

Norm

The longitudinal cephalic presentation of the fetus determines the type of delivery. An ultrasound is performed already at 22 weeks, where it can be seen that the head is in the direction of the exit from the uterus. This is a normal presentation and labor is easy.

In the cephalic presentation, the longitudinal position differs in different positions. This can be the anterior head, frontal, facial, and occipital views. The latter is considered optimal, since the neck is bent in such a way that the back of the head appears first.

It is possible to determine the low longitudinal head position of the fetus during pregnancy from 20 to 36 weeks. In order not to provoke early childbirth, follow the recommendations of the obstetrician. When diagnosing this type of presentation, they are prescribed wearing a bandage, limiting physical activity. Running is not recommended. It is important to pay attention to good rest.

In the normal longitudinal head position, the head appears first. If there are pathologies, a woman will be at risk. Some pregnant women have to be hospitalized.

With multiple pregnancies, a caesarean section is often prescribed. Under certain conditions, self-delivery is possible. This process is not allowed with the cephalic presentation of the first child and the pelvic presentation of the second. This can lead to clutching of the heads. Caesarean section is performed if one of the fetuses is located transversely. If triplets are expected, surgery will be needed regardless of the location of the babies.

In primiparous, the head before childbirth can be high up to 34–36 weeks. With repeated pregnancy, the head drops in a day - three. In only 5% of women in labor, the belly does not drop at all.

Reasons for the wrong position

Until 32 weeks, the fetus is in constant motion, so its location is constantly changing. In case of incorrect presentation of the head, the reason is found out, which plays an important role in the choice of the method of childbirth.

The reasons for the incorrect presentation of the child before childbirth:

  1. narrow pelvis;
  2. high water;
  3. abnormal structure of the uterus;
  4. myoma;
  5. multiplicity;
  6. heredity.

Pathology of the uterus. When a woman has a longitudinal position of the fetus, but myoma is confirmed, the head is presented incorrectly, since the growing tumor does not allow to roll over. This also includes the bicornuate of the uterus with a septum. With a large volume of amniotic fluid, the fetus becomes too active. He does not feel the uterine walls, which leads to an incorrect posture.

Multiple pregnancy. When the head presentation is longitudinal, but the pregnancy is multiple, babies cannot take the correct position for a long time. When moving, children interfere with each other. If a woman gives birth many times, the muscles weaken. The child in utero moves as quickly as possible, which leads to a change in position. The weight of the fetus matters. With an excess, the baby cannot move, and with a deficiency, on the contrary, it moves too quickly.

Hypertonicity of the uterus complicates the course of pregnancy and childbirth, limits the motor ability of the baby. The diagnosis indicates an increased risk of various events.

With hypertonia, the following occur:

  • premature birth;
  • early rupture of the amniotic membrane;
  • running lateral position;
  • lack of water.

With a lack of amniotic fluid for a long time, an infection can penetrate, which will lead to blood poisoning and peritonitis. Labor activity for 10-12 hours will lead to fetal hypoxia. If the body is bent while passing through the birth canal, the child will die.

Obstetric coup

When a woman has a longitudinally cephalic presentation of the fetus, normal childbirth takes place with a child weighing up to 3600 g. In other cases, a cesarean section is used. Premature outpouring of water provokes the onset of labor.

With multiple pregnancies, if there are no signs of complications, an obstetric coup is used. To do this, check the location of the fetus, then the child turns over with his hands, the position becomes longitudinal head. This method is used when the first baby is born, and the second is located across. Obstetricians recommend corrective gymnastics without the use of additional methods. Despite the positive reviews, it is important to know about contraindications.

Do not charge in such cases:

  • with discharge and bleeding;
  • lack or excess of fluid;
  • neoplasms and tumors;
  • increased uterine tone;
  • multiple pregnancy;
  • pathology of the placenta.

Before the appointment, study the medical history and pregnancy management chart. A woman is recommended to pay attention to bending, lifting the pelvis, knee-elbow position. Gymnastics is prescribed by the method of I.F.Dikan. She is allowed to start from 30 weeks. Perform simple three-fold turns from one side to the other.

During labor, in the head and breech presentation, the obstetrician's algorithm of actions is standard. In the seventh month, the stomach is palpated. If the position of the fetus is longitudinal, and the presenting part with the head is in a bent state, the measures necessary for the normal course of the birth process are carried out.

The mother can independently correct the presentation of the baby. If the head is on the side, it is necessary to lie more often on the side where the fetus is located. As soon as the baby is lying longitudinally, put on a bandage. The product will help to fix the presentation. Remove the bandage when swimming or to change clothes. Often the child changes position at the last moment. This is affected by the outpouring of amniotic fluid, when there is more space and the fetus turns its head down.

The only delivery option in the wrong position is a cesarean section. The natural process is considered dangerous, it will harm the baby and complicate the mother. You should not risk your health, but listen to the advice of an obstetrician. The need for prompt delivery will allow the baby to be born healthy and unharmed.