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How to understand breech presentation. Is it possible to eliminate the pathological position of the fetus. What it is

Many pregnant women on the eve of childbirth learn about the breech presentation of the fetus - a position when the child lies in the womb with the buttocks or legs forward. What to do in this case and whether it is possible to turn the child over, we will talk in this article.

How to determine breech presentation?

As a rule, the woman herself rarely independently determines the incorrect location of the child. There are only a few indirect signs of breech presentation:

  • Closer to childbirth, there is no natural “lowering” of the abdomen and easier breathing.
  • A woman, especially a thin one, may feel a hard, rounded formation in the upper abdomen - a head, which can make it difficult to turn on her side or bend.
  • Periodic "hiccups" of the fetus are more clearly felt in the upper abdomen, and not below the navel.
  • Before ascertaining the fact of breech presentation, a woman can feel the rapid movement of the baby for a long time, which is actively turning over.

Even experienced doctors during a routine examination of a woman, especially with excess fat in the abdomen, do not always determine such a pathological situation.

  • Below, above the entrance to the pelvis, the doctor determines with his hand a softer, irregularly shaped formation - the buttocks of the child.
  • Fetal heart sounds are heard more clearly above the navel. More about .
  • When viewed on a chair with a closed cervix - that is, not in childbirth, it can be difficult to determine the presenting part. If the buttocks or legs are low enough, they can be felt through the anterior wall of the vagina.

As a rule, in such controversial situations, ultrasound examination brings clarity. The ultrasound clearly shows which part of the fetus is closer to the exit.

A child in a breech presentation: how to turn it over?

As a rule, the greatest number of spontaneous or induced cephalic rotations occurs in terms of 35-37 weeks. Coups after 37 weeks are quite rare due to the large size of the fetus and a decrease in the amount of amniotic fluid. Simply put, the longer the pregnancy and the weight of the baby, the more difficult it is for him to make a 180-degree turn in a tight space.

Special sets of exercises and gymnastics have been developed that can help turn the child into the correct position. All of them, one way or another, are based on the maximum relaxation of the uterus and the anterior abdominal wall.

  1. Several times a day, at least 2 hours after eating, the pregnant woman takes the knee-elbow position or the dog position. The abdomen hangs down freely, the muscles of the abdomen and uterus relax. With one hand, the woman makes intense stroking and pushing movements along the back of the fetus to the buttocks. With this movement, the pregnant woman seems to push the buttocks to the side and up. It is recommended to stay in this position for 10-15 minutes 4-5 times a day.
  2. Following the previous complex, it is recommended to lie down on a hard surface, for example, on a hard mattress or floor, on your side. About 10 minutes on the right, then the same amount on the left. At the same time, you need to relax as much as possible.
  3. A variety of sets of exercises with pelvic elevation are also quite effective. The essence of the method is to raise the pelvis 30-40 centimeters above the floor. The woman lies on her back, and either pillows are placed under the pelvis, or her legs are thrown onto a hill: on a sofa, armchair or partner’s shoulders. It is necessary to stay in this position for 10 minutes 6-7 times a day. You can also simply raise and lower the pelvis with legs bent at the knees, as if pushing it up from a supine position.
  4. Swimming is very effective for relaxing the muscles of the uterus and pelvic floor. It is after 30-40 minutes in the pool that the sets of exercises will be more effective.

If it seemed to the woman that the baby nevertheless turned into the correct position, it is necessary to fix it tightly with a bandage. It would be even better after that to take a quiet walk.


What to do if gymnastics did not help?

First of all, do not panic and do not get upset. It is important not to stop exercising and to believe in your child's "compliance". There are cases, albeit infrequently, when the child turns over on his own a day or two before birth or with the first contractions.

If the baby "persists", perhaps there are objective reasons for this:

  1. . The larger the mass of the fetus, the more difficult it is for him to move.
  2. Low water. Insufficient amount of water does not allow the child to “swim” freely and makes it difficult to roll over.
  3. Short umbilical cord, entanglement with the umbilical cord. In such cases, the baby is happy to accept the physiological position, but the umbilical cord somehow prevents him from doing this.
  4. Myomatous nodes in the wall of the uterus. Often during pregnancy significantly increases in size. Sometimes the nodes directly deform the uterine cavity, preventing the child from turning into the correct position.
  5. Structural features of the uterine wall: septum, additional horn. These anomalies can also directly affect the positioning of the child, making it difficult for him to lie down correctly.

Tactics of delivery in breech presentation

A hundred years ago, when cesarean section was performed extremely rarely and was a very dangerous operation, various methods of turning the fetus during childbirth were actively used. These were very complex intrauterine manipulations that required great experience and skillful hands of a doctor. Now, a simple and low-traumatic caesarean section is preferred to the complicated course of such childbirth.

Breech presentation is considered pathological, natural childbirth with it is possible, but under a number of conditions:

  • good labor activity;
  • adequate understanding of the situation by the woman in labor,
  • small size of the child (up to 3700 g)
  • obstetrician experience.

Pregnant women who have a baby in a breech presentation, on the eve of childbirth, are allocated to a special obstetric risk group and are sent for prenatal hospitalization in the maternity hospital. There, a council of doctors will evaluate all of the above factors, the readiness of the birth canal for childbirth, the condition and mood of the woman, and decide which way is better to deliver a particular patient.

Alexandra Pechkovskaya, obstetrician-gynecologist, specially for the site

Useful video

Many factors influence the successful bearing of pregnancy and childbirth, and one of them is the position of the child in the mother's stomach. That is why, closer to delivery, every woman hears about the presentation of the fetus. And if along with this phrase the word “pelvic” sounds, then many questions arise.

Breech presentation of the fetus

The breech presentation of the fetus in the womb is a position in which the butt and legs of the baby are facing the exit from the uterus, and the head looks into the bottom of the reproductive organ, that is, it is at the top. It occurs infrequently - only in 2.5-5.3% of cases.

The baby in the womb can be in three positions: head, transverse (horizontal), pelvic. And if the head is the norm, then the transverse and pelvic is pathological.


 The fetus in the uterus can be in one of three positions: head, pelvic, horizontal

Throughout pregnancy, the baby is in the amniotic fluid, so it can change its position. However, normally, by the 22–24th week, he turns his head down. If this did not happen, then experts unanimously repeat that there is no reason for concern. Presentation up to 35 weeks is considered unstable and can change repeatedly. But still, in order to promote a coup, experts advise resorting to a number of measures.

Breech classification

Specialists distinguish several types of pelvic position:

  • the child lies with the buttocks down, his legs are bent at the hip joints, unbent at the knees and parallel to the body (breech or true presentation);
  • the child lies with his legs down, that is, during childbirth, his feet will appear first from the birth canal (foot full presentation);
  • the child lies with one leg down, and the second is unbent at the knee and pressed against the body (foot incomplete presentation);
  • the child lies with the buttocks and legs down, which are bent at the hip joints and knees (mixed presentation).

True presentation occurs in 60-68% of cases. Mixed, according to statistics, occurs in 20-25% of births, and foot is the least common. Moreover, the breech presentation during childbirth can change its appearance from a full foot presentation, for example, to move to an incomplete one, or vice versa.


 Breech presentation is breech, mixed, foot full and incomplete

Causes of breech presentation

This is the normal course of pregnancy. It is in this position that the child develops normally in the womb. And if the fetus turns its buttocks towards the exit from the uterus, then there are reasons for this, which can be divided into three main groups:

  • maternal factors;
  • fruit factors;
  • placental factors.

maternal factors

Maternal factors are related to the health and physiology of the mother. These include:

  • anomalies in the development of the reproductive organ (one-horned, saddle-shaped, underdeveloped uterus and other pathologies);
  • tumors in the uterus or pelvis;
  • discrepancy between the head of the fetus and the pelvis of the woman;
  • increased or decreased contractility of the uterine muscles;
  • scar on the uterus;
  • stress and nervous exhaustion.

A woman who is diagnosed with a breech presentation experiences nervous tension, worries about childbirth, which only increases the tone of the uterus and does not contribute to the coup of the fetus.

fruit factors

The cause of breech presentation may be the developmental features of the fetus. In such situations, one speaks of fetal factors, which include:

  • multiple pregnancy;
  • prematurity of the fetus;
  • anomalies in the development of the skull;
  • malformations of the central nervous system, cardiovascular, urinary and other systems.

 With multiple pregnancies, the likelihood of malpresentation increases

The wrong position is associated with prematurity because preterm birth takes place before 36 weeks. It is likely that the fetus would have had time to roll over into the head position, provided that it was born on time.

Placental factors

Sometimes breech presentation is the result of pregnancy. In such cases, they talk about placental factors, which include:

  • excess or insufficient amount of amniotic fluid;
  • short umbilical cord.

Features of the course of pregnancy

When observing a pregnant woman who has an increased risk of breech presentation (there are one or more maternal factors), the doctor resorts to a number of preventive measures to prevent possible complications. These include the prevention of placental insufficiency and the prevention of increased uterine tone.

The expectant mother is recommended to monitor her diet and lifestyle, not to overwork, avoid stressful situations, get enough sleep at night and rest during the day. All this helps to avoid nervous strain, which causes muscle tone of the reproductive organ and leads to the fact that the child, in an attempt to take a more comfortable position, turns his head up. If necessary, the doctor prescribes drugs that improve blood circulation in the placenta and reduce muscle tension.

Pregnancy caregivers know that breech presentation is associated with an increased risk of complications, so the woman is monitored more closely.

Ways to turn the fetus at different times

Since the fetus must go head first for a successful birth, various methods are used to help turn the baby from breech to cephalic.

Special gymnastics

Special gymnastics is a set of actions aimed at relaxing the muscles of the uterus, which contributes to the rollover of the fetus. The simplest include gymnastics according to Dikan and exercises to raise the pelvis, but there are other methods, for example, according to E. V. Bryukhina or V. V. Fomicheva and others.

But you should not make a decision on your own to perform gymnastics to flip the fetus. The doctor should prescribe and recommend it, choose a specific method, taking into account the characteristics of the course of pregnancy. In addition, exercises have a number of contraindications:

  • preeclampsia;
  • the likelihood of premature onset of labor;
  • the location of the placenta above the cervix (previa);
  • two or more fetuses in the womb;
  • anomalies in the structure of the uterus;
  • infertility, miscarriages and premature births in the past;
  • malformations of the child.

Gymnastics in Dikan

This method is very simple, has no contraindications and is used from the 29th week of pregnancy. It consists in the fact that the expectant mother should lie alternately on one side and the other on a hard surface for ten minutes, changing the position of the body 3-4 times. You need to perform the exercise daily for 10 days, 4 times a day before meals, and after the fetus turns head down, sleep mainly on the side where its back is located. Also, the doctor may prescribe wearing a bandage, which helps to fix the child in the head presentation.
Gymnastics according to Dikan - a very simple way to help the heart turn over to the head position

Raising the pelvis

Raising the lower body over the upper body is an effective way to help the fetus take the head presentation. Experts identify two main exercises with which you can stimulate the child to turn his head down:


The second pelvic lift exercise is also very simple:


The pelvic lift can be resorted to from the 30th week of pregnancy. You need to do the exercises on an empty stomach. If during their implementation dizziness, pain or other unpleasant sensations appear, then the classes should be stopped and consult your doctor for advice.

External rotation of the fetus

External rotation of the fetus is a manipulation performed by a gynecologist in order to turn the baby in the womb into a head presentation using light pressure on the abdomen. To carry out the procedure, the doctor gropes the head and pelvis of the child with his hands, after which he gently turns his head forward, while shifting the pelvis in the opposite direction. If it is not possible to give the desired position in this way, then an attempt is made to turn in the opposite direction (backward).

Pain medication may be used to perform external rotation, although this is not necessary for multiparous patients. The probability of successful completion of the manipulation is higher if drugs are used to relax the muscles of the uterus.


 External rotation of the fetus is carried out through the abdominal wall without vaginal intervention

External rotation of the fetus is performed at 34–36 weeks. Its success is estimated at an average of 50%, that is, it is possible to turn the child into head presentation in half of the cases. Manipulation is performed under the control of ultrasound and CTG, so experts consider it safe for the fetus, although in rare cases, negative consequences are possible:

  • twisting or compression of the umbilical cord, which causes hypoxia. Observing a pregnant woman after performing a turn avoids negative consequences;
  • placental abruption;
  • discharge of water and the development of labor activity. This complication is not critical if the turn occurs at 36 weeks;
  • trauma to the fetal shoulder joint after the successful completion of the rotation;
  • uterine rupture.

There is a lot of speculation about this manipulation that I hear from both patients and medical professionals. For many years of practice (I have been performing turns since 2001), I have not observed any complications of this manipulation. Although there is a risk of some complications, and it is negotiated with the pregnant woman before manipulation, the risk of such complications is extremely small. This risk is not comparable to that of a caesarean section or a breech birth.

Rudzevich Aleksey Yuryevich, Doctor of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology of the FPC and PPS of the Tyumen State Medical Academy, obstetrician-gynecologist

http://lib.komarovskiy.net/naruzhnyj-akusherskij-povorot.html

Even after successful external rotation of the fetus, it is possible to return to the breech presentation. This is observed on average in 10% of cases.
External rotation of the fetus is carried out under the mandatory control of ultrasound and CTG

Contraindications for external rotation:

  • multiple pregnancy;
  • scar on the uterus;
  • dilatation of the cervix;
  • the threat of termination of pregnancy;
  • fetal hypoxia;
  • placenta previa;
  • pregnancy, accompanied by toxicosis, bleeding, preeclampsia;
  • narrow pelvis;
  • high water or low water;
  • large fruit;
  • anomalies in the development of the uterus.

Conducting an external obstetric turn - video

Diagnostics

In order to determine the presentation of the fetus and conduct related studies, they resort to the help of:

  • external examination;
  • vaginal examination;
  • dopplerography;
  • cardiotocography.

External examination

This type of diagnosis is performed by a gynecologist observing pregnancy during the next visit to the antenatal clinic. It is carried out by hand, that is, the specialist feels the belly of the expectant mother and, according to certain signs (the large, hard and movable part - the head - is at the top of the abdomen, and the soft, small one is at the bottom) comes to the conclusion about the position of the child in the womb. But this method does not give an idea about the type of breech presentation, fetal weight, location of the head and other important parameters, so there is a need for other research methods.

An external examination suggests breech presentation, but other types of diagnostics are needed to clarify the position of the fetus.


 In breech presentation, the fetal heart is heard at or above the umbilicus.

In some cases, it is difficult to determine the presentation by external examination. This is possible with:

  • well-developed abdominal muscles;
  • obese women;
  • increased tone of the uterus;
  • twin pregnancy;
  • anencephaly - a malformation of the skull.

In such situations, it is possible to reliably determine the position of the fetus, as well as to find out its weight and other important parameters using ultrasound diagnostics.

Vaginal examination

Vaginal examination is a diagnostic method usually used during delivery. It allows you to accurately determine which part of the fetus (buttocks, legs, or both) is supposed to enter the small pelvis. Its necessity is explained by the fact that, even if the position of the child was accurately established before the birth, it can change during the period of labor, and this determines the tactics of childbirth and the actions of doctors.

A vaginal examination is performed when the cervix is ​​already partially dilated and the amniotic sac has ruptured. But at the same time, you must remember to be careful, because sudden movements can cause injury to the child.

Additional Research

Additional studies include dopplerography and cardiotocography. These two types of diagnostics are also carried out with the correct position of the fetus, but for breech presentation it is difficult to overestimate their importance, because Doppler and CTG give an idea of ​​the state of health of the child, the presence or absence of hypoxia. In addition, cardiotocography is necessary during natural childbirth, when the baby goes with the buttocks or legs forward. It allows you to determine oxygen deficiency in time and take the necessary measures.
CTG during childbirth with breech presentation of the fetus allows you to monitor the condition of the child and prevent acute hypoxia

Natural birth or caesarean section

With a breech presentation, delivery is possible both naturally and by caesarean section. Which of the ways the baby will be born depends on a number of factors:

  • weeks of pregnancy
  • the age of the woman and the number of births in the past;
  • the expected weight of the child;
  • varieties of breech presentation (breech, foot or mixed);
  • position of the fetal head;
  • the degree of maturity of the cervix;
  • the presence or absence of hypoxia and its degree;
  • the size of the pelvis of the expectant mother.

The doctor evaluates all the listed parameters and only then makes a decision. In this case, a caesarean section is shown to everyone without exception in such cases:

  • narrow pelvis;
  • delayed pregnancy;
  • immaturity of the cervix;
  • fetal weight over 4 kg;
  • strong extension of the head of the child.

Despite the possibility of birth through the birth canal, such a birth is dangerous with a number of complications, so a cesarean section is often done with a breech presentation.


 Normally, the chin of the fetus in the womb should be pressed to the chest, and if excessive extension of the head is established during breech presentation, then natural childbirth is contraindicated

Features of the birth process

Childbirth with breech presentation has its own characteristics both during contractions and with attempts.

During contractions, doctors usually recommend that the expectant mother lie down. This is necessary to prevent premature rupture of the membranes. The fact is that the head, when entering the pelvis of a woman, covers the entire space, therefore, only the outflow of the anterior waters occurs, and the fetus itself remains in its familiar environment. The buttocks of the child are smaller in size, which means that the amniotic fluid flows out completely, the anhydrous period increases, and the likelihood of complications increases.

One out of 20 pregnant women is diagnosed with a breech presentation of the fetus before childbirth. What does this mean? Is this a norm or a pathology? How will the birth go, and what will be the consequences for the child?

What is breech (breech) presentation

How to give birth with a breech presentation

If, after 30 weeks, the fetus “prefers” the head-up position, in some cases, with the help of gymnastic exercises and the mother being in a position lying on her side with a raised pelvis, it is possible to “persuade” the baby to roll over. But often he again takes a more convenient position for him, especially if there are anatomical prerequisites for this. Sometimes, at his own peril and risk, the doctor makes an attempt to make an external turn of the child, pushing him with his palms. But this is fraught with very dangerous complications for both the woman and the child, therefore such techniques are used less and less.


Trust an experienced doctor. He will compare the size of the mother's pelvis with the dimensions of her bladder. If a girl is expected, and the mother's birth canal is wide enough, then natural childbirth is possible. A woman will definitely be well anesthetized, they will introduce drugs that prevent spasm of the cervix. Even if mom dreamed about, during contractions and attempts she would have to lie down so that the water would not break for as long as possible. When the fetus erupts, the doctor will press the woman in labor strongly on the perineum with her palm in order to prevent the child’s legs from straightening ahead of time, thus expanding the birth canal as much as possible and facilitating the passage of the fetal head.

If a boy is in the womb, or birth in a breech presentation is recognized as pathological (see conditions above), then the pregnant woman is hospitalized in advance and, with the onset of labor, a caesarean section is performed. Only in this way can obstetricians insure both the mother and her little one from all dangerous complications.

With the normal location of the fetus in the uterus, its head is located below, above the womb, and during childbirth, the first one passes through the mother's birth canal. But this is not always the case. In 3-4% of all women, the fetus is in the so-called breech presentation. In a breech presentation, the buttocks of the fetus (breech presentation), legs (foot presentation), or buttocks with legs (mixed breech presentation) face the entrance to the mother's pelvis. Leg presentations are formed during childbirth. Breech presentations account for 30-33% of all breech presentations. Very rarely (in 0.3% of cases) there is a knee presentation - a kind of foot presentation, in which the bent knees of the fetus face the mother's pelvis.

Births in breech presentation can proceed quite normally, but situations often arise that are unfavorable for mother and child. They may be associated with a longer opening of the cervix, an increased risk of oxygen starvation of the fetus during childbirth, and difficulties in removing the baby.

Why is breech presentation formed?

Breech presentation can occur for the following reasons:

  • increased fetal mobility with polyhydramnios, premature pregnancy (the amount of water in this case is greater than with full-term pregnancy), multiple pregnancy;
  • narrow pelvis, placenta previa (its location on the path of the fetus moving along the birth canal), fetal abnormalities (too large size of the fetal head);
  • oligohydramnios, anomalies in the development of the uterus (this limits the mobility of the fetus in the uterus);
  • decreased uterine tone (in this case, the ability of the uterus to correct the position of the fetus in response to irritation of its walls decreases). With a reduced tone, the uterus does not respond to irritation - that is, contact with the wall of the uterus of parts of the fetus does not lead to the fact that the uterus, as it were, “fixes” the correct position of the child.

Diagnosis of pelvic presentation of the fetus

During an external obstetric examination, during an examination of a pregnant woman, a large, irregularly shaped and softish consistency presenting part is probed above the entrance to the pelvis. There is also a high standing of the bottom (the uppermost part) of the uterus compared to the same gestational age with head presentation (at 32 weeks of pregnancy, the bottom of the uterus is located in the middle between the navel and the xiphoid process with head presentation). This is due to the position of the pelvic end of the fetus above the entrance to the mother's pelvis until the end of pregnancy and the onset of labor. In the bottom of the uterus, on the contrary, a dense, rounded fetal head is determined. In breech presentation, the fetal heartbeat is well heard above the navel of the pregnant woman.

You can clarify the diagnosis with a vaginal examination. At the same time, softish tissues of the presenting buttocks and legs of the fetus are probed. Since all pregnant women are repeatedly done ultrasound, diagnosis is not difficult.

How does pregnancy proceed with breech presentation?

Pregnancy with a breech presentation proceeds in the same way as with a head presentation. Starting from the 32nd week of pregnancy, a certain set of exercises is recommended to correct the breech presentation. The pregnant woman, lying on the bed, turns alternately on the right and left side and lies on each for 10 minutes; the exercise is repeated 3-4 times. Classes are held 3 times a day. Often, the fetus turns onto the head within the first 7 days, unless there are aggravating circumstances (including oligohydramnios or polyhydramnios, an irregular shape of the uterus). The meaning of these exercises is to stimulate the nerve receptors, increase the excitability of the uterus. If by the 37-38th week (i.e. 2-3 weeks before the expected date of birth) the "stubborn" baby has not changed its position, the birth is carried out in a breech presentation. 2 weeks before the expected date of delivery, hospitalization is offered in a hospital, where the issue of the method of delivery is being decided. This is necessary for all women with breech presentation of the fetus to develop a plan for the management of childbirth (conservatively or operatively), to identify concomitant pathologies, which also affect the choice of the timing and method of delivery.

Conducting childbirth with breech presentation of the fetus

When choosing a method of delivery, doctors in the maternity hospital evaluate the following points:

  1. The age of the woman (the first childbirth after 30 years is classified as aggravating).
  2. Features of past pregnancies of Herods. An important point is the presence in the past of independent childbirth, if they took place, then childbirth is more often carried out through the natural birth canal.
  3. Features of the course of this pregnancy: are there any edema, high blood pressure, impaired kidney function.
  4. Estimated fetal weight (weight over 3500 g inclines doctors to decide in favor of caesarean section).
  5. The condition of the fetus (signs of a chronic lack of oxygen, which can be aggravated by complications during childbirth).
  6. The size of the mother's pelvis in relation to the size of the fetus. It is possible to use X-ray pelviometry (assessment of the size of the bone pelvis using X-rays).
  7. The condition of the cervix, its readiness for childbirth (the mature cervix is ​​soft, shortened to 1.5-2 cm, located in the center of the small pelvis, passes the tip of the finger).
  8. Type of pelvic presentation. The most unfavorable is the foot presentation (in this case, complications often occur in the form of prolapse of the fetal leg, umbilical cord loop).
  9. The position of the fetal head (if the ultrasound showed that the head is thrown back, operative delivery is also recommended; this position of the head can lead to injuries of the brain, cervical spine).

In the presence of complications during pregnancy, a narrow pelvis, a fetal weight of more than 3500 g, the age of a primipara is more than 30 years, a caesarean section is also performed.

How can doctors help with breech presentation of the fetus?

If the condition of the mother and fetus is good, the cervix is ​​mature, and the estimated weight of the fetus is small, childbirth is carried out under careful control through the natural birth canal.

In the first stage of labor (contractions and opening of the cervix), a woman must observe bed rest to avoid complications (premature discharge of water, prolapse of the fetal leg or umbilical cord loops).

In the second stage of childbirth, a special, so-called obstetric allowance is provided (a series of successive manual techniques to facilitate the birth of a child). The main principle is to maintain the articulation of the fetus (the legs are extended along the body and pressed to the chest by the arms of the fetus). First, the baby is born to the navel, then to the lower edge of the angle of the shoulder blades, then the arms and shoulder girdle come out, and then the head.

As soon as the baby is born before the navel, his head presses the umbilical cord, and hypoxia develops - a lack of oxygen. When providing obstetric care, important points are: prevention of premature prolapse of the legs before the birth of the shoulder girdle, assistance, if necessary, in removing the arms and head of the fetus. This is necessary to prevent asphyxia (acute oxygen starvation of the fetus). Until the full birth of the child, no more than 5-10 minutes should pass, otherwise the consequences of oxygen starvation can be very unfavorable. A perineal incision is also made to speed up the birth of the head and make it less traumatic. The incision is made longitudinally towards the anus (perineotomy) and - more often - at an angle (episiotomy). Already during contractions, a woman in labor is always given a dropper with saline, so that at the time of attempts it is possible to quickly inject the medicine to enhance the contractility of the uterus.

The condition of children born in breech presentation during spontaneous childbirth requires increased attention. Often, signs of hypoxia suffered during childbirth adversely affect the child's nervous system. Therefore, all children born in breech presentation require consultation with a neurologist. These children often have dysplasia (underdevelopment) of the hip joint. This condition requires timely treatment and diagnosis from the very first days after childbirth. At birth, a neonatologist (pediatrician) is always present to provide resuscitation if necessary. When precautions are taken, children born this way do not differ from their peers.

The correct position is when the fetus is in the uterus with its head closer to the pelvic floor, and the legs up. If the fetus is located with the buttocks or legs down, the birth of the baby may pass with complications. This position in the uterus is called "breech presentation of the fetus." Doctors can voice such a diagnosis to a pregnant patient after the 30th week, when the baby takes the most comfortable position for himself before childbirth. And so that such words of the gynecologist do not become a reason for frustration, we decided to tell you why the child can take this position, and how the birth takes place with the breech presentation of the fetus.

Breech presentation of the fetus is quite common among women in an interesting position (in 8-9% of all cases). At the same time, the natural birth of a child in this position is not excluded, although such births are much more difficult.

From conception to birth

From the moment the embryo begins to actively move, it can move freely in the uterine cavity and change its position quite often. However, when he grows up and rapidly gains weight, he has less room for free movement. Therefore, from about 29-32 weeks, the child takes the most comfortable position for himself, remaining in it until he is born.

In most cases, the fetus is positioned longitudinally head down (classic cephalic presentation). This option is considered a classic, in which natural childbirth is allowed. In other situations, if the buttocks, legs are supposed to enter the birth canal, or when the baby is located transversely to the pelvis, doctors advise the woman to give birth through.

However, it is always worth remembering that until the moment of birth, the baby can change its position by turning its head towards the entrance to the small pelvis. This will allow a woman to give birth naturally without injuring the child and without surgical intervention.

To help the baby take the position necessary for delivery, it is necessary to perform special exercises. In addition, the external method of exposure (the principle of action in the photo) allows the fetus to be turned over in the uterus, in which the manipulation is carried out by doctors in stationary conditions, necessarily using medications that relax the uterus and under ultrasound supervision.

However, let's go back to the beginning and tell you what a breech presentation of the fetus is and what other types of baby positions in the uterus are during pregnancy.

Basic terms and concepts

The ideal option is for the child to take the correct position before childbirth, when, during delivery, his head appears first, and then the rest of the body. But under the influence of a number of reasons, the baby can turn upside down, which can lead to many adverse consequences during his independent birth.

This position is called breech presentation (or breech). And there is the following classification of pelvic presentation of the fetus:

1. Breech presentation- this is when the baby in the uterus is located in such a way that his buttocks will be present at the bottom of the pelvis, and his legs will be straightened and pressed with his knees to the tummy. A similar phenomenon is observed in 50-55% of pregnant patients, mostly primiparas. In turn, the gluteal type of presentation can be purely gluteal or mixed. In the first case, the baby will be located with his buttocks closer to the exit to the birth canal, while his legs, straightened at the knees, will be extended along the body. In the second case, the child in the uterus occupies a position - with the buttocks and feet of the legs bent at the knees (or one foot) closer to the entrance to the birth canal (see photo).

2. foot, which also comes in several types depending on the position of the legs of the fetus:

  • full foot presentation - both lower limbs of the child are presenting;
  • incomplete - only one leg is adjacent to the entrance to the birth canal;
  • knee presentation is a rather rare position when the baby in the stomach takes a pose, as if kneeling.

3. Breech presentation of the fetus- a very common occurrence when a baby in this position is waiting for its birth. The most common is purely gluteal and mixed presentation of the gluteal type. However, this position may not be maintained until the moment of delivery, because there is a high probability that an arbitrary rotation of the fetus will occur during breech presentation. In addition, the expectant mother can help the baby roll over by performing special exercises for breech presentation. Therefore, women in an interesting position should not be prematurely upset and panic if the doctor announced a similar diagnosis during the examination.

Etiology and provoking factors

Clarifying what breech presentation means, future women in labor are also interested in what the etiology and causes of this phenomenon may be. First of all, until now, doctors cannot say definitively what are the causes of breech presentation of the fetus. However, they have already identified a list of provoking factors that can indirectly affect the fact that the baby in the uterus will take a non-classical position.

It is worth noting that all predisposing factors are divided into three groups, depending on what their etiology is.

1. A group of factors that are associated with the body of the expectant mother:

  • various congenital or acquired malformations of the uterus, as well as neoplasms and some diseases;
  • or decreased uterine tone;
  • overstretching of the uterus, provoked by or a large number of births in history;
  • pathology of the development of the pelvis;
  • numerous abortions, mechanical interventions;
  • pregnancy and childbirth with deviations.

2. Factors that are directly related to the fetus:

  • prematurity of the fetus, due to which the baby moves less and can remain in the breech presentation until the birth itself;
  • bearing 2 or more children, which occurs with the wrong presentation of one or two babies;
  • congenital pathologies of fetal development, which include malformations of the central nervous system, urinary, cardiovascular and musculoskeletal systems. In addition, pathologies at the chromosomal level can also affect whether a doctor diagnoses a breech presentation of the fetus during pregnancy.

3. A group of factors whose etiology is associated with the formation and development of the placental system:

  • short or umbilical cord wrapping around the baby's neck;
  • the placenta presenting to the entrance to the birth canal;
  • many;
  • , which provokes increased fetal activity, and can also cause malnutrition or abnormalities in the development of the child.

How does pregnancy proceed with such a diagnosis?

As previously indicated, the doctor makes the final diagnosis regarding the position and presentation of the baby in the uterus at 30-36 weeks. But, despite the fact that the child at the time of diagnosis will be in a breech presentation, there is always a chance for a spontaneous coup in the weeks remaining before the birth.

It is worth noting that the classic version of the position of the fetus (upside down) during pregnancy excludes the occurrence of any complications. The likelihood of abnormalities in pregnant women with a breech presentation of the fetus is higher. Therefore, from the moment of diagnosis, doctors put such patients under special control in order to be able to more closely monitor the development of the fetus and the course of pregnancy.

The main deviations that may occur in a patient in a position diagnosed with a breech presentation of the fetus are:

  • risk of premature delivery;
  • risk of miscarriage;
  • placental insufficiency;
  • symptoms of gestosis.

Each of these deviations is fraught with oxygen starvation of the baby in the womb. In turn, this can provoke a delay in development and the appearance of anomalies.

Very often, pregnancy with a breech presentation of the fetus is accompanied by abnormal formation of the placenta (), premature rupture of amniotic fluid, and an unstable position of the child in the uterus.

Considering what breech presentation means and what consequences it entails, doctors not only put patients with such a diagnosis on special account, they prescribe a number of preventive measures. They are considered necessary, as they can prevent the threat of miscarriage, as well as hypoxia. In particular, patients in position are advised to rest more, follow a special diet, refrain from intimacy and perform gymnastic exercises that will help “turn” the baby in the womb before the scheduled delivery.

When examining a pregnant woman, gynecologists throughout the entire period of bearing a child monitor its position in the uterine cavity. Therefore, breech presentation up to 21 weeks is considered physiological and does not pose a threat to the baby and his mother. After 30-36 weeks, if the baby does not change its position, experts consider its position presented by the pelvic end to be pathological. This diagnosis is the reason for the appointment of a caesarean section. It will be relevant until an arbitrary fetal flip or external rotation occurs, performed under the condition of stationary observation and constant monitoring of the patient's condition.

What is prevention?

To stimulate the rotation of the fetus in breech presentation, doctors advise expectant mothers not only to reduce physical activity and follow a special diet, but also to perform certain exercises. Especially in order to provoke a coup of the baby in the womb, future women in labor are prescribed special exercises with a breech presentation of the fetus. Techniques according to Dikan and Shuleshova, Bryukhina are actively practiced.

It is worth noting that the most popular exercises for flipping a baby from a pelvic position to a classic one are according to Dikan. To perform them, a woman should take a pose lying on her back. From this position, she needs to turn on her side and lie down for 10 minutes, and then roll over to the other side for another 10 minutes. In just one session, it is enough to roll over 3-4 times. It is advisable to do 2-3 sets per day so that the child turns over. As soon as he assumes a classic pose, it is necessary to fix his position.

Another effective exercise is the bridge with support. It can be performed by a pregnant woman with a diagnosis of breech presentation of the fetus after 20 weeks. Having taken a supine position, a woman needs to put her feet on a chair or sofa, placing a roller or a large pillow under her lower back so that the pelvis is above the level of the head, as shown in the photo. It is allowed to lie in this position for about 10-15 minutes (no more). In total, you can resort to this exercise twice during the day, until the baby takes the classic presentation position.

However, despite the high probability of an arbitrary overturn, the implementation of gymnastic exercises has some contraindications. So, for example, if a patient is diagnosed with a severe form of EGP, preeclampsia, or the threat of the onset of labor ahead of schedule, she should not do gymnastics with a breech presentation of the fetus. In addition to this, doctors do not recommend exercising for pregnant women who have a scar on the uterus or appear during / after exercise.

How can childbirth take place in patients with such a diagnosis?

Although the diagnosis of breech presentation is not definitive until the child is born, it remains a significant factor in determining the delivery option. As a rule, in such situations, when the baby did not want to roll over in the uterus to take the correct position, doctors insist on a surgical option - a caesarean section. But natural childbirth is not excluded.

When deciding how to give birth in pregnant women with a breech presentation, doctors are also guided by additional information. In particular, they evaluate:

  • the age of the patient in position (the risk group is women after 30, for whom pregnancy is the first);
  • the course of previous pregnancies (especially the presence of independent childbirth);
  • the course of the actual pregnancy (presence or absence of deviations, pathologies);
  • the state of the child in the mother's womb;
  • the approximate weight of the baby (children weighing more than 3.5 kg are helped to be born surgically);
  • features of the physiological structure of the body and the state of the uterine cavity of the woman in labor;
  • type of presentation of the pelvic type, as well as the position of the fetus in the uterus.
    In the cases discussed above, obstetricians are inclined in favor of a caesarean section with a breech presentation of the fetus.

Childbirth in patients with a similar position of the fetus in the uterus proceeds under special control. With the onset of labor activity, the woman in labor is advised to observe bed rest. This is necessary to avoid the threat of early rupture of amniotic fluid and prolapse of the lower extremities from the birth canal. If the birth proceeds naturally, doctors try to maintain the child's articulation, and for the speedy exit from the birth canal without complications () make a perineal incision. Obstetricians carefully monitor the state of health of a newborn born on their own during the first day after the actual delivery.

Delivery in women with a baby presenting to the gluteal part, by caesarean section, is carried out if there are no arguments in favor of natural childbirth.

Summing up what breech presentation means, and what options for the birth of a baby in this position can be, you should always remember that the process of giving birth to a child is a very responsible and incredibly hard work not only for a newborn, but also for him. mother. Therefore, each case of pregnancy is considered purely individually in order to assess the possible risks and help the child to be born completely healthy.