Professional publications of doctors 

Breech presentation of the fetus: natural birth or cesarean? This and other important questions. Breech presentation. Possible complications

- the longitudinal location of the fetus in the uterus with the legs or buttocks facing the entrance to the small pelvis. Pregnancy with breech presentation of the fetus often occurs in conditions of the threat of interruption, preeclampsia, placental insufficiency, fetal hypoxia, birth trauma. Diagnostics of the breech presentation of the fetus is carried out using external and vaginal examination, echography, Doppler ultrasonography, CTG. Treatment of breech presentation includes complexes of corrective gymnastics, preventive external rotation of the fetus, early selection of the method of delivery.

General information

Breech presentation of the fetus in obstetrics and gynecology occurs in 3-5% of all pregnancies. Management of pregnancy and childbirth with breech presentation of the fetus requires qualified and highly professional assistance to a woman and a child. With a breech presentation of the fetus during childbirth, the buttocks or legs of the child are the first to pass through the birth canal. In this case, the cervix is ​​still in an insufficiently smoothed and open state, therefore, the advancement of the head, as the largest and densest part of the fetus, is difficult. With breech presentation, childbirth can be uncomplicated, but there is an increased risk of asphyxia, fetal stillbirth, birth trauma to the child and mother.

Classification of breech presentation of the fetus

The options for breech presentation of the fetus include leg and breech presentation. Foot presentations account for 11-13% of all fetal pelvic presentations. Leg presentation can be complete (both legs), incomplete (one leg), or knee (fetal knees). Breech presentation is most common. In 63-75% of cases, an incomplete (purely breech) presentation is diagnosed, in which only the buttocks are adjacent to the entrance to the small pelvis, and the legs of the fetus are extended along the body. With a mixed breech presentation (20-24%), not only the buttocks, but also the legs of the fetus, bent at the knee or hip joints, are facing the entrance to the small pelvis.

With different variants of breech presentation of the fetus, the development of the biomechanism of labor has its own characteristics. With a purely breech presentation, a medium-sized fetus and a normal size of the mother's pelvis, uncomplicated independent childbirth is possible. With foot and mixed presentation, birth through the vaginal birth canal is associated with significant risks for the newborn - asphyxia, prolapse of the umbilical cord and individual parts of the fetus.

Causes of breech presentation of the fetus

The factors causing breech presentation of the fetus are numerous and not fully understood. The presence of uterine fibroids, ovarian tumors, anatomical narrowing or irregular shape of the pelvis, abnormalities in the structure of the uterus (intrauterine septum, hypoplasia, bicornuate or saddle uterus) can prevent the establishment of the head at the entrance to the small pelvis.

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

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

In numerous observations carried out by obstetrics and gynecology, it is noted that the breech presentation of the fetus develops in those women who were themselves born in a similar situation, therefore, the question of the hereditary condition of the leg and breech presentation is considered.

Features of the course of pregnancy

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

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

Diagnostics of the breech presentation of the fetus

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

Breech presentation of the fetus is characterized by a higher standing of the fundus of the uterus, which does not correspond to the gestational age. External examination techniques allow us to determine in the bosom area a softish, irregularly shaped, inactive part of the fetus that is not capable of running. In the area of ​​the uterine fundus, on the contrary, it is possible to palpate a large, rounded, hard and mobile part - the head of the fetus. The heartbeat is heard above or at the level of the navel.

Pregnancy and childbirth management

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

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

Carrying out an external preventive turn of the fetus on the head according to Arkhangelsk in a number of cases turns out to be ineffective and even dangerous. The risks of such an obstetric technique can be the onset of premature placental abruption, rupture of membranes, premature birth, rupture of the uterus, trauma and acute fetal hypoxia. These circumstances in recent years have limited the use of an external obstetric aid in the practice of treating breech presentation of the fetus.

A pregnant woman with a breech presentation of the fetus at 38-39 weeks of gestation is hospitalized in an obstetric hospital to plan labor tactics. With an uncomplicated obstetric situation (satisfactory condition of the fetus and the woman in labor, the proportionality of the pelvis and the fetus, the biological readiness of the maternal organism, pure breech presentation, etc.), birth through the natural birth canal is possible. At the same time, prevention of premature opening of the fetal bladder, constant monitor CTG monitoring of the fetus and uterine contractions, drug prevention of abnormalities of labor are carried out

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

The preventive direction provides for a thorough examination and correction of violations in women planning pregnancy; identification of pregnant risk groups for the development of breech presentation of the fetus and timely and adequate preparation for childbirth; early selection of labor tactics and their management under continuous monitoring

In the first half of pregnancy, the fetus constantly moves in the uterus and changes its position, but usually by 30 - 32 weeks it turns over with its head down and is set in this position. But sometimes the baby becomes legs or bottom down - this is the breech presentation of the fetus. Natural childbirth in such a situation is possible, although it is more difficult and requires the use of special allowances. In the breech presentation, 3-5% of all babies are born.

Currently, the following types of such presentations are distinguished, it is necessary to resolve the issue of the method of delivery:

  • Breech presentation:
  1. Pure gluteal- the buttocks are presented at the entrance to the small pelvis, the legs are straightened at the knee joints and extended along the body, the feet are located near the face. This is the most favorable type for independent childbirth. It occurs in 60 - 70% of cases.
  2. Mixed breech presentation- the fetus is located in the uterus, as it were, on its haunches, that is, the buttocks and legs of the fetus are turned into the small pelvis. The frequency of occurrence is 20 - 25%. In the process of childbirth, it can turn into a purely breech presentation.
  • Leg presentations are formed most often during childbirth (found in 10 - 15% of all breech presentation):
  1. Complete- both legs of the fetus are presented at the entrance to the small pelvis.
  2. Incomplete- one leg of the fetus is presented, and the other is extended along the body.
  3. Knee- the knees of the fetus are facing the entrance.

Reasons for development

Currently, a large number of reasons and factors have been put forward that provoke the formation of a breech presentation of the fetus. They can be divided into groups:

  • Maternal factors:
  1. - the narrowing of the entrance to the small pelvis does not allow the baby to establish itself correctly, and he turns over to the bottom, with its narrower part - the buttocks;
  2. Abnormalities in the development of the uterus(, saddle uterus, the presence of an internal septum in the uterus);
  3. Tumors of the uterus(especially myomatous nodes in the lower segment of the uterus);
  4. Pelvic tumors, abnormalities in the shape of the pelvis due to fractures;
  5. Postoperative scar on the uterus;
  6. Change in multiparous.
  • Fruit factors:
  1. Prematurity- the shorter the gestation period, the more often breech presentation occurs. This is associated with the immaturity of the vestibular apparatus, in this regard, the fetus cannot take the correct position in the uterus and set its head down;
  2. Multiple pregnancies- when there are two or more fetuses in the uterus due to lack of free space and limited mobility, they are often not located correctly;
  3. - due to developmental lag, the rate of maturation of the fetal nervous system and its vestibular apparatus also slow down. Also, with a normal amount of amniotic fluid and a small size of the fetus, its excessive mobility occurs, which makes it difficult to install in the correct position.
  4. - anencephaly (a decrease in the size of the fetal head due to the complete or partial absence of the cerebral hemispheres of the brain and skull bones) and hydrocephalus (an increase in the volume of the head due to excessive accumulation of cerebrospinal fluid). The wrong size of the fetal head does not allow it to be correctly inserted into the entrance to the small pelvis.
  5. Increased activity of neurosecretory cells of the hypothalamic nuclei(the part of the medulla oblongata, which is responsible for many functions of the body, including the spatial location).
  • Placental factors:
  1. - a condition in which the placenta partially or completely overlaps the uterine pharynx, because of this, the head cannot take the correct position.
  2. Location of the placenta in the area of ​​the fundus or corners of the uterus changes the inner space of the uterus, and the fetus cannot be established in the cephalic presentation.
  3. - by the end of pregnancy, the amount of amniotic fluid is less than 500 ml, which complicates all movements and movements of the fetus.
  4. - an excessive amount of amniotic fluid (more than 1500 ml) does not allow the fetal head to gain a foothold in the entrance to the small pelvis, and it constantly changes its position.

Diagnostics

  • Palpation of the abdomen during a general examination of a pregnant woman... You can distinguish between cephalic presentation and pelvic presentation by palpating (feeling) the abdomen of a pregnant woman using Leopold's classic obstetric techniques. At the same time, softish irregularly shaped buttocks of the fetus are determined above the entrance to the small pelvis, and a rounded dense head is located in the bottom of the uterus or in one of its corners. The heartbeat is better heard at the level of the navel to the right or to the left, depending on the position (where the fetal back is turned).
  • At vaginal examination the fetal ass is also felt through the fornices of the vagina.
  • is the most accurate way to determine the position of the fetus. During the study, many more parameters are determined that are necessary for choosing a method of delivery (this is gender, estimated weight, position of the fetal head (bent or unbent), cord entanglement, location of the placenta, degree of maturity, nature and amount of amniotic fluid). And based on all the data received, choose the method of delivery.

Ways to change the breech presentation to the cephalic presentation

Information The presentation is finally formed by 35 - 36 weeks of pregnancy, that is, from the moment the diagnosis is made, there is still time to try to help the baby roll over.

A number of exercises have been developed that change the tone of the muscles of the anterior abdominal wall and uterus, affect the vestibular apparatus of the fetus, stimulating its overturn. Here are the simplest ones:

  • Lying on a hard surface, you need to alternately turn over 3-4 times on the right and left sides, and lie on each of them for 10 minutes. Repeat the exercise 3 times a day.
  • In a supine position with legs bent at the knees, raise the pelvis and hold for 2-3 seconds in this position and lower. Do it at a calm pace, remembering to breathe, 5-6 times. If it is difficult to perform the exercise, then you can put pillows under the ass so that the pelvis is located above the head, and lie there for 5 to 10 minutes. Also perform 3 times a day.

When performing these exercises, turning the baby on the head can occur during the first week.

  • The external preventive turn, proposed by Arkhangelsky B.A., must be carried out only in a hospital, at present it is rarely used, since it can lead to many complications.
  • Communicate more with your baby, ask him to roll over. Imagine that the baby is already in the head presentation.

Breech delivery

In a planned manner, a cesarean section is performed if, in addition to the breech presentation, there is also additional indications for surgery:

  • Anatomically narrow pelvis;
  • The estimated weight of the fetus is less than 2000g or more than 3600g (with a breech presentation, such a fetus is considered large);
  • A scar on the uterus;
  • Varicose veins of the vulva and vagina;
  • Fetal head extension
  • Foot presentation of the fetus;
  • Posterior view of the breech presentation of the fetus;
  • Mixed breech presentation in primiparous;
  • Placenta or umbilical cord previa
  • The age of primipara is over 30 years old;
  • History of long-term infertility;
  • Chronic fetal hypoxia;
  • Immature cervix in full-term pregnancy.

The frequency of cesarean section for breech presentation of the fetus is currently 80 - 85%.

Although breech delivery is abnormal, there are a number of conditions under which natural childbirth ends safely. Let's list them:

  • Good condition of the mother and fetus;
  • The average size of the fetus with a sufficient capacity of the pelvis of the pregnant woman;
  • Bent head of the fetus;
  • Maternal readiness for childbirth, mature cervix;
  • Pure breech presentation.

However, such childbirth requires increased attention from the doctor and midwife, and constant monitoring of the fetal heart rate and uterine contractile activity. The mechanism of childbirth is significantly different from childbirth in the cephalic presentation, because the bottom and legs of the fetus are born first, and the largest part, the head, goes last, and it does not have time to take the optimal shape and stretch the birth canal. When the whole body is born and only the head remains, it presses the umbilical cord against the walls of the pelvis and the blood supply to the fetus is sharply reduced. To prevent serious damage to the child's brain, it is necessary to push the head out in 5, maximum 10 minutes. During childbirth, the following complications may occur:

  • Premature(before the onset of labor) or early (up to 5 - 6 cm) rupture of amniotic fluid;
  • Prolapsed umbilical cord or the legs of the fetus with rupture of the fetal bladder and outpouring of amniotic fluid. In such a situation, an emergency operation is indicated;
  • Abnormalities of labor: primary and secondary weakness, weakness of pushing;
  • Acute fetal hypoxia- cessation of oxygen supply due to pressing of the umbilical cord by the head of the fetus;
  • Premature occurs due to a sharp decrease in the volume of the uterus after the birth of the legs of the fetus.
  • Deep tears of the cervix and the mother's vagina.

Additionally Regardless of the method of delivery, all babies born in breech presentation are under the special supervision of a neonatologist (micro-pediatrician) for early detection of the possible consequences of hypoxia during childbirth. Although, of course, there are much fewer such complications after the operation.

1. Diagnostics. Breech presentation is diagnosed using external obstetric examination, vaginal examination and ultrasound. The position of the fetus is determined by the location of the sacrum. The breech presentation is divided into pure breech, mixed breech and leg. In breech presentation, the prevalence of fetal malformations is 6.3% (increased 2.5 times). Early diagnosis is possible with ultrasound.

2. Prevalence. Breech presentation is observed in 3-4% of all births.

3. Etiology. Breech presentation is more often observed with premature birth, fetal and uterine malformations.

4. External head rotation of the fetus is indicated when a breech presentation is detected after the 37th week of pregnancy. This manipulation is performed in the operating room in order to perform an emergency caesarean section if complications arise. Before the operation, the condition of the fetus is assessed using a non-stress test. Tocolytic agents are administered. The pelvic end of the fetus is displaced to the bottom of the uterus, and the head to the entrance to the small pelvis. Rotation can be carried out both in the direction and counterclockwise. The manipulation is performed under ultrasound control. The efficiency is 60-70%. The main complication is intrauterine hypoxia due to premature placental abruption, pressing or entanglement of the umbilical cord.

5. Delivery. Complications of labor in breech presentation: infringement of the head, damage to the spinal cord due to hyperextension of the head, damage to the brachial plexus, prolapse of the umbilical cord, asphyxia, intracranial hemorrhage and damage to the internal organs of the newborn. Babies born in breech presentation often receive a low Apgar score. It is believed that breech delivery through the vaginal birth canal is possible only if the following conditions are present: pure breech presentation, estimated fetal weight 2500–3800 g, normal pelvic dimensions of the pregnant woman, confirmed by CT or X-ray pelvimetry, absence of overextension of the fetal head. At the same time, the risk of birth trauma in the fetus does not exceed 3.3%. In other cases, most authors recommend delivery by caesarean section, although the main cause of complications and death of a newborn after giving birth in a breech presentation is prematurity and congenital defects, and not the method of delivery. The extraction of the fetus by the pelvic end is not currently used.

Manual assistance for breech delivery is as follows. The nascent trunk is supported until the lower angles of the shoulder blades appear. Then the handles are released. To do this, the legs and body are taken up and towards the inguinal fold of the woman in labor, opposite to the released handle. The back handle is brought out first: the extended fingers of the obstetrician slide along the back, shoulder blade and shoulder to the elbow of the fetus, the handle is brought down, without moving away from the body. After that, the body of the fetus is turned 180 ° in order to release the second handle from the side of the sacrum in the same manner. After removing the handles, the fetal torso is placed horizontally and the head is released according to the Morisot-Smelli-Fayt method (bending the head by pressing fingers on the upper jaw of the fetus) and by pressing on the anterior abdominal wall above the pubis of the woman in labor. An episiotomy is recommended. Piper forceps can be used to remove the head.

6. Pelvimetry. Currently, two methods are used: X-ray pelvimetry and CT pelvimetry. CT pelvimetry is considered safer, since the radiation dose received by the fetus is 3 times less than with X-ray pelvimetry.

Expectant mothers, having learned from the doctor that their baby is located in the tummy with the head up, begin to worry, because this position of the fetus is considered incorrect. It is called breech presentation. The baby in the uterus should be positioned with its head down as it represents the widest part of the fetus.

It is best if the head appears first during childbirth, and then the rest of the body. However, 3-5% of women have childbirth with breech presentation of the fetus, which is fraught with complications.

The location of the child in the uterine cavity is classified as follows:

  1. Foot- both hips are unbent or only one of them, and one leg is located at the exit from the uterus. This type of presentation is observed in 10-30% of pregnant women (most often in multiparous women).
  2. Buttock- the legs of the fetus in the hip joints are bent, and the knees are pressed to the tummy and straightened. This presentation occurs in 50-70% of women in position (most often in primiparous).
  3. Mixed(gluteal leg) - knees and hips bent. This type of presentation occurs in 5-10% of cases.

Causes of breech presentation of the fetus

Until 32 weeks, the fetus can take various positions in the mother's tummy. The presence of free space in the uterus allows it to move. As the child grows, he tends to sit with his head down.

For the following reasons, breech presentation of the fetus may persist until delivery:

  • lack of water or;
  • pathology of the placenta: location in the area of ​​the tubal corners,;
  • pathology of the uterus: violation of tone, fibroids;
  • fetal pathology: anencephaly, hydrocephalus;
  • multiple pregnancy;
  • the consequence of a cesarean section.

Signs of a breech presentation of the fetus

Many women are concerned about the question of what the breech presentation of the fetus means, and by what signs it can be determined. Pregnant women do not feel at all that their baby is lying incorrectly in the uterus. There is no discharge or pain. Breech presentation can only be determined by a doctor during examination.

Experts note that when the child is placed head up, there is a higher standing above the pubis of the fundus of the uterus, which does not correspond to the gestational age. In the area of ​​the navel, the fetal heartbeat is heard more clearly.

With a vaginal examination, the doctor may reveal signs of a breech presentation of the fetus. With the mixed and foot position of the child, his feet are probed, and with the gluteal position, the sacrum, the inguinal fold, the soft volumetric part, the tailbone. Despite all the signs, an accurate diagnosis is determined only by ultrasound.

Delivery with breech presentation of the fetus

A baby can be born in a breech presentation naturally or as a result of a cesarean section.

The choice of a specific method of delivery depends on the following factors:

  • the age of the pregnant woman;
  • gestational age;
  • history data;
  • existing diseases;
  • the size of the pelvis;
  • type of breech presentation;
  • the sex and weight of the fetus, the degree of extension of its head.

Delivery with breech presentation of the fetus can take place naturally if: the gestational age is more than 37 weeks; the average estimated weight of the fetus is 2500-3500 g; the size of the mother's pelvis is normal; it is known that a girl will be born, not a boy; presentation is gluteal or gluteal-leg presentation.

If the above conditions are not met, then it is required. In addition, the operation is necessary if: delivery is premature; the weight of the fruit is less than 2500 or more than 3500 g; male fetus; breech presentation is foot, ultrasound revealed hyperextension of the fetal head.

Your doctor may decide to have a caesarean section once you start to give birth naturally. It will be called emergency. Indications for immediate surgery may be as follows:

  • weak labor activity;
  • falling out of the baby's legs, arms or umbilical cord;
  • discoordination of labor (contractions are observed, and the cervix does not open).

Possible complications during childbirth with breech presentation of the fetus

Breech presentation of the fetus in the longitudinal position has absolutely no effect on the course of pregnancy. Complications can occur during childbirth.

First, labor may be weak. This is due to the fact that the pelvic end of the fetus is smaller than the head in volume. He weakly presses on the uterus, and as a result, it contracts worse, its cervix opens more slowly.

Secondly, during childbirth, the baby's head may tilt back. Her birth will be difficult. There is a risk that the child will be injured.

Thirdly, often with a breech presentation of the fetus, the umbilical cord is clamped between the wall of the birth canal and the head. This will hinder the flow of oxygen. The fetus will develop hypoxia.

Fourthly, during childbirth, the handles may be thrown back. This is also fraught with various injuries.

Is it possible to correct the breech presentation of the fetus?

Many young mothers start to panic too early when they find out that their baby is in the wrong position in the tummy. For example, some women find out on ultrasound about the breech presentation of the fetus at 20, 21 or 22 weeks and are already beginning to look for ways to correct its posture. However, it is still too early to think about it. In most pregnant women, the baby is in the correct position by 32 weeks or even later.

If at 32 weeks the ultrasound showed that the fetus did not turn over and remained in the head up position, then you can begin to perform special exercises. They are effective, and in most cases, thanks to them, the breech presentation of the baby is replaced by the head presentation.

Exercises can be started with breech presentation of the fetus from 33 weeks. You should first consult with your doctor. During pregnancy with complications, you may have to give up exercise altogether so as not to harm the baby. Only the doctor will tell you whether physical exercises can be performed, and whether they will negatively affect the condition of the expectant mother and fetus.

It is recommended to start all classes with a warm-up. For several minutes, a pregnant woman can walk with a normal step, and then - on her toes and heels. Hand movements (rotation, raising and lowering), raising the knees to the side of the abdomen will not be superfluous. Below are some examples of simple exercises that can be done after 32 weeks with a breech presentation.

Exercise 1

Stand with your back straight and legs apart. The arms should hang freely along the torso. Then you should stand on tiptoes and spread your arms to the sides, bend your back, take a breath. After that, exhale and take the starting position. Do the exercise 4 - 5 times.

Exercise 2

You will need pillows to complete it. They are necessary in order to raise the pelvis. The pregnant woman should lie on the floor and put on some pillows. As a result, the pelvis should rise above shoulder level by 30-40 cm. The pelvis, knees and shoulders should form a straight line. This exercise is recommended to be performed a couple of times a day for 5-10 minutes, but not on a full stomach.

Exercise # 3

Get on all fours with your head tilted down. While inhaling, round your back. Then return to starting position. Exhale, bending in the lumbar region and lifting your head up.

Exercise 4

It is necessary to lie on your back, spreading your legs shoulder-width apart and bending them. The feet should rest on the floor. Hands should be relaxed and extended along the body. When you inhale, you should raise your back and pelvis, resting on your shoulders and feet, and when you exhale, take the starting position. Then you need to straighten your legs, take a breath, drawing in your stomach. The muscles of the perineum and buttocks should be tense. When you exhale, take the starting position again. This exercise is recommended to be repeated 6-7 times.

If you want to start doing physical exercises early (for example, at 30 weeks with a breech presentation of the fetus), then you should definitely consult your doctor.

Exercise is not the only thing that can affect the position of the fetus. Proper nutrition, walks in the fresh air are of great importance.

It is advisable for pregnant women to sit on chairs with a firm and straight back and a hard seat. Sitting on upholstered furniture, it is recommended to slightly spread your legs so that your stomach lies freely. If possible, then it is worth buying a fitball and performing special exercises on it that can affect the position of the child in the mother's tummy.

Thus, do not panic after learning from the doctor about the breech presentation of the fetus earlier than 27 weeks. The baby can change his position several times before giving birth. If desired, from 30-32 weeks in the absence of contraindications, you can begin to perform special physical exercises.

If they do not affect the position of the fetus, then the doctor will select the optimal delivery option (cesarean section or natural childbirth), which will not harm either the woman or her baby.

Replies

In the overwhelming majority of cases, by 34-36 weeks of pregnancy, the baby settles down with its head down. Obstetricians call this position - cephalic presentation. It is easier and easier to be born with a head, both for the mother and the baby. But from 3 to 5% of children are in breech presentation. With breech presentation, the baby's head is at the top, in the bottom of the uterus, and the pelvic end is located above the entrance to the small pelvis.

It is customary to distinguish between several types of breech presentation: purely breech, mixed breech, leg, knee presentation is extremely rare. With a pure breech presentation, the baby's legs are raised and the stacks are near the baby's head. With a mixed breech presentation, the baby seems to be squatting. And with a foot presentation, the baby's legs are unbent, he "stands" on both legs (full foot presentation) or one (incomplete foot presentation). The most common is a pure breech presentation 65%, less often a mixed breech presentation - 22%, a leg presentation occurs in about 13% of cases. Obstetricians note a decrease in the number of breech presentation as pregnancy progresses. This is quite understandable, because nature tends to position the child in the most convenient position for childbirth. From a scientific point of view, this fact is explained in this way: the shorter the gestation period, the less mature the baby's vestibular apparatus is, the higher the frequency of breech presentation.

The reason for the formation of breech presentation is not well understood. Normally, the uterus has the shape of an ovoid (egg) with a more significant oval at the bottom. The outline of the baby is also similar to an ovoid with a large oval at the pelvic end. Thus, by setting the head down, the baby adapts to the shape of the uterus.

That is why one of the reasons for the formation of a breech presentation is the irregular shape of the uterus (saddle, two-horned, etc.). In addition, breech presentation can occur for the following reasons:

  • increased mobility with polyhydramnios, premature pregnancy, multiple pregnancies;
  • a reduced amount of amniotic fluid limits the baby's mobility;
  • placenta previa when it "blocks" the baby along the birth canal;
  • too large a fetus or narrowing of the bone pelvis, i.e. violation of the correct ratio between the size of the head and the size of the entrance to the small pelvis.

The most common reason for the formation of breech presentation is the lack of readiness of the body for childbirth, which is manifested by a violation of the tone of the uterus. It can be either low, or high, or uneven. Studies have shown a high frequency of menstrual irregularities and various gynecological diseases, which leads to disruption of the neuromuscular apparatus of the uterus and, as a consequence, breech presentation.

Diagnosis of breech presentation is usually straightforward. With an external examination, the obstetrician-gynecologist palpates (probes) the soft presenting part, and in the fundus of the uterus the head is determined - it is harder, more rounded, and is running (displaced in relation to the neck of the fetus). With breech presentation, there is a higher standing of the uterine fundus in relation to the gestational age. The baby's heartbeat is heard clearly above the navel of the pregnant woman. Gynecological examination and ultrasound helps to establish the diagnosis of breech presentation. Ultrasound examination allows you to obtain additional information about the type of breech presentation, the size of the baby, the position of the head (it is bent or unbent), the localization of the placenta, the location of the umbilical cord.

There were no specific features of the course of pregnancy in breech presentation. The presence of a breech presentation before 28-30 weeks of pregnancy does not require treatment, dynamic observation is shown, because head rotation occurs spontaneously in more than 70% of cases. However, starting from 29 weeks of pregnancy, special exercises are recommended to help the baby turn around correctly. It is very important to talk to your baby, explaining to him why it is better to sit with his head down. There are several different complexes recommended in this case.

Method I.F. Dikanya applies from 29 to 40 weeks. 3 times a day, a pregnant woman lies alternately on one side, then on the other. You need to lie on each side 3-4 times, each time for 10 minutes. To do this, you can use a regular couch or bed. When the head is set over the entrance to the small pelvis, it is recommended to lie more on the side corresponding to the back of the child. This method increases the baby's motor activity, changes the tone of the uterus by increasing the irritation of its receptors when changing the position of the body. The method is good for its simplicity and accessibility, practically has no contraindications.

Method V.V. Fomicheva applies from 32 weeks. This is a special set of exercises, which is carried out 2 times a day for 20-25 minutes. First, a warm-up is carried out - this is walking on toes, on heels, on the outer arch of the foot and on the inner, walking with raising the knees to the side of the abdomen. Exercises are performed at a slow pace in a specific sequence from easy to more difficult. You will need a stable chair and rug.

  • I. p. - standing, feet shoulder-width apart, arms down. Tilt to the side - exhale, return to I.p. - inhale. Repeat 5-6 times in each direction.
  • I. p. - standing, hands on the belt. A slight backward bend - inhale, a slow forward bend (bend in the lumbar region) - exhale. Repeat 5-6 times.
  • I. p. - standing, feet shoulder-width apart, hands on the belt. Spread your arms to the sides - inhale, turn to the side, while joining your hands in front of you. Repeat 3-4 times in each direction. Execute slowly.
  • I. p. - standing facing the back of a chair, holding on to it with outstretched arms. Raise the leg bent at the knee joint to the side of the abdomen so that the knee touches the hand - inhale; lowering the leg, bend in the lumbar spine - exhale. Repeat 4-5 times.
  • I.p. - standing to the side of the chair, put one leg with a knee on the seat of the chair, hands on the waist. Spread your arms to the sides - inhale, turn the torso and pelvis to the side, slowly bend over, lowering your arms in front of you - exhale. Repeat 2-3 times in each direction, changing the supporting leg.
  • I. p. - knee-elbow position. Straighten one leg, slowly lift it up. Repeat 4-5 times with each leg.
  • I. p. - lying on the right side. Bend the left leg to the side of the abdomen - inhale, unbend - exhale. Repeat 4-5 times.
  • I. p. - lying on the right side, the leg is raised not high above the floor. Circular movements of the left leg 4 times in each direction. Repeat 3-4 times.
  • I. p. - standing on all fours. Lower your head down, round your back - inhale, return to the starting position - exhale. Repeat slowly 10 times.
  • I. p. - lying on the left side. Bend the right leg to the side of the abdomen - inhale, unbend - exhale. Repeat 4-5 times.
  • I. p. - lying on the left side, the leg is raised not high above the floor. Circular movements with the right leg 4 times in each direction. Repeat 3-4 times.
  • I. p. - standing on all fours. Straighten your legs, lifting your pelvis up (the heels come off the floor). Repeat 4-5 times.
  • I. p. - lying on your back, support on the feet and the back of the head. Raise the pelvis up - inhale, return to the starting position - exhale. Repeat 3-4 times.

We finish the complex with breathing exercises in a lying or sitting position - 4-5 calm, slow breaths.

Tilting the body in different directions, exercises to activate the oblique muscles of the abdomen increase the tone of the uterus, the motor activity of the fetus, and thus contribute to the displacement of the head in the desired direction.

  • I. p. - knee-elbow position. Slowly inhale and exhale. Repeat 5-6 times.
  • I.p. - knee-elbow. Slowly tilting the body down, touch the hands with the chin - inhale, smoothly return to the starting position - exhale. Repeat 4-5 times.
  • I. p. - knee-elbow. Slowly raise your straight right leg up, take it to the side, touch the floor with your toes, return to the starting position. Repeat 3-4 times in each direction, breathing is arbitrary.
  • I. p. - On knees. Lower your head down, round your back - exhale, slowly bend in the lumbar region, raise your head - inhale. Repeat 8-10 times.

We finish the set with exercises to strengthen the muscles of the pelvic floor. The most common is the Kegel exercise (tighten the pelvic floor muscles, as if stopping a stream of urine, count to 10, relax, strain, counting to 8, then to 6, 4, 2). This set of exercises additionally helps to improve the condition of the cervix, possibly due to the fact that blood circulation in the pelvic organs improves.

Before performing any exercise technique, you should consult with your obstetrician-gynecologist. You should always remember about the presence of contraindications to classes. You can not do gymnastics in the presence of preeclampsia (it is manifested by edema, increased blood pressure, the presence of protein in the urine); serious pathology from the heart, kidneys, liver; the presence of placenta previa (the placenta blocks the exit from the uterus); with the threat of premature birth. In addition, the choice of a set of exercises depends on the state of the tone of the uterus. With increased tone, the Dikan complex is recommended. With reduced and normal - a set of exercises by Fomicheva, and with an uneven tone (tone in the body of the uterus and the lower segment is higher than in the bottom) - exercises according to the Bryukhina method. The doctor observing a pregnant woman will also help to determine what the tone of the uterus is and to choose the correct technique.

If, by the time of full-term pregnancy, the baby remains in breech presentation, it is very important to resolve the issue of childbirth. The fact is that breech delivery is pathological: it is difficult and dangerous for the baby. When giving birth in a cephalic presentation, the head going first slowly passes along the birth canal. There is time to adapt to the complex shape of the pelvis, to find the greatest space, to turn around so that it is easier. The shape of the head even changes: in a newborn, it is extended from the chin to the crown. When giving birth in a breech presentation, the pelvic end passes first along the birth canal. When the baby is born to the umbilical ring, the head enters the small pelvis and necessarily presses the umbilical cord. This means labor should be completed in the next 3-5 minutes. Otherwise, oxygen starvation will develop - hypoxia. The head passes through the bone pelvis very quickly, does not even have time to change its shape. A newborn born in breech presentation has a round head. Such a rapid birth of the head is unfavorable. This is why women with a breech presentation are considered to be at increased risk.

If by 37-38 weeks the baby has not changed its position, and its head remains at the top, it is necessary to carefully weigh: how to give birth? Usually, an antenatal hospitalization is recommended for a pregnant woman in order to assess all the factors in a hospital setting and correctly answer the question posed.

If by 37-38 weeks the baby has not changed its position, and its head remains at the top, it is necessary to carefully weigh: what is the best way to give birth? Usually, an antenatal hospitalization is recommended for a pregnant woman in order to assess all factors in a hospital setting and choose the right method of delivery. For this, the following factors must be assessed:

  • estimated fetal weight. A kid over 3600 g is considered large. Its head may be too large for such a delivery, which means it is better to have a cesarean section.
  • type of breech presentation. The most preferable is considered to be purely gluteal. With foot presentation, various complications are more common, such as prolapse of the umbilical cord.
  • head position. It is important that the head is bent, while the size of the head with which it enters the pelvis is the smallest. The more the head is unbent (the child seems to be looking at the stars), the larger the circumference of the head, the more dangerous it is for her to pass such a quick and unprepared passage through the small pelvis.
  • the normal size of the bone pelvis of the expectant mother. The narrowing of the bony pelvis will also make it difficult to give birth to the head.
  • general condition of mom and baby. The presence of any serious complications of pregnancy (gestosis, pathology of the cardiovascular system, etc.) in the mother, signs of chronic intrauterine hypoxia (chronic lack of oxygen) in the baby persuade obstetricians-gynecologists to decide in favor of a cesarean section
  • the degree of maturity of the cervix. Closer to due date, the cervix matures (this is the medical term). It shortens, softens, the cervical canal opens. This suggests that the preparation of the female body for childbirth is proceeding correctly.

In addition, other points are important:

  • the age of a primiparous woman is over 30 years old, because statistically more often they have weakness of labor pains and attempts;
  • burdened obstetric history (infertility, miscarriage);
  • gestational age. With preterm birth, a caesarean section is often done. The pelvic end is small and can be born with insufficient dilatation of the cervix, while the head can be delayed and injured;
  • the estimated sex of the fetus. If it is a boy, then the likelihood of a caesarean section increases, because with spontaneous childbirth, there is a risk of trauma to the testicles with the subsequent development of infertility.

If the council decides on the inexpediency of spontaneous childbirth, then delivery is carried out by cesarean section in a planned manner. But spontaneous childbirth is also possible.

Childbirth through the natural birth canal has a number of features, and therefore is carried out by obstetricians in a special way. In the first stage of labor, such complications as untimely discharge of amniotic fluid are often encountered, so it is recommended that the woman in labor lie more. It is better to lie on the side towards which the back of the child is facing. Monitoring of the state of labor and the state of the fetus is often carried out. Weakness of labor with such labor contractions occurs more often than with birth in a cephalic presentation. Careful monitoring of the baby's condition is extremely important in any birth. When attempts begin, it is necessary that the woman in labor understands the responsibility of the situation. It is very important to push well after the birth of the child to the umbilical ring, because the umbilical cord was pressed, which means you need to hurry. The child, if he is born in breech position, is received by an obstetrician-gynecologist, the midwife helps him. The doctor provides a special obstetric allowance that will allow a baby to be born without problems. The presence of a neonatologist at childbirth is mandatory. The condition of children born in breech presentation requires increased attention. In these children, the pathology of the hip joints and the nervous system is more common.