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External obstetric turn. Why is breech presentation of the fetus considered dangerous, what causes it and how does childbirth proceed? Combined obstetric rotation with full opening of the uterine os


Closer to the eighth month of pregnancy, most babies turn head down, thus preparing for childbirth. But if your baby has not done this, then in 90% of cases this means that he is preparing to come out of the womb forward with his buttocks or legs. This is called breech presentation. If this is found before 35 weeks, then you can try to help the baby take the right position on your own. Sometimes from 37 weeks, you may be offered obstetric revolution. Births in which the baby is in a breech presentation (that is, booty or feet down) require more skill from obstetricians and are more likely to have complications. But that doesn't mean you can't give birth on your own.

The first thing you can do is help your baby roll over. And help you do it


  1. Conversations. Do not laugh. But your attitude, your mood and words, greatly affect your baby.

  2. Swimming. If there are no contraindications from your doctor, start visiting the pool! Most often, a sedentary lifestyle is the reason that the baby seems to be stuck and cannot roll over. In addition, water is a good relaxant. Aqua gymnastics and water aerobics will cheer you up, relieve tension from the spine and abdominal muscles. And your baby will be helped to roll over

  3. coup. It is very important for mom lying down to roll over from side to side. Sleeping and lying in the same position can cause breech presentation. Just your baby, get comfortable too. So the first exercise is:

Lie on a hard, flat surface (sofa, couch, floor) on your side. Lie down like this for 10 minutes, roll over over your back to the other side, and lie down like this for another 10 minutes. It is good if the exercise can be done at least 2-3 times. It is best to do it before meals.

  1. Kitty. One of the most recommended exercises. Get on all fours and slowly rock your hips. Bend as you inhale, and as you exhale, arch your back like a cat, and lower your head down.

  2. Incline. Lie down near the wall, put a pillow under the spike, so that the pelvis is slightly higher than the head, and rest your legs against the wall with half-bent legs .. Try to relax and lie down like this for 5-10 minutes

  3. Sit on the floor and join your feet. Try to press your knees to the floor. Hold this position for 10-20 minutes. Repeat the exercise 3 times a day

  4. Long live fitball! Don't be lazy, buy yourself a pregnancy ball. He will be useful to you again and again. The best exercise on it is

    • Bend your knees, put on the ball, lie on your back, raise and lower your pelvis. Repeat the exercise 10 times.

    • Bend your knees and place on the ball. Slowly rock them from side to side. Exercise repeat 10 times

    • Sit on the ball, put your feet shoulder-width apart. Start making light circular motions with your hips.


Do not be discouraged if you have done everything to make your baby roll over, and he stubbornly sits on his ass. But sometimes the child takes this position because it is most convenient for him to be in it - the length of the umbilical cord and the location of the placenta make this position convenient for the child. In this case, trying to turn the baby over is useless.

Separately, I would like to tell you about the obstetric revolution. In our country, the external rotation of the fetus is very rarely recommended, and no one dares to do the internal one at all, since the method itself is considered outdated and unreliable. There is a risk that the child from the head, after turning, will go into a transverse presentation - and from there it will be almost 100% delivered by caesarean.
It is up to the future Mom and her attending physician to decide unambiguously.

Obstetric rotation is an operation with the help of which it is possible to change the position of the fetus, which is unfavorable for the course of childbirth, to a favorable one, and, always, only longitudinal. There are the following methods of obstetric rotation: outer turn on the head, less often on the pelvic end; inner turn with the full opening of the uterine pharynx - a classic, or timely, turn.
The external rotation of the fetus is performed by the doctor only by external methods through the abdominal wall without any influence from the vagina. Indications: transverse and oblique positions of the fetus, pelvic presentation of the fetus. Conditions for carrying out: good fetal mobility (with receded waters, rotation is not shown); normal pelvic dimensions (true conjugate not less than 8 cm); lack of indications for the rapid end of labor (fetal asphyxia, premature detachment of the placenta, etc.).

There are also contraindications.

Please note that not all women may be subject to this procedure! If you are carrying twins or your pregnancy is complicated by bleeding or oligohydramnios, this manipulation is contraindicated for you! And, of course, this procedure is not carried out for those women who, in any case, will give birth by caesarean section - for example, with placental presentation, carrying triplets, or having a history of two or more caesarean sections or operations on the uterus. Severe complications, although relatively rare, can occur. For example, obstetric fetal rotation can cause the placenta to detach from the wall of the uterus, forcing the doctor to decide on an emergency caesarean section. The procedure can also cause the baby's heart to slow down, a condition that requires immediate delivery if it doesn't go away on its own within a short amount of time. For these reasons, the doctor should only perform this procedure in a hospital with an operating theater, intensive care unit, and medical staff that may be needed to perform a caesarean section in the event of any complications.

Technique of obstetric coup.

The classic internal rotation is performed only by a doctor. When carrying out an internal obstetric turn, one hand is inserted into the uterus, the other through the abdominal wall of the woman in labor helps the first. A classic internal rotation is shown in the transverse position of the fetus, as well as in presentations dangerous for the mother (for example, frontal) and insertions of the head (for example, posterior parietal). With a classic turn, you can turn the fetus from a transverse position (sometimes longitudinal) to the head and to the leg. Turning to the head is currently of no practical importance. Conditions for rotation: full opening of the uterine os, full fetal mobility. A contraindication to internal rotation is the neglected transverse position of the fetus.
Today, doctors rarely risk the health of a woman in labor and a child. Therefore, caesarean is preferred to an internal coup.

Easy pregnancy and childbirth!

Until a certain period, the child in the womb is in constant motion and can change its position several times. Head presentation is considered the most favorable for childbirth, when the fetus is located vertically with its head down. In this case, childbirth takes place without complications.

In about 5% of cases, the fetus is in a breech presentation, in which it is head up. If childbirth takes place naturally, the legs and pelvis are born first, and the head is born last. Pathological is the longitudinal-transverse position, in which childbirth cannot occur on its own.

To avoid the negative consequences of a pregnant woman, it may be recommended to do a caesarean section. But surgery is also regarded by many expectant mothers as highly undesirable. As an alternative option for breech presentation, an external obstetric rotation, once proposed by Arkhangelsky, can be used.

Reasons for the formation of presentation

All the reasons that can provoke an incorrect position can be divided into two groups. The first is caused by the characteristics or pathologies of the mother. These include:

  • abnormalities in the structure of the uterus;
  • violation of the volume of amniotic fluid (oligohydramnios or polyhydramnios);
  • entanglement with the umbilical cord, which prevents the child from turning his head down;
  • pregnancy with twins (triplets);
  • uterine fibroids of large sizes, which creates mechanical obstacles to the normal position;
  • malformations and anomalies in the structure of the mother's pelvic bones;
  • anomalies in the development of the placenta;
  • a slight break between pregnancies, especially if there was a caesarean section in the previous one;
  • decrease in uterine tone - more common in multiple births or in those who have undergone multiple abortions, curettage, caesarean section or other operations on the uterus;
  • hereditary factor.

Breech presentation presents certain risks for the baby. Mortality during childbirth in this case is 9 times higher than with normal head presentation. 80% of pregnancies with this indicator end in a caesarean section. During natural childbirth, the woman in labor increases the risk of rupture of the internal genital organs, and the child may develop asphyxia, hypoxia, and hematomas may appear. Childbirth is often complicated by the weakness of labor activity.

Until the 36th week, the fetus can change its position. If the mother had a breech presentation before this period, this does not mean that it will continue until the very birth. In this case, they take a wait-and-see attitude. After the 36th week, the chances of a natural improvement in the condition are minimal. In this case, medical attention is needed.

Misposition Diagnosis

Presentation is determined no earlier than the 22nd week of gestation. The phenomenon is more common in multiparous women. The course of pregnancy in breech or transverse presentation does not have any specific features.

Diagnosis of pathology is not difficult. During an external examination, attention is paid to the discrepancy between the height of the fundus of the uterus and the circumference of the abdomen, the presence of large parts of the fetus in the lateral sections, listening to the heartbeat in the navel.

The most informative diagnostic method is this. With its help, they not only establish the wrong position, but also determine the location of the placenta, the approximate weight of the unborn child, the amount of amniotic fluid, the presence of tumors or nodes in the body of the uterus, and intrauterine development disorders.

When is an external obstetric turn performed?

If an abnormal position of the fetus was found on the ultrasound, there are a number of measures that can transfer it to the head presentation without medical intervention. Pregnant women are recommended to perform special gymnastics, fitball exercises, swimming or water aerobics. Full-fledged physical activity encourages the child to take a position favorable for childbirth.

Among the recommended exercises, one can single out being in the knee-elbow position for 15 minutes several times a day and quick flips from side to side at intervals of 10 minutes. However, as practice shows, such exercises are not very effective.

Contraindications to corrective gymnastics should be taken into account - the threat of premature birth, low attachment of the placenta, narrow pelvis, high blood pressure.

Corrective gymnastics for pelvic presentation of the fetus

If the presentation by the 34-35th week has remained unchanged, one of the ways out in this situation is the use of an external obstetric turn. This technique has been known for a long time, but over the years it was used quite rarely, because, not wanting to take risks, many doctors preferred to perform a caesarean section. Modern equipment has made it possible to control and monitor the condition of the mother and fetus during the rotation, which has caused doctors to increasingly return to this method and refuse to perform surgery.

External obstetric rotation should be carried out by a doctor in a hospital.

The procedure can be carried out only if the following conditions are met:

  • one fruit weighing no more than 3700 g;
  • the integrity of the fetal bladder;
  • normal amount of amniotic fluid;
  • lack of increased or decreased tone of the uterus;
  • the size of the woman's pelvis is normal;
  • a satisfactory condition of the woman and the absence of anomalies of intrauterine development of the fetus.

The procedure is carried out only if the operating room is equipped with ultrasound equipment and if it is possible to provide emergency medical care in case of unforeseen circumstances.

Contraindications

External obstetric rotation is not performed if a history of recurrent miscarriage and premature birth was diagnosed. Symptoms of late toxicosis, such as high blood pressure, heart rhythm disturbances, edema as a result of poor kidney function, are also a contraindication.

Other contraindications include:

  • pregnancy with twins, triplets;
  • fetus weighing over 4 kg;
  • cord entanglement;
  • violation of the integrity of the fetal bladder and leakage of water;
  • the presence of large uterine fibroids or multiple myoma nodes;
  • expressed;
  • risk of bleeding and placental abruption;
  • previous births by caesarean section;
  • previous operations on the uterus.

Relative contraindications include excess weight of the pregnant woman.

Approximately 15% of women have Rh negative blood. Before carrying out the manipulation, the presence or absence of anti-Rhesus antibodies in the blood is taken into account. Obstetrical rotation is not possible in the presence of antibodies, which usually occurs with repeated pregnancies. If antibodies are absent, a negative Rh factor is not a contraindication.

How is the procedure carried out?

The rotation procedure takes place in several stages:

  1. Hospitalization of a woman at the 35-36th week of pregnancy and full informing the expectant mother about the upcoming manipulation, her moral preparation.
  2. Conducting ultrasound and CTG to assess the condition of the pregnant woman, determine the location of the placenta, assess the readiness of the female body for the upcoming birth.
  3. General preparation for the procedure, including bowel and bladder emptying.
  4. Carrying out - the introduction of tocolytics, drugs that inhibit the contractile activity of the uterus.
  5. Conducting external obstetric rotation.
  6. Control ultrasound and CTG to assess the condition of the fetus and prevent complications.

The probability of maintaining head presentation until delivery is about 60-70%. If the turn is made at a later date, the effectiveness of the procedure is reduced.

How painful is the manipulation?

During it, the pregnant woman experiences some discomfort, which is still not a reason for the introduction of anesthesia. Multiparous people tolerate obstetric rotation more easily. In some cases, epidural anesthesia is indicated.

The patient should lie on her back on the couch, and the doctor should take a position next to her, facing her. One hand of the doctor is on the pelvic area, and the second - on the head of the fetus. With careful, but rhythmic and persistent movements, the buttocks are displaced towards the back, and the back towards the head. The head is displaced towards the abdominal wall of the fetus.

The obstetrical rotation technique allows its implementation both along and counterclockwise, depending on the position of the fetus. In the transverse position, the fetus is first transferred to the pelvic, and then to the head position.

Control ultrasound allows you to make sure that all procedures were performed correctly. It is mandatory to monitor the fetal heartbeat and. But often the successful outcome of the turn does not guarantee that the child will keep the head presentation until the very birth. Perhaps his return to the pelvic position.

What measures should be taken to reduce the risk of pelvic position recurrence?

To fix the position of the child favorable for childbirth, a special bandage is used. It is a ribbon 10 cm wide, which is fixed at the level of the navel. Such fixation excludes the return of the fetus to the transverse or pelvic position. The bandage must be worn for 2 weeks, that is, almost until the very birth.

Is external obstetric rotation dangerous?

There is an opinion that it is prohibited due to the increased danger to the fetus.

Indeed, turning has certain risks, but caesarean section and even natural childbirth in the pelvic position are no less dangerous.

It is almost impossible to injure a child, since it is reliably protected by amniotic fluid. The procedure lasts only a few minutes, and in total a woman spends about three hours in a medical institution (the time for preliminary and control ultrasound and preparation is taken into account).

As a rule, a second visit to the doctor is scheduled after 1-2 days in order to assess the success of the rotation. If everything went well, expect a natural birth. Otherwise, the patient is preparing for a caesarean section.

The failure rate is about 30%. As a rule, they are associated with the contraindications indicated above. If the turn could not be carried out, the patient must be provided with complete rest in order to prevent damage to the fetal bladder and not provoke.

Sometimes manipulation can provoke premature birth. This is not critical, since the rotation is carried out no earlier than the 35th week, when the fetus is already quite viable.

Possible Complications

External obstetric rotation is carried out only in a specialized institution, so the risk of complications is no more than 1%. In some cases, the following negative consequences are possible:

  • premature detachment of the placenta;
  • fetal distress;
  • premature rupture of the fetal bladder;
  • the appearance of heavy bleeding;
  • uterine rupture;
  • infectious complications in the postpartum period.

Bleeding and severe cramping pains, aggravated by palpation, testify to premature detachment of the placenta. With a small loss of blood, no signs of hypoxia in the fetus and a satisfactory condition of the pregnant woman, a decision is made to maintain gestation. If the detachment progresses, an urgent caesarean section is necessary to prevent hypoxia (lack of oxygen) of the fetus. Insufficient oxygen supply leads to the development of neurological problems and the child's lag in physical and mental development.

Fetal distress (intrauterine asphyxia) also has a detrimental effect on the child's condition. Due to the lack of oxygen, hemorrhage occurs in the brain, heart, liver, kidneys. The main sign of asphyxia in a newborn is a violation of breathing, which negatively affects the baby's cardiac activity and the functioning of its nervous system.

In the future, children who have had birth asphyxia develop hyperexcitability syndrome, hydrocephalus, a tendency to convulsions and other neurological problems.

Uterine rupture is a very rare occurrence, in most cases occurs in the presence of scars left over from a previous caesarean section or surgery. To eliminate the gaps, the organ is sutured, followed by the appointment of antibiotics and drugs that prevent thrombosis.

To agree to an external obstetric turn or rely on, the woman herself decides after weighing all the pros and cons, as well as after consulting a doctor. Even if there are certain risks during the procedure, one should not forget that natural childbirth is always preferable to surgical intervention.

By the 36th week of pregnancy, the baby takes the position that will remain until the moment of birth. That part of the baby's body that will be turned into the mother's pelvic cavity is called the presenting. In 97% of cases, this is the head, and the most favorable of the head presentations is occipital presentation, when the chin of the fetus is close to the chest. But in 2.5% of pregnancies, a breech presentation or, even more rarely, a transverse or oblique position may persist. In such cases, in order to avoid caesarean section, they resort to obstetric rotation of the fetus.

External rotation of the fetus: indications and contraindications

With the pelvic position of the child before delivery, an external obstetric rotation of the fetus can be performed. This series of manipulations, which is recognized by obstetricians around the world, allows you to reduce the frequency of delivery by caesarean section.

Previously, with insufficient development of technical means, it was difficult to control the effectiveness and safety of manipulation. Currently, everything is carried out under the control of ultrasound and CTG, so the risk of complications is much lower than after a caesarean section.

The procedure is performed at 35-36 weeks. The probability of maintaining head presentation after it reaches 60%. When performed at a later date, the effectiveness is much lower. Mandatory conditions are:

  • good fetal mobility;
  • pliable abdominal wall;
  • pelvis of a pregnant woman of normal size;
  • general good condition of mother and fetus.

It is not necessary to perform a breech presentation obstetric rotation if a caesarean delivery is planned. Manipulation is contraindicated in the following cases:

  • history of preterm birth or antenatal death;
  • operated uterus;
  • pregnancy was complicated by toxicosis, preeclampsia or bleeding;
  • multiple pregnancy;
  • oligohydramnios and polyhydramnios;
  • large fruit;
  • anomalies in the development of the uterus,.

Technique for performing an obstetric turn

Obstetric rotation is performed in a hospital setting, where it is possible, if indicated, to transfer a woman to a birth unit or deploy an operating room.

  • Before starting, an ultrasound scan is mandatory to determine the position of the fetus, the amount of water and the location of the placenta, and CTG to assess the condition of the fetus.
  • The woman is given an enema, asked to empty her bladder, or passed urine with a catheter.
  • Be sure to introduce tocolytics, which will prevent the development of uterine tone.
  • The pregnant woman takes a supine position on the couch.
  • The doctor is located nearby, facing the pregnant woman. He places one hand on the pelvic end, and the other on the head of the fetus.
  • The pelvis is shifted upward very carefully, at the same time pressure is applied to the head. The fetus rotates towards its abdominal wall.

Obstetric rotation of the fetus may have consequences in the form of recurrence of breech presentation. To avoid this, it is recommended to apply a bandage at the level of the navel or slightly below it. It can be an elastic 10 cm tape. It will give the uterus a more elongated vertical shape. If the bandage is removed, the child can assume a transverse position.

Many fear trauma to the fetus when performing a turn. If there are no contraindications, the procedure is quite safe. The child cannot get injured, all manipulations are softened by amniotic fluid.

If during the manipulation a deterioration in the condition of the mother or child is noticed, it is immediately stopped. The second attempt is carried out only under the condition of complete well-being.

After turning, ultrasound is done again, CTG is recorded to assess the child's condition. After 1-2 days, it is recommended to come back for examination and assessment of the condition of the fetus. If everything went well, then childbirth can go through the natural birth canal. Otherwise, a caesarean section will be offered.

Obstetric rotation can be complicated by twisting or compression of the umbilical cord and the development of fetal hypoxia. Continuous monitoring allows you to monitor the child's condition and take the necessary measures. Sometimes the water may break or labor may develop. This is not critical, since the manipulation is performed at 36 weeks, when there is no longer a risk to the fetus.


Rotation of the fetus on the leg during childbirth: indications and technique

Diagnostic errors can lead to the development of the transverse position of the fetus during childbirth. To correct the situation, the obstetric rotation of the fetus on the leg will help.

The transverse position is not the only indication, besides it, manipulation is carried out in cases of prolapse of small parts of the body and the umbilical cord during the presentation of the head. By themselves, incorrect head insertions (posterior parietal, frontal, facial) are not recognized as indications for manipulation.

This type of assistance is carried out with the opening of the pharynx by 10 cm and the preserved mobility of the fetal head and the whole fetal bladder. If a running transverse position has developed, the procedure is not resorted to. The head of the fetus must match the size of the mother's pelvis, otherwise everything loses its meaning. With the onset of rupture of the uterus, the rotation is not carried out.

In modern conditions, the course of the operation is monitored with the help of ultrasound and CTG apparatus.

  • The woman in labor is given anesthesia, urine is released through a catheter.
  • The external genitalia are thoroughly disinfected.
  • The hand is smeared with Vaseline.
  • The doctor usually inserts the right hand into the vagina, but some practice matching the position of the fetus: if the head is turned to the left, then the left hand, if to the right - the same name.
  • When the uterine os is reached, the second hand is placed on the stomach. The waters open and penetration into the uterine cavity occurs.
  • To search for the legs, they determine the side of the child by touch, moving from the armpit in the wrong buttocks. At the same time, the pelvis of the fetus is held with the outer hand and slowly shifted towards it.
  • The fetal leg is grasped by the shin, clasping it with four fingers, and placing the large one under the knee. Alternative option: a grip is made on the foot, holding it with the thumb from below.
  • The outer hand is transferred to the head area, the inner one is sipped and the leg is lowered into the vagina. Immediately after this, the fetus is removed.

During the procedure, complications may occur in the form of prolapse of the umbilical cord loops. The action continues carefully, trying not to press it. If by mistake the handle is captured and withdrawn, then it is taken to the side with a bandage loop, re-enters the birth canal, finds the leg and rotates.

If all the prerequisites for performing a turn are not met, uterine rupture is possible. To avoid it, you need to follow all the instructions exactly.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

Breech presentation of the fetus occurs in 3% -5% of cases at full-term pregnancy. Vaginal delivery with a breech presentation of the fetus is associated with high risks for both the mother and the fetus. Thus, breech presentation is currently considered pathological, even if the conditions necessary for vaginal delivery are ideally met, and the fetus is relatively small in relation to the size of the mother's pelvis. During vaginal delivery, the arms and head of the fetus may tilt back, which can lead to injury.

Currently, the most common method of delivery in breech presentation is caesarean section (90%). Among the indications for the use of caesarean section, breech presentation is in third place among others worldwide. However, this operation does not make it possible to completely eliminate the risk of trauma to the fetus, since when it is removed, the arms and head of the fetus can also be thrown back, and complex manipulations are necessary to release them.

To correct breech presentation today, the world is using EXTERNAL OBSTETRIC TURN OF THE FETUS ON THE HEAD , proposed at the end of the century before last by the Russian obstetrician Arkhangelsky B.A.

External cephalic fetal rotation (EFRT) is a procedure in which a doctor turns the fetus from breech to cephalic from outside through the wall of the uterus. A successful attempt at NAPP allows women to give birth on their own, avoiding a caesarean section.

What is needed for external obstetric rotation of the fetus on the head?

External obstetric rotation of the fetus on the head is performed before the onset of labor, usually starting from 36 weeks of pregnancy.

It is necessary to consult a doctor and conduct an ultrasound examination to confirm the fact of the breech presentation of the fetus and determine the conditions for conducting NAPP, starting from 34-35 weeks of pregnancy.

When is NAPP possible?

  • From 36 to 37 weeks, since with earlier use there is a high probability of its return to breech presentation.
  • In the presence of a singleton pregnancy.
  • Subject to the mobility of the buttocks of the fetus (if they are tightly pressed against the entrance to the mother's pelvis, it will be extremely difficult to change the position of the fetus).
  • Sufficient amount of amniotic fluid. With oligohydramnios, this manipulation can be traumatic for the fetus, while with polyhydramnios, there is a high probability of the fetus turning back into a breech presentation.
  • When the fetal head is bent

When NAPP is not possible:

  • With the outflow of amniotic fluid.
  • If the patient has contraindications to the use of drugs used to relax the uterus (tocolysis).
  • In the presence of obstetric indications or indications from the health of the mother for delivery by caesarean section.
  • With the extensor position of the fetal head.
  • If the fetus has congenital developmental features.
  • With multiple pregnancy.
  • In the presence of structural features of the uterus in a pregnant woman

However, in addition to this, there are a number of factors that may favor or, conversely, serve as a contraindication to external obstetric rotation of the fetus on the head, and which can only be determined by a doctor during a direct examination of a pregnant woman.

How NAPP is carried out

For manipulation, hospitalization in the maternity hospital is necessary. Preliminary, an additional examination of the pregnant woman is carried out in the required volume, including an ultrasound examination.

When conducting an NAPP:

Immediately before the start of the manipulation, a CTG is recorded to assess the condition of the fetus.

Drugs are administered to prevent uterine contractions (tocolytics).

Holding both hands on the surface of the pregnant woman's abdomen, one on the head of the fetus, and the other on the buttocks of the fetus, the doctor pushes and rotates the fetus to the “upside down” position. A pregnant woman may feel some discomfort during the procedure. The degree of discomfort depends on the individual sensitivity of each patient.

After the procedure is successfully completed, the CTG is re-recorded to make sure that the fetus feels well and successfully endured the procedure. Usually, the condition of the mother and fetus is monitored during the day, after which the patient is discharged and continues the pregnancy until spontaneous labor occurs.

If the doctor notices a deterioration in the condition of the fetus according to the monitoring data, then the procedure is immediately stopped.

If the first attempt was not successful, your doctor may suggest another attempt if the fetus is in good health.

APP is performed ONLY in a maternity ward where there is an opportunity for an emergency delivery, if necessary.

Risks Associated with NAPP

Subject to constant monitoring of the condition of the fetus, constant tocolysis (administration of drugs that relax the uterus), the risks of this manipulation are minimal. Complications from its use occur in less than 1-2% of cases.

Complications of NAPP include:
- compression or "twisting" of the umbilical cord. In this case, constant monitoring of the condition of the fetus allows you to immediately fix its deterioration and stop the procedure.
- discharge of amniotic fluid or the development of labor. This complication can be considered relative, since the rotation in most cases is carried out at full-term pregnancy.

Any deviation from the normal course of the procedure serves as a reason to stop the manipulation and decide on the choice of further management tactics.

Conducting NAPP with Rh-negative maternal blood.

The presence of Rh isoimmunization (that is, the presence of anti-Rh antibodies in the mother's blood) is a contraindication to this procedure, as it increases the risk of anemia in the fetus.

In the absence of isoimmunization (absence of anti-Rh antibodies), it is possible to carry out NAPP with prophylaxis by introducing anti-Rh immunoglobulin.

If you have a breech presentation of the fetus and you want to know about further options for pregnancy management, delivery, external obstetric rotation of the fetus on the head, the presence of indications and contraindications for its implementation, please consult our specialists.

Most babies turn their heads towards the exit of the uterus, which is known as cephalic presentation. But if your baby has not done this, then in 90% of cases this means that he is preparing to come out of the womb forward with his buttocks or legs. For such children, a gynecologist or obstetrician may try to “help” roll over with the help of an external obstetrical rotation fetus.

By the time of birth, about 97% of babies are in the cephalic position, and only 2.5% of babies remain in the breech position. Where did the other 0.5% go, you ask? This value falls on such rare cases when the child becomes shoulders or arms towards the exit from the uterus, that is, it takes a transverse presentation.

Breech presentation is divided into several types: foot (when one or both legs are located first in relation to the exit from the uterus), gluteal (when the buttocks of the child are facing the exit from the uterus) or knee (when legs bent at the knees are directed towards the exit from the uterus).

By the beginning of the third trimester of your pregnancy, your gynecologist, by probing through the abdomen for the placement of the baby's head, his back and lower torso, will already be able to tell which position your baby has taken. About ¼ of babies are in a breech position, but over the next two months, most of them are in the correct prenatal position.

If there is very little time left before the birth, and your doctor cannot determine the presenting part of the fetus during palpation of the abdomen, then he can conduct an internal examination for you to feel which part of the baby's body is in the pelvis. Very often to confirm the position of the child to a woman.

What is external obstetric fetal rotation?

Children who by the beginning of the ninth month of pregnancy have not taken the head presentation are unlikely to do it on their own. So if your baby at 37 weeks is still feet or butt down, your gynecologist should suggest trying to turn your baby into a more favorable head-down position.

This procedure is known as external obstetric turn on the head. The rotation of the fetus is carried out by applying pressure on the abdomen, and manually manipulating the child in the direction of his head down.

The cephalic rotation is effective in 58% of breech presentations and 90% of lateral presentations. But sometimes the baby refuses to budge, or turns back into the pelvic position even after it has already rolled over head first. Doctors have noticed that most often the rotation of the fetus works, provided that this is not the first pregnancy for a woman.

Contraindications and complications of obstetric rotation

Please note that not all women may be subject to this procedure! If you are carrying twins or your pregnancy is complicated by bleeding or oligohydramnios, this manipulation is contraindicated for you! And, of course, this procedure is not carried out for those women who, in any case, will give birth by caesarean section - for example, with placental presentation, carrying triplets, or having a history of two or more caesarean sections or operations on the uterus.

Severe complications, although relatively rare, can occur. For example, obstetric turn the fetus can lead to from the uterine wall, because of which the doctor will be forced to decide on an emergency caesarean section.

The procedure can also cause the baby's heart to slow down, a condition that requires immediate delivery if it doesn't go away on its own within a short amount of time.

For these reasons, the doctor should only perform this procedure in a hospital with an operating theater, intensive care unit, and medical staff that may be needed to perform a caesarean section in the event of any complications.

How is the rotation of the fetus on the head?

Starting at midnight before your procedure, you will not be able to eat or drink anything. This is necessary in case you end up needing surgery (caesarean section).

In advance, a woman undergoes an ultrasound examination to check the intrauterine position of the child, the amount of amniotic fluid and the localization of the placenta. Also, ultrasound will be repeated after the manipulation (some doctors use ultrasound during the procedure).

Before obstetrical rotation a woman must be prescribed a blood test for group and Rhesus compatibility with a child. If both parents are Rh-negative, then the woman is given an injection of immunoglobulin. Throughout the procedure, and some time after, the child's heart rate will be closely monitored.

Birthing tactics if fetal rotation is ineffective

In this case, the tactics of childbirth depends on many things. A woman can give birth vaginally if she is pregnant with twins, provided that the first child is cephalic and the labor progresses so rapidly that the woman is admitted to the hospital when the baby is already in the birth canal, making a caesarean section impossible.

However, the vast majority of babies with a breech or transverse presentation are delivered by caesarean section. If a caesarean section is planned, then it will most likely be carried out no earlier than the 39th week of pregnancy.

To make sure that obstetric turn did not bring results, and the child has not changed his position until that time, the expectant mother will have an ultrasound in the hospital, immediately before the operation. There is also a chance that the woman may go into labor or break her water before the date of the planned caesarean section. If this happens, you need to urgently call a doctor and go to the hospital!