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The transverse position of the fetus. Features of the course of pregnancy. What is dangerous for a woman and a child a transverse presentation of the fetus

The position of the fetus is one of the most important factors in labor. Incorrect position of the baby in the uterine cavity often leads to complications during delivery.

The transverse position of the fetus differs in that the line from the coccyx to the head is perpendicular to the axis of the uterus. In addition, there may be an oblique position when the above line and the axis of the uterus make up an angle of less than 45º. Moreover, the reasons and methods of prevention of these two provisions are the same.

Views

There are two types of pathology:

  • Transverse position of the fetus with an abdominal presentation - the longitudinal line of the baby is perpendicular to the axis of the uterus, while the limbs rest against the birth canal;
  • Transverse position of the fetus with a dorsal presentation - the fetal line is located at right angles to the axis of the uterus, and the spine is pressed against its entrance.

Causes

The list of reasons for the transverse and oblique position of the fetus is extensive:

  • Insufficient tone of the walls of the uterus leads to the impossibility of the normal position of the child. Most often, such a negative change occurs if the previous birth was complicated or was accompanied by a postpartum infection.
  • The lack of space and the limitation of activity for the movement of the fetus are the consequences of multiple pregnancies, large weight of the child, lack of water, increased tone of the uterus.
  • Abnormalities in the anatomy of the genital organs, such as saddle or bicornuate uterus.
  • Placental prolapse and presentation.
  • Narrowing of the pelvis 3-4 degrees.
  • Deformity of the baby's head caused by anencephaly (no brain) or hydrocephalus (dropsy of the brain).
  • Excess amniotic fluid leads to significant stretching of the uterine cavity, due to which the baby cannot determine the boundaries of the uterus.
  • Weakness of the abdominal muscles, which appears in women who have given birth more than three times. The abdominal muscles cannot hold the baby in the desired position.

Diagnostics

Recognizing the abnormal position of the baby in a singleton pregnancy is not difficult. During palpation of the uterine cavity and examination of the abdomen, the problematic position of the fetus is determined by the following signs:

  • The girth of the abdomen exceeds the standard for the current period, and the level of the fundus of the uterus is less than normal;
  • The baby's buttocks are felt from the side of the uterine cavity.

When carrying two or more children or polyhydramnios, this diagnostic method does not work. In these cases, the problem can only be determined using ultrasound. It provides the most accurate information on such important factors as:

  • head position;
  • the size of the fetus;
  • location of the placenta;
  • polyhydramnios;
  • entanglement with an umbilical cord;
  • changes in the structure of the uterus.


Dangers

Most often, the transverse position of the fetus can cause a miscarriage; with this pathology, the uterus is constantly in a state of hypertonicity.

The second most common complication is premature rupture of amniotic fluid. It is also possible for the umbilical cord and one of the baby's limbs to fall out. All this leads to a lack of oxygen in the child and the penetration of infection.

In addition, there is a risk of the appearance of a doubled body. This can happen due to premature discharge of water and strong contractions: the walls of the uterus squeeze the fetus too tightly and, as it were, fold it in half, in half. At the same time, it is almost impossible to give birth to a viable child.

The most dangerous complication is the neglected lateral position of the fetus. With such a pathology, after the water leaves the child, it is too much covered by the contracted uterus, one of the shoulder joints is fixed in the cervix, and the handle is in the birth canal. With the onset of contractions, the lower part of the uterine cavity is deformed more than acceptable. Damage to the walls of the uterus occurs, and acute bleeding begins. It is extremely difficult to save a woman in labor. The kid has practically no chances to survive due to the lack of blood flow in the "child's place" and hypoxia.

Features of childbirth

All women diagnosed with a lateral position of the fetus are advised to await delivery in a medical facility. In 5% of cases, the baby himself takes the correct position. The remaining 95% is shown a cesarean section, the timing of which is determined individually. An urgent COP is carried out in the event of:

  • identification of cicatricial formations in the uterine cavity;
  • discharge of amniotic fluid;
  • the appearance of signs of oxygen starvation in a child;
  • detection of the umbilical cord or fetal limbs in the birth canal.


Fact. Before the widespread introduction of caesarean section into medicine, the method of intrauterine rotation of the fetus was used. Nowadays, it is used only when it is not possible to carry out an operation and at least a woman needs to be saved. Such manipulations overwhelmingly lead to rupture of the uterus and stillbirth.

Prophylaxis

Gymnastics is the best prevention of the lateral position of the fetus. It is prescribed if there are no such contraindications as:

  • prolapse of the placenta and its presentation;
  • violations in the vessels of the umbilical cord;
  • multiple pregnancy;
  • scar formation on the uterus;
  • hypertonicity of the uterus;
  • benign tumors;
  • lack of water or polyhydramnios;
  • bloody issues.

The obstetricians have compiled a set of exercises that contribute to the overturn of the fetus in the transverse position. Due to it, a rhythmic contraction of the muscles of the abdomen and trunk occurs, combined with deep breathing. This method of preventing complications is prescribed from 32 weeks of pregnancy when the transverse position of the fetus is established.

Doctors advise to perform this complex 3 times a day:

  1. Tilts of the pelvis. You need to lie on the floor and raise your pelvis about 25-30 centimeters relative to your head. Fix the pelvis in this position for 10 minutes.
  2. Cat. Get on all fours. As you inhale, stretch your stomach to the floor, while exhaling, bend your back up. And so 10 times.
  3. Knee-elbow stand. Press your elbows and knees to the floor. Put your head in your hands. You need to stand in this position for 20 minutes.
  4. Half-bridge. Lie on the floor. Place two pillows under your thighs so that the height from the floor is approximately 35 centimeters. In this position, you need to raise your legs 10 times.

Usually, thanks to this complex, the child takes the correct position for one and a half weeks, then he is fixed with a bandage with vertical rollers. It is recommended to use this method of fixation before the onset of labor.

Thus, the transverse position of the fetus in the bulk of cases can really be changed before complications arise with timely prevention. But even if the baby does not turn around by the beginning of labor, a cesarean section will reduce possible complications to a minimum.

Pregnancy is one of the happiest stages in a woman's life. But in the same period, problems occur that darken the happiness of future motherhood. One of these problems is the transverse presentation of the fetus. It leads to problems during childbirth and poses a threat to the life and health of the baby and mother.


Why is the child in this position?

The final position of the child is determined at 32 weeks of gestation, since at earlier stages he can change it on his own several times. Most often, the child takes a normal position - with the head towards the birth canal.

But it so happens that it can be transverse or oblique. Transverse is characterized by the fact that the transverse axis of the baby's body is at right angles to the axis of the uterus. Oblique presentation - at an acute angle. Both cases are pathological.

This is usually explained by:

  • ... This state creates the conditions for the fetus to move actively.
  • Flabby muscles. Most often, flabbiness is characteristic of the second and subsequent pregnancies, when the mother's muscles are no longer able to fix the fetus in one position, and it continues to move even for long periods.
  • ... The baby is looking for the most comfortable position during pregnancy. The nodes in the uterus, which are formed by the tumor, interfere with it. In this case, the fetus will take such a position that the head does not touch them.
  • Deviations in the structure of the uterus. Often there are pathologies such as a saddle and two-horned uterus. If the shape of the uterus is non-standard, then the baby may also be uncomfortable in the right position to be in the womb. He will move to take the most comfortable position.
  • Abnormalities in the development of the fetus.
  • Premature birth. The child does not have time to roll over after the water has departed.
  • The structure of the female body. If the woman has too much, the head of the fetus cannot take the necessary position.
  • Multiple pregnancies. Two or three fetuses prevent each other from taking the correct position in the womb.


Types of presentation of the fetus

There are three types of fetal presentation:

  1. - when the axis of the fetus and the mother's uterus coincide and lie on the same line. Normally, there should be a head. When the baby lies with its buttocks forward, it also complicates the process of childbirth.
  2. Transverse - the baby is at a 90 ° angle to the mother's uterus. The head and buttocks are located on the sides above the ilium of the pelvis.
  3. Oblique - when the child in relation to the mother is at a beveled acute angle, the head and buttocks are not on the same line. One part is on top, the other is on the bottom.

The doctor makes the final decision about the position of the fetus in the second half of the third trimester of pregnancy. Previously, this makes no sense, since the child can still take a normal position.

How is previa diagnosed

There are several ways to understand how the baby is located in the womb:

  1. Screening ultrasound... The most popular method as the position of the fetus is immediately visible.
  2. Palpation. The doctor finds the location of the baby and his body parts by touch.
  3. Examination through the vagina.

An experienced doctor can identify abnormalities in the shape of the abdomen.

Why is transverse presentation dangerous?

In medicine, there is a practice when specialists independently turn the child into the correct position by an external method. However, now such manipulations are used extremely rarely, since there is a high risk of complications for both.

The child, as a result of such a procedure, may develop serious injuries. In the mother, this can lead to rupture of the uterus. In addition, the fetus may suffocate, in which case even an operation will not help save it. Moreover, the procedure is quite painful.

After a miscarriage is diagnosed and the fetus is fixed in the uterus, the doctor determines how the pregnancy and childbirth will proceed.

In the absence of contraindications, a special one is assigned to the pregnant woman, which helps to turn the fetus in the right direction. In addition, the doctor explains to the woman on which side it is better to lie in accordance with the position of the baby's head.

Here is one of the most common sets of exercises that can help your child turn in the right direction:

  1. Lie on a hard surface, couch or sofa on either side and lie in this position for 5 minutes. Then slowly and carefully roll over onto the other side, and lie on it for the same amount. The sides need to be changed several times. It is recommended to repeat the procedure 3 times a day.
  2. Lie on your back. Put a rolled blanket under the buttocks and lie for up to 10 minutes. Repeat also 3 times a day.
  3. Get on all fours with support on your elbows and knees and stand that way for several minutes.

Such gymnastics will create favorable conditions for the child to take a normal position. However, you should check with your doctor before starting exercise.

Some elements of physical activity may be contraindicated for a pregnant woman due to health problems. The specialist will select gymnastics individually, taking into account the history and general well-being of the expectant mother.

Delivery with transverse presentation of the fetus

Transverse presentation is a great danger for both the pregnant woman and the fetus itself. If the situation does not change before the onset of labor, then it is not recommended to give birth on your own, since there is a high risk of complications.

Spontaneous childbirth is possible only when the baby's weight is very low or started early in pregnancy.

But it is important to take into account the level of uterine dilatation. Even if the baby's weight is acceptable, but disclosure does not allow childbirth on its own, an urgent cesarean section will be required.

With a transverse presentation of the fetus, in most cases, a planned cesarean section is prescribed. At the 37th week of pregnancy, hospitalization is made and the expectant mother is prepared for surgery.

In the case of premature birth, doctors usually decide on an emergency operation, since a natural birth in this position is unacceptable.

Unlike oblique presentation, it is very unlikely that the child will take the correct position in the womb at the last moment.

A planned caesarean section is done on an empty stomach. Before the operation, you must empty your bladder and bowels. Anesthesia is then administered.

Now it is made to choose from: general or. The second is the most popular because it has fewer risks to the health of the child. After the anesthesia has worked, the surgeon cuts and spreads the muscles, then the uterus, amniotic fluid, and removes the baby.

Answer

Transverse ( situs transverses) and oblique ( situs obliguus) the position of the fetus is incorrect.

The oblique or transverse position of the fetus is determined by the ratio of the large part of the fetus to the line connecting the iliac crests. In the oblique position of the fetus, one of its large parts (head or pelvic end) is located below the iliac crest. In the transverse position, both the head and the pelvic end of the fetus are above the line connecting the iliac crests.

In the transverse position, the axis of the fetus forms a right angle with the longitudinal axis of the uterus, in the oblique position, it is acute.

With great mobility, the fetus can take a longitudinal, and then again be positioned obliquely or transversely. This condition is called unstable fetal position.

Causes formation of abnormal fetal positions:

Excessive fetal mobility (with polyhydramnios, fetal malnutrition, laxity of the muscles of the anterior abdominal wall in multiparous);

limited fetal mobility (with low water, large fetus, multiple pregnancies, uterine fibroids, increased uterine tone with the threat of termination of pregnancy);

Obstacles to head insertion (placenta previa, narrow pelvis, fibroids in the lower segment of the uterus);

Anomalies in the development of the uterus (two-horned, saddle-shaped uterus, a septum in it);

Fetal developmental abnormalities (hydrocephalus, anencephaly).

Diagnostics. One of the signs of an abnormal position of the fetus is the transverse-oval or oblique-oval shape of the abdomen of the pregnant woman, the low standing of the fundus of the uterus.

With an external obstetric examination, the presenting part of the fetus is not determined. Large parts are palpable in the lateral parts of the uterus (Fig. 15.1). The position of the fetus in the transverse and oblique positions is determined by the head: when the fetal head is located on the left - the first position, on the right - the second position. The type of fetus is determined in the same way as in the longitudinal position: in relation to the back to the front (front view) or back (back view) of the uterine wall. The fetal heartbeat is better heard in the navel area.

Rice. 15.1. The transverse position of the fetus. External obstetric examination. A - the first reception; B - second reception; B - the third reception; D - fourth reception

With a vaginal examination, the presenting part of the fetus is not determined.

After the discharge of amniotic fluid, it is possible to determine the shoulder or arm of the fetus, the loop of the umbilical cord, sometimes the ribs, the spine of the fetus are palpated.

Ultrasound is a great help in diagnosing the position of the fetus.

The course of pregnancy and childbirth. Pregnancy with incorrect fetal positions can proceed without complications. If the fetus is in the wrong position, one of the frequent complications (up to 30%) is premature birth.

The next common complication during pregnancy and childbirth is untimely (premature or early) rupture of amniotic fluid, which may be accompanied by prolapse of the umbilical cord, small parts (arms, legs), which contributes to fetal hypoxia and infection. The most formidable complication in the transverse position is loss of mobility fetus - running lateral position... It is formed after the outpouring of amniotic fluid and a tight embrace of the fetus by the uterus. When the lateral position of the fetus is running, one of the shoulders can be hammered into the small pelvis, and the handle falls out of the cervix (Fig. 15.2). As a result of labor, the lower segment is overstretched. In this case, at first there is a threat of rupture of the uterus, and then its rupture occurs, if a cesarean section is not performed in a timely manner. The fetus usually dies from acute hypoxia.

Fig 15.2. The transverse position of the fetus. First position, front view. Drop out of the right handle

With small sizes of the fetus (prematurity, malnutrition) and large sizes of the pelvis, self-rotation of the fetus into a longitudinal position or self-rotation can rarely occur. Even less often, childbirth occurs with a double body, when the fetus folds in the spine in half and is born in this state (Fig. 15.3). In this case, the fetus often dies.

Rice. 15.3. Launched transverse position of the fetus

Pregnancy and childbirth management. If a transverse or oblique position of the fetus is detected, the outpatient doctor should monitor the patient more closely, advising her to avoid excessive physical exertion. With the transverse position of the fetus, a woman during the day should lie several times on the side where the head is located, and with an oblique position - on the side below the located large part. The woman is warned about the need for immediate hospitalization in case of rupture of amniotic fluid. At 38-39 weeks, the patient is admitted to the obstetric hospital. In the absence of contraindications, an attempt is made to make an external obstetric rotation of the fetus into a longitudinal position. While maintaining the transverse position of the fetus, regardless of the parity of childbirth, the only method of delivery is cesarean section.

The first stage of labor is most favorable for operative delivery. When the first contractions appear, the position of the fetus sometimes changes to a longitudinal one (self-rotation). Before the onset of labor, a caesarean section is performed with a tendency to overmaturity, placenta previa, prenatal rupture of amniotic fluid, fetal hypoxia, scar on the uterus, tumors of the genitals (with their subsequent removal).

When small parts of the fetus (umbilical cord, pen) fall out, an attempt to reposition them into the uterus is not only useless, but also dangerous, as it contributes to infection and increases the time to operative delivery. Labor management with the loss of small parts of the fetus through the natural birth canal is possible only with a deeply premature fetus, the viability of which is in great doubt.

The combined rotation of a viable fetus on the stem with subsequent extraction is used extremely rarely, since it is unsafe for the fetus. Such a turn is carried out mainly with the transverse position of the second fetus in a woman in labor with twins.

Every woman wants her pregnancy to proceed without complications and end with the birth of a healthy baby. But sometimes it happens that the gestation period has its own characteristics that can affect the health of the mother and child. One of these features that complicates childbirth is the transverse presentation of the fetus.

Causes and complications

The named pathology of pregnancy occurs approximately once in 200 cases (0.5-0.7%). It happens more often with repeated pregnancies. It is determined after 32-34 weeks. Before that, the fetus is quite mobile and often changes its location in the uterus. And at 33-34 weeks, the baby is placed in a certain position, preparing for the upcoming birth. There are three provisions that a child can take after the named period:

  • longitudinal (the fetal body is placed along the uterine cavity, addressing the birth canal with the head (head position) or buttocks (gluteal position). The longitudinal position is considered normal and is typical for more than 99% of pregnancies);
  • transverse (the baby is located across the uterus, large parts of the fetus are felt on the right and left sides of the uterus);
  • oblique (the baby's body is located at an acute angle to the longitudinal axis of the uterus).

There may be several reasons for the manifestation of a pathological presentation (transverse or oblique). This is polyhydramnios and oligohydramnios, multiple pregnancies, too narrow a pelvis, abnormalities in the structure of the uterus or some of its diseases (for example, with myoma, nodes on the muscle tissue of the uterus prevent the child from positioning correctly). The wrong position also happens in babies with developmental pathologies or too large a body weight.

As already mentioned, transverse presentation is characteristic of the second and subsequent pregnancies. There is a simple explanation for this. The muscles of the anterior abdominal wall stretch from the pressure of the growing uterus, become flabby and can no longer restrain the movement of the fetus. Therefore, it turns incorrectly.

In most cases, transverse presentation pregnancy is normal. Although in a third of such cases, childbirth begins prematurely with premature rupture of amniotic fluid. If, in addition to this, there is also such a pathology as placenta previa, then severe bleeding may occur.

With transverse presentation, complications are possible during natural childbirth. For example, prolapse of the umbilical cord or limb (arm, leg) of the fetus. This can cause infection of the amniotic fluid and inflammation of the membranes of the fetus (chorioamnionitis), provoke sepsis.

Premature rupture of amniotic fluid and prolonged "anhydrous" stay of the fetus can lead to its hypoxia (lack of oxygen) or even asphyxia (suffocation).

With a transverse presentation, it is extremely rare, but births with a "double body" also occur. After the discharge of amniotic fluid and during intense contractions, the walls of the uterus press so hard on the fetus that it bends in the thoracic region. In this case, labor ends spontaneously. First, the chest comes out with the neck pressed against it, then the stomach with the head pressed against it, after that - the buttocks and legs. Such births occur with a large prematurity or a dead fetus.

Sometimes, with a transverse presentation during childbirth, the baby itself turns into a normal position, taking the head or gluteal position.

What is the neglected lateral position of the fetus?

Quite often, with transverse presentation in childbirth, a complication occurs, which is called the neglected transverse position of the fetus. Its essence is that after the premature discharge of the amniotic fluid, the baby's mobility is limited, his shoulder and hand are "hammered" into the pelvic bone, blocking the movement of the head and trunk to the birth canal.

This complication can cause the uterus to rupture. To prevent him, a cesarean section is performed.

How to correct transverse presentation

Once transverse presentation, as a rule, ended fatally for both the mother and the child. Now this risk is minimized. The incorrect position of the fetus is determined during a routine examination by a gynecologist, the doctor presses lightly on his stomach with his fingers and determines where the parts of the baby's body are. During the ultrasound scan, the incorrect position is confirmed. To correct it, pregnant women are often asked to do simple exercises that should stimulate the baby to take the correct position. However, it should be said that they do not help everyone.

Exercises for transverse presentation of the fetus

Special exercises should be done several times a day, for at least a week.

  • Lying on a bed or sofa, make three or four turns from side to side. You need to lie on each side for 5-7 minutes, then turn over.
  • Lying on your back, lift your buttocks above the level of your head. You can place a rolled-up blanket or pillow underneath. In this position, you need to lie down for 5-7 minutes.
  • Cat pose: kneel down, rest your hands on the floor, inhale and raise your head and tailbone, arching your lower back, while exhaling, lower your head and arch your back.
  • Get on your knees, rest on your elbows (pelvis above your head). Stay in this position for 5-7 minutes.

As you know, in late stages, sleeping on your back is not very comfortable, and even not desirable. After all, a large enough fetus presses on the vena cava and on the internal organs. Therefore, pregnant women are advised to sleep on their side. With the transverse position of the fetus, it is advised to turn to the side where the baby's head is. Although the expectant mother must determine for herself how it is more comfortable for her to sleep. If you feel uncomfortable, you can change your position.

For a more comfortable position, you can place a rolled blanket or a pregnancy pillow under your belly or back.

Is it possible to wear a bandage with transverse presentation

Often in the second half of pregnancy, women are advised to wear a bandage. This helps reduce stress on the spine, back muscles and internal organs. However, in transverse presentation of the fetus, wearing a bandage is not recommended. After all, he fixes the position of the child in the womb, which means that he does not allow him to turn and take the correct position. If the child has turned from the transverse to the longitudinal position, the doctor may recommend wearing a bandage to fix this correct position of the baby.

Childbirth in the transverse position of the fetus

The position of the fetus is decisive for the management of childbirth. If the child has not turned over and lies across the uterus, then natural childbirth is impossible, since it can have dangerous consequences that threaten the life of the baby and his mother.

In such cases, a planned caesarean section is performed. At the 37th week, a woman goes to the hospital and prepares for this procedure. It is performed under general or local anesthesia.

If childbirth begins prematurely, then an emergency caesarean section is performed to avoid dangerous consequences.

Specially for -Elena Semenova

Pregnancy and childbirth is a natural process that takes place in a woman's body. From the moment of conception to the birth of the child, the body of the expectant mother obeys special laws and needs. New life develops, and the female body for 9 months serves as a habitat for the fetus, supplying it with all the resources for normal growth.

During this mysterious period, it is very important that the expectant mother stays healthy, as the body needs to focus on maintaining a new life within itself. Otherwise, complications may arise that affect the health of both the mother and the child. One of these complications is transverse presentation of the fetus.

What is transverse presentation of the fetus?

The most favorable and natural position of the baby in the uterus at the time of delivery is with the head down towards the birth canal. And with the normal course of pregnancy, this position is established by itself. The organisms of the mother and baby are preparing for the difficult process of childbirth. The woman's hips expand and the baby turns head down into the resulting hollow, facing the mother's back. This position is called the cephalic presentation and is considered the most favorable for the safe course of labor.

But in some cases, the child is located in the uterus incorrectly and is risky for birth. One of these locations is the transverse presentation of the fetus. This means that the axes of the spine of the mother and the child are perpendicular to each other, that is, the child lies in the stomach across, and not along.

You should not scare yourself in advance and look closely at the outlines of the abdomen - only 0.5% of pregnant women diagnose a transverse presentation of the fetus. And almost always medicine is able to help mother and baby.

Diagnostics

Inside the fetal bladder, the child feels safe - there is warmth, the beat of her mother's heart is heard, the sound of her voice is heard. And a wonderful aquatic environment, amniotic fluid, keeps the little body in a state of "weightlessness." The child turns, twists and turns. This period of mobility lasts up to 34-35 weeks, while the body of the fetus is still small, and there is an active process of formation of internal organs in it.

Therefore, until the end of the seventh month of pregnancy, you are unlikely to hear from the doctor a categorical diagnosis of the incorrectness of the fetal position. But at 8-9 months, the baby is actively gaining weight, his position becomes stable, and the gynecologist during this period can already objectively judge the position of the child in the uterus.

Sometimes a woman herself may suspect something was wrong. The transverse oval shape of the abdomen is a sign of the abnormal position of the fetus. But since from the seventh month, visits to the obstetrician-gynecologist become more frequent, the doctor closely examines and examines the expectant mother.

The following methods are used to determine the position of the fetus:

  • Visual inspection. If the baby is large, its location in the womb is obvious and visible to the naked eye.
  • Palpation (examination by touch). The doctor puts his hand on the baby's head, and the other on his pelvis or heels. It also listens to the heartbeat - in the transverse position, the child's heart rate is heard only in the navel of the woman. A vaginal examination is usually not done.
  • Ultrasound examination (ultrasound). This is the final stage of the diagnosis, which gives a complete confirmation (or refutation) of the preliminary diagnosis.

Causes of occurrence

The factors and reasons for the incorrect position of the child inside the uterus are varied - from the peculiarities of intrauterine development of the fetus to the consequences of mother's diseases and pathologies of the child himself.

Do not neglect visits to the doctor, even if you are not pregnant for the first time and consider yourself an experienced mother and woman in labor. ... The transverse position of the fetus in women giving birth is more common than in women giving birth for the first time.

Excess or insufficient amniotic fluid

The factors affecting the volume of amniotic fluid are not fully understood. This is the mystery of the body of a pregnant woman. The inner epithelium of the amniotic bladder generates amniotic fluid, and at the end of pregnancy, its composition is updated every three hours.

With polyhydramnios (the volume of amniotic fluid is 1.5-2 liters or more), it is more difficult for a child to "lie down" with his head down, since the inner space of the uterus is extensive. Conversely, with a small amount of amniotic fluid (less than 600 ml), the movement of the fetus inside the uterus is so difficult that the child is squeezed by its walls.

Decreased tone of the walls of the uterus and weakness of the abdominal muscles

Most often, weak muscle walls of the uterus are found in women who give birth again. The natural location of the uterus is vertical, inverted pear-shaped. Ideally, the smooth muscles of the genital organ are elastic enough to stretch as the fetus grows and elastic enough to maintain an upright position. And since we are all exposed to gravity, without proper support, the muscles of the uterus and abdominal wall, the child is located as it is convenient for him, and not in the way he needs.

Incorrect placement of the placenta

In medical terminology, an abnormal position of the placenta is called "presentation" and means the attachment of a "baby seat" in the cervical region. The placenta completely or completely occupies the place that the baby's head should take by the end of pregnancy. Placenta previa is a definitive indication for caesarean section (CS), since natural childbirth is impossible.

The normal location of the placenta and its presentation in the lower segment of the uterus

Neoplasms in the uterine cavity

Of course, for the well-being of the child, a calm and safe course of pregnancy, it is recommended to carefully monitor the health of the mother. Indeed, in the presence of adenomas, fibroids and polyps in the lower segment of the uterus, the risk of transverse presentation of the fetus increases significantly. Regular visits to a gynecologist and strict adherence to medical recommendations are recommended throughout pregnancy.

Features of the structure of the uterus

Saddle and two-horned uterus are quite rare pathologies - only 0.1% of pregnant women can hear such a diagnosis. It means that the shape of the uterus is not a regular elongated pear-shaped shape, but a saddle-shaped (with a deflection in the bottom) or two-horned (divided in two by a septum in the upper section). And it is understandable that it is difficult for a child developing in such conditions to accept the position necessary for an easy exit from the mother's body.

Options for the structure of the uterus in the photo

Bicornuate uterus The structure of the uterus is normal

Fetal pathology

Since cephalic presentation of the fetus is necessary for a successful birth process, pathologies of the child's development, such as hydrocephalus (cerebral edema) or anencephaly (underdeveloped cerebral hemispheres), can prevent the fetus from taking the desired position inside the uterus.

What threatens the transverse presentation of the fetus?

Cross-presentation pregnancies can be completely normal, although women who have given birth know that "normal" in recent weeks includes aches in the lower back and hips, heaviness, shortness of breath and a state of constant fatigue. The most risky moment comes during childbirth due to the uncomfortable position of the baby relative to the "exit" from the uterine cavity.

The uterus is pear-shaped with a narrow part directed downward. And it is logical that with the transverse position of the fetus, an increased load falls on the lateral walls of this organ. Therefore, when diagnosing this condition, a pregnant woman should be under constant supervision of doctors in a hospital.

Risks and complications:

  • Early discharge of amniotic fluid and premature birth;
  • Uterine rupture and uterine bleeding;
  • Hypoxia (oxygen starvation) of the fetus with a prolonged anhydrous state during childbirth;
  • Launched lateral position and the loss of parts of the child's body from the uterine cavity (limbs, shoulder or umbilical cord);
  • Death of a child or mother.

With a responsible approach of the expectant mother to her condition and following the doctor's recommendations, the transverse presentation of the fetus is just a difficulty, but not a stop factor for the happy birth of the child.

The most common and justified solution for transverse presentation is a cesarean section. Especially if a number of measures (exercises, external turn) did not give results, or due to pathological reasons (placenta previa, uterine neoplasms or pathology), natural childbirth is impossible.

But with a small size and weight of the fetus, it is still possible to resolve the burden in a natural way, although it is risky. In any case, the gynecologist will give recommendations regarding childbirth individually for each woman.

Transverse presentation of twins

Pregnancy is a test for a woman and a child, especially carrying twins. Two babies can take a variety of positions relative to each other and the axis of the uterine cavity. Optimal locations are cephalic presentations of both fetuses or the head position of one child and the pelvic (booty down) position of the other.

Transverse presentation of one or two twins is extremely rare (1% of the total number of multiple pregnancies) and is a strong argument in favor of surgical intervention during childbirth.

If one child has a vertical position and is born first, then for the second baby, lying across the uterus, a turn on the leg can be applied. But this is a risky and complex procedure, which is practically not performed in our time. As a rule, an emergency caesarean section is performed.

Gymnastics for fetal flipping

A few simple exercises will help the fetus change its position. But you can do this gymnastics only after consulting a doctor and making sure that there are no contraindications: full or partial placenta previa, the threat of miscarriage.

It is better to do gymnastic exercises on an empty stomach or a few hours after eating. Relax, relax your body and calm your nerves.

  1. In a lying position on your side, spend 7-10 minutes, take a deep and calm breath, turn on the other side. Perform 3-4 calls during the day. It is better to lie on a firm surface of a sofa or couch rather than on a soft bed.
  2. Place one pillow under the lower back, several under the legs so that they are 20-30 cm above the head. Lie in this position for 10-15 minutes 2-3 times a day.
  3. A useful stand in the knee-elbow position, which also needs to be done 2-3 times a day for 15-20 minutes.

The sleeping position is on the side, towards which the child's head is facing. Swimming is very effective. During water procedures, muscles are activated that do not work “on land”. The general tone of the body rises, blood flow to the internal organs improves, and the fetus is stimulated to take the correct vertical position.

A set of exercises according to I.I. Grishchenko and A.E. Shuleshova

  1. Lie on the side opposite to the head of the fetus, bend your legs at the hip and knee joints. Hold in this position for about 5 minutes, turn on the other side.
  2. Lying on your side, straighten your legs one by one. Lying on the right side - left, on the left - right.
  3. Having taken a sitting position, grasp the bent knee opposite to the side to which the child's head rests. Gently bend forward, making a semicircle with your knee and touching the front wall of the abdomen. Inhale deeply and calmly, straighten your leg and relax.

When the child is in the desired position, it is advisable to put on and wear a special prenatal bandage during the day.

Outward rotation of the fetus

This manipulation consists in the forced pressure on the belly of the pregnant woman in order to turn the baby into the desired position. This is an extreme procedure, often painful for the mother and dangerous for the child, because the hands of even the most experienced obstetrician cannot “see” through the skin and the uterine wall. Fetal inversion is carried out only by a doctor in a hospital setting, since this procedure is fraught with complications - rupture of the uterus, placental abruption, premature birth.

To date, external fetal turns are practically not used, and in a number of European countries are strictly prohibited.

The main thing when diagnosing a transverse presentation of the fetus is to remain calm, rely on common sense and the recommendations of a gynecologist. Listen to less "horror stories" from experienced friends, do not engage in self-diagnosis and self-medication. Although the lateral position of the fetus is considered a rare occurrence, any obstetrician knows exactly what to do in each case. And the task of the pregnant woman is to patiently and accurately follow the advice of the doctor and think only about the good. Happy meeting with your baby!