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Cerebral presentation: the problem of extensor insertions of the fetal head in obstetric practice. Head presentation of the fetus: a fine line between the norm and pathology

If a woman already has a child, then she has already received answers to many questions regarding pregnancy and childbirth. But for expectant mothers who are waiting for the birth of their first baby, this path has yet to be passed. At different periods of fetal development, questions arise that are specific to this particular time. So, starting from the 32nd week of pregnancy, according to the results of a photo ultrasound examination, the doctor can diagnose a breech or head presentation of the fetus. For proper gestation and upcoming childbirth, this information is labeled "especially important."

What the statistics say

If we take the total number of women in labor as 100%, then only 3-5% falls on the so-called breech presentation. Childbirth in this case is considered pathological and often occurs by caesarean section.

Head presentation of the fetus is the desired and most common position for natural childbirth, when the baby's head is located at the entrance to the small pelvis. There are several varieties of this option:

  • frontal;
  • facial;
  • occipital;
  • anterior head.

Presentation and its variants are determined using a photo of an ultrasound examination, and depending on this, the gynecologist determines the tactics of childbirth. The most ideal is the occipital presentation of the fetus. In this position, the baby moves through the birth canal with a slightly bent neck and is born with the back of the head forward. Such childbirth, as a rule, takes place without breaks for the mother and without injuries for the baby.

The head presentation of the fetus according to the facial type is characterized by the maximum tilting of the baby's head. In this position, it turns out that it comes out of the birth canal with the back of the head. In this situation, focusing on palpation and the results of an ultrasound examination, the doctor may recommend a caesarean section. The option of natural delivery is also possible under certain conditions:

  • the woman in labor has a wide or regular size pelvis;
  • the fruit is not large, up to 3,200 g;
  • active course of the birth process;
  • the baby's chin is directed in accordance with the anterior variety of facial presentation.

Head frontal presentation is a 100% indication for childbirth by caesarean section. Such an arrangement of the fetus during childbirth is very rare, about 1-2% of the total.

Anterior head, or as it is also called anterior parietal, the presentation variant is characterized by such a position during childbirth, when the baby is forced to move forward with the fontanel. In this case, the mother can give birth on her own, but there is a possibility of hypoxia and trauma to the fetus.

In addition to the head arrangement of the four types, it is also taken into account to which wall of the uterus, left or right, the baby is turned back. The left, most common option, doctors call the 1st position of head presentation. If the baby is turned back to the right side of the uterus, then we are talking about the 2nd position.

That's what nature intended

The incorrect position of the fetus at the time of the onset of childbirth is caused by several reasons. This may depend on the anatomical structure of the uterus or be explained by hereditary factors. The position of the baby directly depends on the location of the placenta and polyhydramnios during pregnancy.

Head low presentation is also considered a deviation from the norm if it is diagnosed starting from the 22nd week of pregnancy. In the normal course of pregnancy, the downward movement of the fetus begins at the 38th week. At earlier periods, this may threaten premature birth or the threat of miscarriage, so the further course of pregnancy occurs under the supervision of a doctor and often in a hospital.

When diagnosing "low cephalic presentation" at home, you must adhere to a few simple, but mandatory rules:

  • exclude all types of outdoor activities and physical activity. This is especially true for lifting weights.
  • use a bandage;
  • do not take hot baths;
  • lie more and be less nervous.

Terms and methods for diagnosing the position of the baby

You can talk about the head or pelvic position of the fetus, starting from the 28th week of pregnancy. At this time, the baby's head is already palpable during an external examination during palpation. But for a more accurate determination of the position of the fetus, an ultrasound examination is performed, when on the monitor or in the photo you can see in more detail. But for about a month, the baby can change position. But starting from the 32nd week, head or breech presentation can be diagnosed with a high degree of probability.

One of the main issues closer to childbirth in pregnant women will be the position of the fetus in the uterus. Based on how the baby will be located, the course of childbirth, the possibility of their natural course and the completion of childbirth will largely depend. Why are expectant mothers so worried about the position of the fetus?

First of all, because most of the women tune in. And with incorrect positions of the fetus, often, since the child simply cannot be born on his own without receiving serious injuries. If the position of the child is correct, a woman may well give birth to a baby on her own, in a natural way.

When examining a woman in late pregnancy, the doctor determines several characteristics - the presentation of the fetus, the position of the fetus and the position of the fetus. Why do doctors need this and why are these characteristics so important for further childbirth? We will deal with this in detail.

The position of the fetus during pregnancy

This term is the ratio of a conditional line drawn through the head and pelvis of the baby to the longitudinal axis of the mother's uterus.

The position of the fetus, based on this, can be:

  • longitudinal, if the axes of the body of the fetus and mother's uterus coincide;
  • transverse, if the axes of the body of the fetus are perpendicular to the axes of the uterus;
  • oblique, if the axis of the fetus is at different angles, less than 90 degrees to the axis of the mother's uterus.

Presentation of the fetus during pregnancy

Indicates which part of the child's body is directed to the area of ​​\u200b\u200bthe internal os of the cervix. In other words, this is the place where the baby at birth will move in the pelvis. The internal os of the cervix is ​​called in medicine the presenting part. It will be in close contact during childbirth with the presenting part of the fetus itself.

Fetal presentation may be:

  • headache, if the head is located in the area of ​​\u200b\u200bthe exit from the uterus
  • pelvic, if the buttocks are located in the area of ​​\u200b\u200bthe exit from the small pelvis.

In the transverse position of the fetus, the presenting part is not determined, it does not stand with any part of the body in the pelvic cavity.

Until the time of 32-34 weeks, the position and presentation of the fetus do not play a role, they are not stable and the fetus may well turn around in the right or unsuccessful part. After a period of 34 weeks, the position and presentation of the fetus becomes stable, the baby takes exactly the position and position in which he will be born.

In each of the presentations, there are many options for how the baby can lie down, and the course and outcome of the birth process will depend on the final position of the baby.

Head presentation of the fetus during pregnancy

This arrangement of the fetus is typical for 95-98% of all births. Moreover, this position is most correct for the natural birth of the crumbs. But in this type of presentation there may be variations:

  • occipital presentation;
  • flexion presentations.

Occipital presentation of the fetus

The most physiological and easiest for childbirth is g tin occipital presentation of the fetus.

With it, the head is tilted forward, the child's chin is pressed to the chest. At birth, the baby exits the mother's birth canal with the back of the head forward. In childbirth, there is the concept of "leading point" - this is the place that goes through the birth canal first. In this case, this point will be a small fontanelle, the junction of the occipital bone and the parietal bones of the fetal head.

There are two options for this presentation:

1. Anterior view of the occipital presentation. This is the back of the baby's head, facing the pubis of the mother's body, and the face looks into the mother's pelvic area. This is the most correct and convenient presentation for birth, it is in this form that up to 90% of all births occur. With this presentation, the baby passes through the birth canal with the smallest size of the head, which minimizes the likelihood of injuries in childbirth for both the mother and the child himself.

2. Rear view of the occipital presentation, if the back of the head is facing the mother's pelvis, and the face is facing the pubis. In this type of presentation, childbirth is more difficult, but the baby in the process of movement may well turn around and take the correct position. If the posterior presentation persists, then this will seriously delay the birth process and complicate it.

Depending on where the back of the fetus will look, the legs and buttocks of the fetus may deviate to the right or left.

extensor presentation of the fetus

Cerebral presentation can be extensor, depending on how extended the fetal head will be in relation to the mother's pelvic area. In extensor positions, the fetus raises the chin to varying degrees of height.

1. Anterior head presentation.

With it, the fetus slightly unbends the head, and the area of ​​\u200b\u200bthe large fontanel, the junction of the bones of the frontal and parietal, becomes the leading point in childbirth. With such a presentation, natural childbirth is quite possible, however, they will take longer and more difficult than with the occipital version. With it, the fetal head rises into the mother's small pelvis with its largest size. Sometimes such a presentation of the fetus can become an indication for a caesarean section, everything will be decided directly on the situation, during childbirth.

2. Frontal presentation.

This is the next degree of extension of the fetal head, it is rare, with a normal full-term fetus, natural childbirth will be difficult, and prompt completion of labor is required.

3. Facial presentation, this is the maximum extension of the fetal head with the insertion of the crumbs into the birth canal of the face. At the same time, the baby's face will be born first, this is rare. On the face of the child, a birth tumor will form in its lower part, on the chin and lips. Such childbirth is very traumatic for the mother and the fetus itself, which often leads to the fact that the issue is resolved in favor.

The diagnosis of extensor presentation of the fetus is carried out by the obstetrician-gynecologist leading the birth during a vaginal examination directly in the process of childbirth. He also decides on the further management of childbirth in case of anomalies.

Breech presentation of the fetus

The position of the baby upside down and pelvic end down occurs in about 4-5% of births.

Pelvic presentations are divided into several types:

  • Foot presentation, when the legs of the fetus are the first to enter the birth canal. Less favorable for natural childbirth.
  • Breech presentation, when the child has a pose, as if squatting, positioning his buttocks towards the exit from the birth canal. More favorable for natural childbirth.

In the presence of a breech presentation of the fetus, childbirth is always pathological due to the large number of possible complications in the mother herself and in the fetus. Due to the fact that the pelvic end of the fetus, small in volume, is born first, difficulties can often arise when removing the head later.

In the presence of a foot presentation, the obstetrician delays the birth of the crumbs, the doctor prevents his advancement with his hands. This prevents the fetal leg from falling out until the baby "squats down" as it were. Thus, everything is done to achieve the birth of the first buttocks. Such a procedure, of course, complicates the course of childbirth, making them more painful.

However, today the presence of a breech presentation itself is not an indication for a caesarean section. The question of the type of delivery is taken on the basis of taking into account many factors that will be decisive in the process of childbirth.

These include:

  • the size of the fetus and its weight, for breech presentation it is a weight of more than 3500 g;
  • the size of the mother's pelvis;
  • type of breech presentation - legs or gluteal;
  • the sex of the child, since the birth of a girl in breech presentation is associated with fewer risks than for a boy (since a boy may have damage to the external genitalia during childbirth or an early first breath may occur in the womb due to irritation of the testicles) .;
  • mother's age;
  • during previous births.

Oblique position of the fetus during pregnancy

Usually, the fetus is forced to take this position if there are abnormalities in the structure of the uterus or tumors, obstacles. In this position, childbirth is unequivocally carried out in an operative way, the passage of the natural birth canal by the child in this position is simply impossible.

The presentation of the fetus in this case is not determined - there is no presenting part.

If there are no apparent reasons for the fetus to take this position, it is worth doing the exercises to stimulate the rotation of the crumbs, described below. With an oblique position of the fetus, you need to lie as much as possible on the side towards which the back of the fetus is looking.

With a stable oblique or transverse presentation, a woman is placed in a maternity hospital two weeks before birth and the issue of delivery will be decided, which will be most favorable in this situation -.

Previously, manual correction of malpresentation of the fetus was practiced by external rotation of the fetus. Through the anterior abdominal wall, the doctor tried to move the head of the fetus down. To date, such actions have been abandoned as ineffective, having a large percentage of complications in the form of premature birth, violations of the child's condition and placental abruption.

Exercises to turn the fetus into head presentation

Usually, from the 31st week of pregnancy, if the fetus is located with the legs down or obliquely / peppered, the woman is prescribed special exercises and certain actions. They will stimulate the fetus to turn into the correct position for childbirth.

What can be done:

  • Lie on your right side, lie down for 10 minutes, quickly turn to your left side and after another 10 minutes again to your right. You need to repeat these actions several times in a row throughout the day before eating.
  • Stand in the knee-elbow position for at least 15-20 minutes daily.
  • Swim in the pool.
  • If the baby rolled over on his head, you will be advised to wear a special bandage for a couple of weeks at least, so that you can fix the correct position of the fetus.

Such actions may be contraindicated. Contraindications include:

  • uterine tumors;

With a stable breech presentation, a woman is placed in a maternity hospital two weeks before delivery and the issue of delivery will be decided, which will be most favorable in this situation.

In Mom's Store, buy for sleep,

Basically, every pregnant woman tries to learn as much as possible about her interesting position. Very often, when undergoing an ultrasound scan, you can hear about such a parameter as the head position of the child in the womb.

So what is it - head presentation of the fetus ? Is this phenomenon normal or does it need to be corrected? For details, of course, it is better to ask your doctor. Do not be afraid to ask disturbing questions.

What does cephalic presentation of the fetus mean and what does it affect?

Firstly, this is the most common position of the baby in the uterus. Secondly, this is the most desirable phenomenon for natural childbirth. The term is understood as the location of the head of the crumbs at the entrance to the mother's small pelvis.

In the vast majority of cases, the baby is located in the uterus upside down. Only in 3-4% of situations does breech presentation occur, which is often a contraindication to natural childbirth.

Doctors distinguish several options for situations when the position of the fetus is longitudinal, and the presentation is head. They influence the determination of the tactics of childbirth and the prevention of complications during delivery.

Types of presentation

Among obstetricians and gynecologists, it is customary to divide this phenomenon into the following options:

  • Occipital - the most optimal parameter. When a child is born, the bent neck passes first through the birth canal and the back of the head appears first. Such a mechanism of childbirth is observed in the vast majority of cases. It is worth noting that this position of the head allows the woman to avoid ruptures, and the child - injuries;
  • Facial. It is characterized by maximum extension of the baby's head. It is born with the back of the head. However, due to the prevailing circumstances, a caesarean section is often used, but there are exceptions when natural childbirth is also welcome;
  • Frontal - quite rare. In such a situation, the wire point in the birth canal is precisely the forehead of the child. This option involves only a caesarean section, and natural birth is excluded;
  • Anterior head, or anterior parietal. A large fontanel will be a conducting point during expulsion. Childbirth in this case can be both conservative and operative, however, with natural delivery, the risk of child injury is high. A mandatory preventive measure for an anterior head location is the prevention of fetal hypoxia (lack of oxygen).

In addition, the position of the child is possible in two more positions. The first means that the back of the baby is turned to the left wall of the uterus. This phenomenon is very common. The second position is the opposite - the baby is turned back to the right uterine wall.

However, not in all cases, the back of the baby is facing any of the sides. Often it is turned anteriorly or backwards. Thus, the positions are distinguished: front view - back anteriorly, rear view - backwards, respectively.

Unfavorable situations can be provoked by the following reasons:

  • Narrow pelvis;
  • abnormal shape of the uterus;
  • polyhydramnios;
  • Heredity;
  • uterine fibroids;
  • Placenta previa.

Low presentation in the uterus of the fetal head

The expectant mother often learns about this phenomenon at 20-36 weeks of pregnancy. It is worth noting that normally the fetus should descend at 38 weeks. The low position of the head can cause premature birth, so doctors in this situation should carefully monitor the condition of the woman, and she, in turn, must follow the doctor's instructions and take any actions with extreme caution.

Usually, the process of childbirth under such circumstances goes quite well. Neither the baby nor the mother receive negative consequences.

  • Wear a special prenatal bandage;
  • Refuse physical activity;
  • Not to run;
  • More rest.

Diagnosis of presentation

Already at the 28th week of pregnancy, the observing gynecologist will be able to tell about the presentation of the baby after a routine examination. To determine this parameter, use the techniques of external obstetric research.


It is possible to confirm or refute the diagnosis with the help of ultrasound. An ultrasound scan will help establish the type of presentation as early as 22 weeks. But it should be borne in mind that before the birth, the situation can change several more times. Usually at week 32, the child changes his position several times, since the uterus allows him to actively move, because there is already a lot of space in it.

A woman can determine the location of the baby on her own. It is necessary to take a position lying on your back, bend your knees and put your hand on the lower abdomen.

The biomechanism of childbirth in stages with head presentation:

  • The norm is childbirth with an anterior occipital head longitudinal arrangement. They are also the most favorable. The head appears first. Coming out of the small pelvis, it bends;
  • The chin at this time is strongly pressed against the chest;
  • When entering the birth canal, the small fontanel is the conducting point;
  • Passing, the head turns inside, and the face turns to the sacrum, and the back of the head to the pubic joint;
  • When the head is exposed to the light, it will straighten out;
  • Then there is a turn of the shoulder girdle and at the same time the head, which is outside. As a result, the baby's face turns to the mother's hip;
  • After the release of the shoulders, the turn of the rest of the body comes.

If the birth takes place with a posterior view of the occipital presentation, then the biomechanism of the process is often accompanied by certain difficulties. For example, the head turns to face the pubic joint, and the back of the head to the sacrum, so the progress of the crumbs through the birth canal is delayed.

As a result, there may be a weakening of labor activity, which is dangerous for its complications. In such a situation, doctors conduct artificial stimulation. With the development of asphyxia (suffocation), obstetric forceps are applied.

Natural birth, when head presentation is facial, is possible in the following cases:

  • The fruit is not large (up to 3.5 kg);
  • Normal size of the pelvis;
  • The child's chin is turned forward;
  • Active labor activity.

In this case, doctors take a wait-and-see attitude. Both the dynamics of labor and the condition of the woman in labor are strictly controlled. The baby's heartbeat is monitored using cardiotocography and phonocardiography. If the face presentation is accompanied by a backward chin, then surgical intervention is necessary.

Quite a rare occurrence is an independent birth with a frontal position. It can be complicated by: rupture of the uterus and perineum; the occurrence of vaginal-vesical fistulas; fetal death. Before inserting the head into the small pelvis, the obstetrician-gynecologist is able to turn the fetus, but if this is not possible, then the baby can only be born as a result of a caesarean section.

Anterior presentation also requires waiting. If any complications arise that threaten the health of the mother or child, then a caesarean section is performed.

Prevention of complications in the head position of the child in the uterus

If a woman is diagnosed with head presentation of the fetus in a pathological variant at the 30th week of pregnancy, then she should be hospitalized in advance in a medical facility. Such measures are necessary for doctors to determine the tactics of childbirth.

This is the location of the fetus parallel to the woman's body with the head towards the small pelvis. In gynecology, this situation indicates the preliminary readiness of the female body for childbirth. The presentation of the fetus is determined using ultrasound. It is the head presentation of the fetus that is considered the most favorable for the passage of childbirth in an independent form.

What does cephalic presentation of the fetus mean?

With the head position of the fetus in the womb, its head is turned towards the internal pharynx of the cervix. Head presentation of the fetus is designed for the fact that the head of the child, as the largest part of the body, will be the first to move through the birth canal. This will allow you to leave the uterus and other parts of the baby's body without injuries and complications. Usually, up to 30 weeks, the position of the fetus in the uterus is quite variable, but by 35 weeks, most fetuses are characterized by cephalic presentation.

What is the head presentation of the fetus, a woman can not find out right away. Most often, in the first half of pregnancy, a woman can behave quite freely. But if the breech presentation is further determined, then the likelihood of complications during childbirth increases: timely withdrawal of water, prolapse of the limbs of the baby and the umbilical cord, pathologies during childbirth, fetal asphyxia, infection, prolonged passage of the baby. With such childbirth, there is a high probability of postpartum hemorrhage, to prevent which the woman in labor is given intravenous oxytocin and methylergometrine. In this case, the woman should observe bed rest to the maximum. It is recommended that a future woman in labor lie on her side, where the back of the fetus “looks”.

What are the options for head presentation of the fetus?

The head presentation of the fetus, the longitudinal position of the child in which remains clear and stable, contributes to the formation of several options for the location of the fetal head: facial, frontal, anterior head, occipital.

The safest and most convenient for the child is the occipital flexion presentation. The small fontanel on the baby's head in this case will act as the axial point of movement along the birth canal. The head presentation of the fetus in the occipital version implies such a movement of the child through the birth canal of the mother, in which the baby's neck will be bent and his birth will begin precisely with the appearance of the back of the head. This option includes up to 95% of births.

But the folds of the neck with the head presentation of the fetus can be quite diverse. Therefore, doctors distinguish 3 main degrees of extensor presentation:

Grade 1 - anterior parietal flexion occipital presentation.

In such a situation, as described earlier, the fontanel on the head of the fetus indicates the direction of movement of the fetus. With such a presentation of the fetus, independent childbirth most often occurs, but the level of injury to both mother and child is significantly higher. For such childbirth, prolonged flows are characteristic, so doctors practice prevention of fetal hypoxia.

Grade 2 - frontal presentation.

In frontal cephalic presentation, the fetal head enters the pelvic tract at its widest point. But the main point of movement is already the forehead, which is lower than all other parts of the baby's body. With such a head presentation of the fetus, independent childbirth is completely contraindicated, urgent delivery is urgently required.

Grade 3 - facial presentation.

Facial presentation is the extreme degree of maximum extension of the fetal head. The axial point of advancement along the birth canal of a woman is the chin of the fetus. During childbirth, the initial exit of the baby's head is observed, and after the back of the head. In this case, the probability of childbirth in a natural way is 50/50%. Successful independent childbirth is possible under the condition of a small fetus and a wide pelvis in the mother, in other cases, obstetricians resort to caesarean section.

The main causes of extensor cephalic presentation of the fetus include a narrow pelvis in the expectant mother, uterine fibroids, abnormalities in the structure of the uterus - all this significantly takes the space for the existence of the fetus. Also, polyhydramnios or placenta previa, flabby abdominal wall and more can become causes.

Approaches to the diagnosis of cephalic presentation of the fetus

Gynecologists begin to monitor the head presentation of the fetus from the 28th week of pregnancy. The general study is performed by positioning the doctor's open right palm over the symphysis. In this position, a dense round part is groped, which is the head of the fetus. Head presentation is indicated by its placement above the entrance to the small pelvis. The head of the fetus is very mobile in the uterine waters. Therefore, doctors practice an additional vaginal examination.

With the help of gynecological ultrasound, the position of the fetus, its position, bearing, articulation, type of fetus are determined. Having specified such details, under the navel, women consider the baby's heartbeat.

It is very important to make an accurate diagnosis of fetal presentation, which mainly affects the birth scenario.

The standard correct version of childbirth includes childbirth with an occipital anterior head presentation of the fetus. With such a diagnostic result, a woman in labor should not worry about the conformity of the birth canal and the size and shape of the fetal head. This type of childbirth is the safest, since the baby's chin is hidden inside the body closer to the baby's chest. Due to the correct bending of the head, the birth canal is less injured, since the baby's head is located in the smallest possible way. In addition, there is an additional coup of the fetus, in which the face turns to the sacrum of the mother, and the back of the head is directed towards the pubic joint.

All other options for childbirth are distinguished by their complexity due to the expanded head presentation of the fetus. The baby turns the back of the head to the sacrum. In this case, childbirth is significantly delayed in time, which can cause fetal asphyxia or the development of weak secondary labor activity. In such a situation, care and experience from obstetricians are very much required.

The mechanics of the passage of labor in the anterior head presentation of the fetus is accompanied by the passage of the baby's head, following the movement of the large fontanel. Obstetricians are required to be diligent, to be able to expect, but also to respond urgently in critical situations, if there is a danger to the life and health of the mother or child.

After the diagnosis of frontal cephalic presentation of the fetus, childbirth occurs mainly with the help of surgical intervention. For a woman, such childbirth is very painful. Natural childbirth with such indications threatens to threaten with deep ruptures of the birth canal and genital organs. At the beginning of labor with frontal cephalic presentation, gynecologists try to perform an additional turn of the fetus, but if an attempt is impossible, then they resort to a caesarean section, and a craniotomy is performed.

Diagnostic indicators for the normal course of childbirth with a facial head presentation are the wide dimensions of the woman's pelvis, the small size of the fetus, the body's tendency to active labor, and the baby's chin turning forward. In this case, special attention is paid to the dynamics of childbirth, the state of health of the woman in labor, the heartbeat of the fetus is carefully measured on the basis of cardiotocography, phonocardiography. If, with a facial head presentation, the chin is the dominant point in the direction of movement, then a caesarean section is immediately required. In this case, there are very big threats to the life of the baby. If the fetus is stillborn, a craniotomy is performed immediately.

Features of the prevention of complications in childbirth

If a woman has any abnormal changes in the state of health of the gynecological organs, then the likelihood of a difficult birth that will require surgical intervention is very high. For such women, a very thorough diagnosis of the condition of the fetus, its location, and aspects of placement is required. A woman in labor is most often issued for a stationary regimen to avoid additional stress and irritation in the environment of everyday life. In addition, during this time, a detailed rational tactics for the adoption of childbirth is being developed. With the timely determination of the complicated presentation of the fetus, the woman manages to tune in to a caesarean section, in which case the likelihood of a subsequent psychological disorder decreases.

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

What is cephalic presentation of the fetus?

Pregnant women often hear this wording from gynecologists during examinations from the 30th week of gestation. Far from all expectant mothers understand a complex medical phrase, so they begin to worry about the condition of the baby developing in the stomach. What is fetal presentation, is the head position a norm or a dangerous pathology?

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

What is head presentation of the fetus?

Gynecologists distinguish four types of head location of the child:

  1. Occipital. Obstetricians consider this position the most convenient and safe. When the baby moves through the birth canal during childbirth, his neck is in a bent state. The nape of the baby emerges first from the mother's vagina. More than 95% of births proceed as described above. With occiput presentation, most babies are born without injury, and mothers are usually not diagnosed with ruptures.
  2. Facial. In this position, the baby's head is strongly thrown back. In the process of childbirth, the baby's face is shown first from the mother's genital tract. Usually, with facial placement of the fetus, doctors send patients to a caesarean section to prevent complications. Although many women successfully give birth in a natural way.
  3. Execution. This type of presentation is recorded extremely rarely. During childbirth, the baby's forehead comes out first from the mother's vagina. In this position of the fetus, surgical intervention is necessarily prescribed, natural childbirth is not allowed.
  4. Anterior head. This type of presentation is also called anterior parietal. The first fontanel of the child, located on the top of the head, is shown from the vagina. With an anterior head placement of the fetus, you can give birth both by caesarean section and in a natural way. But with natural childbirth, the baby is more likely to be injured. There is also a high risk of hypoxia of the baby in the process of coming out into the world.

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

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

Doctors usually tell women about low cephalic presentation of the fetus at 20 weeks of gestation. This is too early, normally the child, preparing for birth, should descend into the pelvic cup at 38 weeks. Due to the low head presentation of the fetus at 20 weeks, the risk of preterm labor is high. But there is no need to worry: gynecologists are closely monitoring the condition of patients with an unfavorable diagnosis. Young mothers who have a low head presentation of the fetus in the womb should listen to all the advice of medical specialists and move with extreme caution. Doctors recommend that women with a low placement of the child:

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

In the vast majority of cases, childbirth with a low position of the baby takes place at a normal time, and is not accompanied by complications.

What causes fetal misalignment?

Sometimes gynecologists diagnose in pregnant women not the head presentation of the fetus, but the pelvic one. That is, the baby is not placed in the uterus upside down, but sits in the bowl of the mother's small pelvis with legs or ass. The following factors provoke the wrong position of the child:

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

With a pelvic or transverse location of the child, the gynecologist decides which method to perform obstetric care. With pelvic placement of the fetus, both ordinary childbirth and surgical intervention are allowed. Obstetricians perform a caesarean section in cases where the woman in labor has too narrow hips, or if the baby is large. With a transverse presentation, when the baby is located horizontally in the uterus, obstetric care is carried out exclusively by caesarean section. Natural childbirth is contraindicated.

How is head presentation diagnosed?

How is head presentation of the fetus detected during pregnancy? At about 30 weeks of gestation, the expectant mother will learn from the gynecologist detailed information about the location of the baby in the uterine cavity. Diagnosis of presentation is usually made through a standard gynecological examination. The gynecologist plunges his fingers into the patient's vagina, gropes the crown of the fetal head above the pelvic cup. With a pelvic location, the doctor's fingers stumble on the legs or ass of the crumbs. To confirm the diagnosis, the patient is sent for ultrasound monitoring.

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

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

Obstetricians call childbirth safe, in which there is a longitudinal occipital position of the fetus, head presentation of the fetus. When the baby goes out through the vagina, he tilts his head, his chin is pressed against his neck. The head, pushing forward, makes a turn. The child's face turns to the maternal sacrum, and the back of the head - to the pubic symphysis. When the head finally emerges from the vagina, it unbends, then the baby's shoulders straighten, and the face turns to the mother's thigh. The shoulders and head come out the hardest of all, the trunk and limbs leave the birth canal without difficulty.

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

With a facial arrangement, natural childbirth is allowed only if the woman has sufficiently wide hips, the fetus is medium-sized, labor activity proceeds intensively. During childbirth, obstetricians carefully monitor the physical condition and well-being of the woman in labor, using cardiotocography, they calculate the heart rate of the child being born.

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

In the anterior head position, childbirth is often carried out in a natural way. But if the obstetrician understands that the health of the mother and the life of the child are in danger, then he appoints a caesarean section.