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The longitudinal position of the fetus is breech presentation at 20. Types of breech presentation. Causes of breech presentation of the fetus

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Questions and answers on: breech presentation of the fetus at 20 weeks of gestation

2012-08-03 05:35:24

Irina asks:

Hello! I am 29 years old. She gave birth to her first child at 23, had a cesarean section (for visual reasons). Now she is pregnant with the second. At the first ultrasound at 12 weeks, everything was normal. On the second ultrasound scan (21 weeks), the diagnosis was made: "on the anterior wall of the uterus in the middle part of the right, an intramural-subserous node measuring 19 * 13 mm, mainly reduced echogenicity. On the anterior wall in the middle part of the intramural-myomatous node 8 mm in diameter. Uterine tone is not increased . Breech presentation of the fetus. Myoma of the uterus. " Please tell me how dangerous the diagnosis is for the health of the baby and for his full development? How will this affect the further course of pregnancy and will this not be the cause of premature birth? And is a caesarean section performed with such a diagnosis?

Answers Kolesnik Victoria Leonidovna:

Good afternoon, Irina! With uterine myoma, a cesarean section is done. Nodules can be a cause of premature birth. In your case, it is necessary to observe the antenatal clinic doctor, prenatal hospitalization, repeated ultrasound. This will allow you to determine how the child is developing and, if necessary, prescribe therapy aimed at optimizing the work of the uteroplacental complex, which will contribute to the correct development of the baby.

Answers Silina Natalia Konstantinovna:

In the period of 22 weeks, we do not put the cephalic or breech presentation, since the child is constantly changing the presentation. A uterine fibroid is not an indication for a cesarean section. after 34 weeks, depending on the obstetric situation, the question of the mode of delivery will be decided. At the moment, there is no cause for concern. The criterion for the risk of premature birth is the length of the cervix less than 30 mm. Repeat cervicometry at 30 weeks.

2010-09-22 07:46:51

Natalia asks:

Good day! I have such a situation: at 12 weeks, an increased TVP was found up to 6 mm, I did a chorionic biopsy, the result was 46, XX. All subsequent ultrasounds showed compliance of the fetus with the norms. At 31 weeks, a shortening of the long bones was revealed (corresponded to the period of 29-30 weeks). At 37 weeks, they corresponded to 32 weeks, while the cerebellum corresponded to 37 weeks. Diagnosed with skeletal dysplasia, which causes lung hypoplasia. I have a bicornuate uterus (the child sits on the left side of the uterus throughout the pregnancy), breech presentation of the fetus. On the female side, all women in the family are short (150-155 cm). Can you please tell me if I have a chance to give birth to a healthy baby? And can my girl be just small (constitutional features)?

2008-08-28 14:30:17

Irina asks:

Good day!
tell me if it is possible to harm pregnancy at week 21 by receiving a clitoral orgasm, provided that the placenta is low (25 mm above the internal pharynx) and breech presentation of the fetus.
Thanks!

Answers Zhegulovich Yuri Vladimirovich:

Good afternoon, Irina! From a medical point of view, you have a significant contraindication for sexual relations (including clitoral orgasm) - this is a low attachment of the placenta. With this location of the placenta and orgasm, which is usually accompanied by contractions of the vaginal and uterine muscles, the risk of miscarriage increases. It is especially dangerous if the orgasm coincides with the days when menstruation should have occurred, if pregnancy had not occurred. So, alas, you should limit your sexual activity and give the joy of sex only to your husband. Rely on your imagination and knowledge of each other, treat your partner's desires with understanding and be attentive to yourself. Don't overdo it - sex is not a compulsory activity during pregnancy, there are many more ways to show mutual love! After all, now you need to take care not only of yourself, but also of the baby. Therefore, spend more time outdoors, travel to interesting places, eat well, take special complexes for pregnant women, learn to relax. Also, do not forget about preparing for childbirth, visiting the LCD and following the doctor's recommendations. Good luck to you!

2016-03-10 14:34:31

Elena asks:

Hello! Please tell me what does loose attachment of the placenta mean? This was written on an ultrasound scan at 20 weeks. Pregnancy 1st. Ultrasound results: fetal position: unstable, presentation: pelvic, II position, posterior view, amniotic fluid: normal, water pocket: 32, 39 mm; localization of the placenta: the anterior wall of the uterus, the degree of maturity of the placenta: I, the thickness of the placenta: 24-29 mm, acentric attachment of the umbilical cord 20 mm from the edge (this is how they explained to me the danger of tearing off a piece of the placenta during childbirth, you can not pull the umbilical cord?), cervix : 39.2 * 30mm. All other indicators and blood tests, urine tests are normal, nothing bothers. The doctor prescribed that the placenta was better attached Glutargin 0.75 3 r. in the village - 2 nd. and constantly drink Elevit throughout pregnancy. Should I take these drugs? Is detachment of the placenta possible in this case?

Answers Palyga Igor Evgenievich:

Hello, Elena! I do not know the tactics of your doctor and your anamnesis, but glutargin and multivitamins have nothing to do with placental abruption.

2013-09-23 19:11:19

Christina asks:

Good day! Can you please tell me if such an ultrasound conclusion is normal for 20 weeks of pregnancy (today it is exactly 20 weeks) ?? 22 years old, planned pregnancy, my weight before pregnancy is 49 kg, now 54!
Fetus 1, longitudinal position, breech presentation, fetal size - BPD 4.22 cm 17, the circumference of the head is 16.62 cm, the length of the humerus is 2.93 cm, ---- the dimensions correspond to the period of 19-20 weeks! and lower, etc. limbs are veiled. The head is located at the bottom. The skull is veiled. Brain. the middle m-echo is not displaced, the width of the large ciscerne is 0.5 cm, the width of the posterior horns is 0.53 cm. The cavity of the transparent septum, up to 0.26 cm in size, the spine can be traced. fetal heartbeat up to 142 beats per minute rhythmic. The size of the heart is normal; the stomach is visible. In the intestine, hyperechoic contents are determined in a small amount (is this normal *?). The right and left kidney is veiled, the office is not clear. There is movement, movement is the norm. floor - m))))))) The placenta is located on the back wall of the uterus above the edge of the internal pharynx by 4.4 cm. (Is it good?) The thickness of the placenta is 2.3 cm. The intervillous space is dilated (is this the norm?) The umbilical cord has 3 vessels ... amniotic fluid is normal! Amyotic fluid index 11 cm.
cervix - length 3.9 cm, thickness 3.4, diameter of the internal pharynx - open and such comments - This study does not exclude the possibility of the presence of small unidentified defects in the fetus, including CHD, which may not be diagnosed due to the peculiarities of the fetal circulation. Conclusion - pregnancy 19-20 weeks Recommendations - ultrasound control over time. tell me, is it possible in Russian? Is this ultrasound normal ???? What are the fears of doctors with such a comment ????? help, I am very worried

Answers Gritsko Marta Igorevna:

With a similar location of the placenta and the opening of the internal pharynx by 4.4 cm (this is not the norm!), You need to go to the hospital in the near future!
The size of the fetus corresponds to a period of 19-20 weeks., The conclusion about minor defects sounds strange, they either exist and are visualized, or they are not.
Have you been screened - combined and triple tests? It is advisable to consult a geneticist with all examinations.
I wish you success!

2013-01-03 11:46:03

Zilya asks:

Hello! I certainly do not hope for an answer, but I will try. I am 31 years old. Third pregnancy. The previous two ended in cesarean. There are two daughters. From the first take there were no problems. Caesarean was done because of the breech presentation and a large fruit 4200g. During the second, there was always a threat, the tone of the uterus. It is now six weeks old. I haven’t gone to the hospital yet. Constant pulling pains in the lower abdomen, tone, and a few days ago there were small light brown discharge. The weekend is still far from the end. What to do? I don't drink anything yet. Lying. Thanks in advance.

Answers Gritsko Marta Igorevna:

Of course, you need to go to a gynecologist and undergo an ultrasound scan. The threat of miscarriage is possible. For now, take Dufaston 1 tab. 2 times a day and rectally homeopathic suppositories viburcol.

2012-12-13 11:36:51

Christina asks:

Hello, I am turning to you for advice. The fact is that they cannot put me on the final term of pregnancy. I am 21 years old, my first pregnancy, at the time of conception I was 20 years old. There were no abortions.
The first day of the last menstruation is July 5, 2012, but I am sure that conception could not occur, since I had sex only after the 10th.
At the first ultrasound scan (October 17, 2012), a monthly period was set - 14 weeks 6 days, and according to the results of an ultrasound scan - 13 weeks 3 days.
On the second ultrasound scan (December 9, 2012), the monthly period is 22 weeks 3 days, but the results of the ultrasound scan:
BPR 48mm;
LZR 61mm;
OG 176mm;
Coolant 148mm;
DB / coolant * 100% = 21.6%
Thigh length right and left 32mm;
Shin length right and left 28mm;
The length of the humerus cn. sl. 30mm;
Forearm length cn. sl. 26mm;
The length of the nasal bone is 7.8 mm;
Neck fold thickness (up to 21 weeks) 4.5mm;
Heart rate 134 beats per minute;
The distance from the lower edge of the placenta to the int. throat 70mm;
Placenta thickness 24mm;
0 degree of maturity;
Amniotic index liquid 148mm;
Umbilical cord 3 vessels;
The length of the cervix is ​​36mm;
Localization of the placenta on the back wall;
Longitudinal position, breech presentation.
The spine is located. at 8 o'clock.
Half a girl.
The conclusion is 19-20 weeks of pregnancy, and according to the first ultrasound, it should be 21-22 weeks.
Could this be a delay in the internal development of the fetus?

Answers Gritsko Marta Igorevna:

That's right, in terms of time, it turns out 22 weeks, according to ultrasound data, 20 weeks. Were the results of the combined and triple tests normal? If so, then there is no need to worry, you need to assess the situation in dynamics. I don’t think this is intrauterine growth retardation. Pass the control SPL in a month.

2012-04-22 07:48:27

Anna asks:

Good afternoon. Please tell me pregnancy is 24 weeks. All screenings and ultrasounds are normal. A week ago, at night after urinating on a napkin, I began to notice yellow discharge with an admixture of ichor. They did an ultrasound scan, everything is normal with the fetus, there is no detachment, urine analysis, culture tank and vaginal smear are normal. What could it be? There is no pain in the lower abdomen either. Allocations occur only at night, during the day there is no discharge. I have a breech presentation, the child often hits the bladder, can there be a reason for this?

Answers Wild Nadezhda Ivanovna:

Need an examination of the cervix in the mirrors, ultrasound of the cervix - perhaps there is a threat of premature birth or there is erosion of the cervix, there may be other reasons, but an examination is needed. Perhaps you need to do an ultrasound of the kidneys - to exclude urinary stone disease.

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 inhaling, 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

During pregnancy and childbirth, the child can be in the uterus, and then in the birth canal in different positions and presentations. Presentation is determined by the part of the body with which the baby is in contact with the internal uterine pharynx - the head or buttocks (legs).

What does breech presentation mean?

This is a situation when the child is attached to the inner pharynx with the lower end of the body. It is recorded on average in 4 women per 100 pregnancies and can be gluteal or leg. In the first case, the buttocks are determined in the lower part of the uterus, in the second - the legs or feet.

Why is this condition dangerous?

The likelihood of a baby dying during childbirth increases several times compared to the head down position. What is the threat of such a situation in addition to perinatal death:

  • untimely childbirth;
  • oxygen starvation (hypoxia) of the child when clamping the umbilical cord vessels;
  • Injury at birth if manual intervention by an obstetrician is used to remove the baby's upper body;
  • low weight;
  • getting the umbilical cord loops into the vagina;
  • location of the placenta on the internal pharynx;
  • congenital diseases and defects, often deadly.

The consequences of breech presentation for a child is an increase in the number of diseases in the postpartum period up to 16%. Therefore, the process of childbirth in such a situation is initially considered pathological.

Predisposing conditions

The factors under the influence of which the breech presentation of the fetus is formed are not fully understood. During pregnancy, the uterus has an ovoid shape, and its upper part is wider than the lower one. The fetus adapts to this by placing the wider pelvic part in the upper part of the uterus, and with the heavier head pressing against the upper part of the pelvic ring.

At birth, the baby's head moves forward, changing its shape and pushing the tissues apart. However, under the influence of some factors on the part of the mother, fetus or placenta, this situation may change.

Causes of breech presentation of the fetus on the part of the mother:

  • violation of the structure of the genital organs (septum in the uterine cavity, bicornuate uterus);
  • neoplasms, in particular, especially when it is located in the lower part of the myometrium;
  • discrepancy between the size of the pelvis and head;
  • neoplasms of the pelvic organs (ovaries, intestines and others);
  • violation of the tone of the uterus (reduced, uneven).

Predisposing conditions on the part of the fetus:

  • prematurity or low weight;
  • multiple pregnancy;
  • congenital anomalies (hydrocephalus, myelomeningocele, pathology of the kidneys, heart, bones and muscles, chromosomal diseases).

Placental causes:

  • presentation;
  • location in the corner or top of the uterus;
  • shortened umbilical cord;
  • little or polyhydramnios.

Half of women with such a pathology have no apparent reasons for this condition. On the other hand, it has been established that if a woman herself was born in such a presentation, she is more likely to develop it during her own pregnancy. If the first child was in breech presentation, then for the next such a probability is about 20%.

Classification

Domestic obstetricians have developed a systematization of the breech presentation with the allocation of the main types - gluteal and foot.

Buttock

  • purely gluteal: the child's legs are straightened at the knee joints and bent at the hip joints, they press the folded arms, the head is tilted forward, the buttocks are adjacent to the pelvic ring;
  • mixed breech presentation: the legs are bent at the hip and knee joints, so the gluteal regions and one or two feet are adjacent.

Foot

  • incomplete: one of the legs is directed downward;
  • full: both legs are directed to the cervical canal;
  • knee: rare, transforms into a leg during childbirth.

Conversion of incomplete to full leg presentation leads to an increased risk of birth complications. There are indications for cesarean section.

According to the American division, the following forms of breech presentation are distinguished:

  • true gluteal: legs extended at the knees are pressed to the chest;
  • full pelvic: legs bent;
  • incomplete pelvic: the joints of the legs are straightened so that the legs are presented.

Pure breech presentation occurs in most women, it is determined in 65% of cases. A quarter of patients have a mixed breech presentation, and a tenth have a foot presentation.

If the baby is in breech position, then by the time of birth he will most likely turn head down. This overturn is especially likely with repeated pregnancy and breech presentation. It is observed in 70% of multiparous women and only in a third of primiparous women. Rotation usually occurs before 34 weeks (in 40% of women), then its frequency decreases (12% at 36-37 weeks of gestation). If by this time the child has turned his head down on his own, his turning back is unlikely to happen.

In addition to positioning its head up, the fetus may take an incorrect position in the uterus. Transverse or oblique breech presentation is often the basis for operative delivery.

Diagnostics

Signs of breech presentation are determined by obstetric, vaginal and ultrasound (ultrasound) examination.

During an external examination of the patient's abdomen, the doctor or midwife determines a dense displaceable head in the upper part of the uterus (its bottom), which is often displaced to the side. The fundus of the uterus is higher than in the cephalic presentation, because the baby's buttocks are less tightly pressed against the mother's pelvis. In the lower part of the uterus, a less dense presenting part is determined, it is larger than the head and does not move.

The baby's heartbeat is best determined at the level of the patient's navel.

To independently determine how the child is located in the breech presentation, you need to know where the movements are felt. Since the baby is located with the legs down, the most intense movements will be felt in the lower abdomen. In the upper and middle sections, the tremors are weaker - these are the movements of the handles.

Presentation is not always possible to determine during external examination. This can be prevented by developed abdominal muscles, high tone of the uterus, twins, malformations of the child, obesity in the mother. Therefore, if in doubt, a vaginal examination is performed, during which a large soft formation is felt - the baby's buttocks.

The final diagnosis is confirmed by ultrasound. With its help, the doctor determines the position of the fetus, the place of attachment of the placenta, the amount of water, and calculates the weight of the child. There are ultrasound signs that increase the likelihood that breech presentation will persist until the end of pregnancy:

  • pure breech presentation;
  • extension position of the head;
  • small amount of water;
  • attachment of the placenta in the area of ​​the corners of the uterus.

Pregnancy management

Normally, the fetus is already head down at 20-21 weeks. However, if at this time the breech presentation is determined, you should not worry. In most cases, the baby will roll over into the correct position on its own.

It is important to identify the breech presentation only in the third trimester of pregnancy. At the same time, the efforts of doctors are aimed at the transition from the pelvic to the cephalic presentation at 30-32 weeks and later, so that the child does not then turn over to its original position. At this time, a woman is prescribed remedial gymnastics according to the methods of Dikan, Fomicheva or Bryukhina. The choice of the complex depends on many factors, in particular, on the tone of the uterus.

With an increased uterine tone, Dikan exercises are performed. They can be performed from week 29. Three times a day on an empty stomach, a woman lies alternately on the right and left side for 10 minutes three times in a row. The fetus begins to move more actively, the tone of the uterus changes, and the head turns downward. After that, the patient should use the prenatal brace and sleep on the side where the baby's back is directed.

Can the bandage be worn before the baby is rolled over?

This is allowed up to 30 weeks, since at this time the child is still free to change his body position. In the later period of pregnancy, you can only put on the bandage if the baby is turned head down.

What to do with normal or low uterine tone?

Starting from week 32, gymnastics according to Fomicheva is used. The complex is performed in the morning and in the evening for 20 minutes an hour after a meal. They will need a rug and a chair.

Warm up first. For a few minutes, you need to walk on your toes, on your heels, raising your knees on the sides of your abdomen. This is followed by a set of the following exercises:

  • exhale: bend to the side, inhale: stand up straight, repeat 5 times;
  • exhale: if possible, bend forward with a deflection of the lower back, inhale - lean back, repeat 5 times;
  • inhale: we spread our arms to the sides, exhale: slowly turn the body to the side, while simultaneously bringing our hands together and pulling them forward, repeat 4 times;
  • hold on to the back of the chair; inhale: raise the bent leg near the abdomen, touch the hand with the knee; exhale: lower the leg and bend in the lumbar region, repeat 5 times;
  • we put one knee on a chair, while inhaling we spread our arms, while exhaling we slowly turn our body to the side and bend over, stretching our arms down, repeat 3 times;
  • we kneel, lean on our forearms, raise our straightened leg up, repeat 5 times;
  • we lie down on the right side; inhale: bend the left leg, exhale - unbend it, repeat 5 times;
  • from the same position, raise the leg and perform 5 circular movements with it;
  • we get on all fours; inhale: lower our head and arch our back, exhale: raise our head, bend in the lumbar region, repeat 10 times at a slow pace;
  • we lie on our left side and repeat the two exercises above;
  • we get on all fours, straighten our legs and stand on our toes, raising our heels, repeat 5 times;
  • we lie on our back and raise the pelvis, leaning on the heels and the occipital region, repeat 4 times.

Breathing exercises are then performed to relax. Quite vigorous bending, turning, bending of the legs increases the uterine tone and decreases its length, which helps the fetus to roll over.

With an uneven uterine tone, gymnastics according to Bryukhina is prescribed. It is carried out at the same time as the previous complex. The complex is based on the relaxation of the abdominal muscles:

  • kneeling on the forearms, do 5 deep breathing movements;
  • in the same position, while inhaling, lower the face to the hands, while exhaling, raise, repeat 5 times;
  • in the same position, with free breathing, raise the outstretched leg, make a slow swing to the side and lower it so that the sock touches the floor, repeat 4 times;
  • exercise "cat", the same as in the complex according to Fomicheva, repeat slowly 10 times.

In conclusion, it should be done by straining the muscles of the anus and perineum.

It's important to know! Correctly selected gymnastics helps to correct the child's position in ¾ of all cases. It is believed that the presentation, formed by 35 weeks, will already be final.

Outward rotation of the fetus

How to turn a baby over in breech position if physical therapy does not bring the desired result? In recent years, obstetricians have renewed their interest in external fetal rotation in the third trimester. This is due to the development of ultrasound diagnostics, assessment of the child's heartbeat using monitoring and the emergence of effective drugs that reduce the tone of the myometrium. Now the external turn is performed even in pregnant women with a scar on the uterus after any surgical intervention and is considered safe and effective.

A child in breech presentation with the help of this manipulation moves the head down in about half of the cases. The frequency of turning back to the starting position is about 10%. However, about a third of women with a successful rotation still undergo a caesarean section for other indications. Thus, the active use of this technique can reduce the frequency of operative delivery by 1-2%.

The manipulation is complicated by oligohydramnios, excess weight in the mother, an open cervix. It is safer to carry out the procedure between 34 and 36 weeks of pregnancy.

The external turn is carried out in the hospital under the control of ultrasound and fetal heartbeat. It is contraindicated in the following situations:

  • threat of interruption;
  • location of the placenta over the internal pharynx;
  • malformations of the genital organs;
  • small amount of water;
  • twins, triplets;
  • small size of the pelvis;
  • oxygen starvation of the fetus.

When performing an external turn, the following complications are possible:

  • fetal hypoxia;
  • fetal injury;
  • rupture of the uterus;
  • death of a child when the umbilical cord is clamped.

Therefore, during the procedure, doctors are always ready to perform an emergency caesarean section. The manipulation itself is a rotation of the fetus with the help of the obstetrician's hands through the abdominal wall.

Choosing a method of childbirth

How to give birth with breech presentation? The answer to this question is ambiguous.

The advantage today is a cesarean section. However, according to some obstetricians, an unfavorable outcome of childbirth is often associated not with the position of the child itself, but with other factors - diseases of the mother and fetus, the doctor's little experience. It is believed that the choice of delivery method later than 37 weeks does not affect the child. In addition, the operation is not indicated for rapid delivery.

A special scale is used to choose the method of delivery. Natural childbirth can be carried out with a long term, in multiparous with previous normal childbirth, pure breech presentation, bent head, mature cervix, good condition of the child, normal pelvic size.

However, in breech presentation, surgery is considered the method of choice, in which the risk of injury, illness or death of the child is significantly reduced.

Natural childbirth is possible in such situations:

  • fruit weight 1.8-3.5 kg;
  • one fetus in breech presentation;
  • there is no indication for surgery;
  • normal size of the pelvis;
  • mature neck.

In a third of women during natural childbirth, there are indications for emergency surgery.

Childbirth takes place in several stages: first, the lower part of the body is born to the navel, then the torso is released to the shoulder blades, the shoulders are born and, finally, the head appears. Helping a woman requires the experience and skill of an obstetrician.

Possible complications during childbirth:

  • early outpouring of water and prolapse of the umbilical cord, which leads to oxygen starvation of the child;
  • weakness of labor activity;
  • difficulties in giving birth to the head, most often associated with throwing back the handles.

Natural childbirth

The mechanism of natural childbirth

In the upper, wide part of the pelvis, the buttocks are located in such a way that the axis between the child's hip joints coincides with the mother's. At the beginning of labor, the buttocks gradually descend into the narrower part of the pelvis while simultaneously turning 90 degrees. In this case, the buttock, located in front, passes under the pubic articulation of the woman and is temporarily fixed there.

Based on this point, the child's spine is flexed in the lumbar region and the underlying buttock is born. After that, the spinal column is straightened, and the front buttock is finally born. The fetus quickly leaves the birth canal to the navel.

After birth, the buttocks turn from a straight position to an oblique position, since at the same time the shoulders of the child are pressed against the entrance to the pelvis. They enter the pelvic cavity according to its oblique size.

When moving along the pelvis, the child's shoulders turn again into a straight size, and the torso turns accordingly. The front shoulder goes under the pubic articulation of the woman and is fixed there, as the buttock was fixed before.

The baby's spine bends in the cervical and thoracic regions, the back is born first, and then the front shoulder.

The nascent head enters the pelvis so that its longitudinal seam is located in the transverse or oblique dimensions. When the head passes to the exit from the pelvis, it turns with the back of the head forward. The area below the back of the head is fixed under the bosom.

Then the chin, face, crown of the child appear above the perineum, and then the occipital protuberance is born. The head is not deformed. As a result, significant tears in the perineal tissue may occur. Therefore, from the obstetrician taking part, experience and excellent knowledge of the biomechanism of childbirth is required.

Features of the course of childbirth

Childbirth is different from the usual. A woman should listen to her feelings and be ready for unexpected situations.

Does the abdomen drop in breech presentation?

At the end of pregnancy, if the baby is head down, this presenting part begins to descend into the small pelvis and is tightly pressed against the internal bone protrusions. As a result, the fundus of the uterus becomes lower. With a breech presentation, the larger gluteal part does not fall into the small pelvis, freely shifting above it. Therefore, the belly does not go down until the very birth.

Due to the high standing of the presenting part, the amniotic fluid is often poured out prematurely, and in full, because they are not delayed by the head. This contributes to further weakness of labor and increases the risk of infection in the uterus.

To prevent such a complication, a woman should lie on her side in bed, without getting up, until the waters drain. This will help keep the membranes intact for as long as possible. After the discharge of water, a vaginal examination is performed to exclude prolapse and clamping of the umbilical cord. If the umbilical cord loops are still detected in the vagina, an emergency caesarean section is performed.

The soft presenting part with less force presses on the uterine wall from the inside, so the opening of the cervical canal is delayed. The first period lasts longer than normal by an average of 2-3 hours.

The second period is the most dangerous. At this time, a child is born, and maximum attention and effort is needed from the mother and doctors so that this process goes without complications. Contractions in breech presentation occur as usual, but due to irritation of the nerve plexuses of the pelvis from the gluteal part of the fetus, they may be stronger than in cephalic presentation.

In the second period, the baby's body and legs are rather quickly born. The passage of the head through an insufficiently dilated birth canal can be difficult. In some cases, with the rapid birth of the body, the baby's arms are thrown back, then the shoulder girdle interferes with the eruption of the head. These are the causes of injuries to the baby during childbirth.

Sometimes during this period, the child swallows amniotic fluid. In addition, there is a danger of the umbilical cord falling out, pressing it to the entrance to the small pelvis by the nascent head, which is accompanied by severe oxygen starvation of the child.

During the second period, the woman is injected with certain medications that improve labor and make it easier to have a baby. Dissection of the perineal tissue is mandatory - perineotomy or episiotomy.

After the birth of the lower body, the delivering doctor holds the baby's arms to prevent them from rolling back, and also helps the head to be born. In the foot presentation, the obstetrician holds the baby's heels at the exit from the birth canal, transferring it to the gluteus to sufficiently expand the neck and facilitate the birth of the head.

The third period (separation of the placenta) usually passes without features. Due to abnormal attachment of the placenta, in some cases, it may be necessary to manually remove the placenta. This manipulation is performed under intravenous anesthesia.

C-section

How is a cesarean section in breech presentation? Elective surgery with epidural anesthesia is preferred when the lower trunk is anesthetized. However, general anesthesia is acceptable when the patient falls asleep. In this case, the harm to the child is small, since it is removed very quickly. The duration of the intervention does not exceed 1 hour, its technique is the same as in cephalic presentation.

Indications for the operation:

  • fruit weight less than 2 kg or more than 3.5 kg;
  • narrowing or deformity of the pelvis;
  • overly extended head;
  • weak labor, lack of effect from the initiation of labor with drugs;
  • foot presentation;
  • growth retardation of the child;
  • death or injury of a child during a previous birth;
  • time after the outpouring of water more than 12 hours;
  • overburdening;
  • scars, malformations, neoplasms of the uterus;
  • presentation or placental abruption;
  • breech presentation with twins, if the first child is in the wrong position.

In primiparous patients, caesarean is performed at the age of over 30 years, severe concomitant diseases, myopia, during pregnancy after IVF, hemolytic disease of the fetus, as well as at the insistence of the woman.

Perinatal outcomes in breech presentation of the fetus in the case of timely surgery are favorable. In the future, the child grows and develops normally, unless he has a pathology that was formed even before childbirth.

Complications of childbirth:

  • injury to the cervical spine, spinal cord and brain;
  • asphyxia (suffocation) of the fetus;
  • prematurity and growth retardation;
  • developmental defects;
  • intrauterine infection with early rupture of amniotic fluid;
  • respiratory distress syndrome (impaired lung function after birth);
  • dysplasia of the hip joints.

Birth trauma is associated not only with damage to the cervical spine, but also with excessive pressure on the head during childbirth from the fundus of the uterus. It causes further serious illness in the child. Disorders of motor function (paralysis), strabismus, convulsive seizures (epilepsy), neuroses, endocrine pathology, hydrocephalus, lagging behind peers in physical and intellectual development are noted.

The musculoskeletal system is affected. A baby may develop torticollis, dislocation of the hip, clubfoot, contracture (limitation of mobility) of the knee joints, dysplasia (violation of formation) of the hip joints.

At an older age, children born in breech presentation, often regardless of whether it happened naturally or with the help of surgery, reveal increased excitability, restless sleep, decreased appetite, and hyperactivity syndrome. Subsequently, difficulties may arise in adapting to society and schooling.

To prevent complications in breech presentation, it is necessary to carry out the following measures:

  • the formation in the antenatal clinic of risk groups for breech presentation;
  • regular observation by a doctor;
  • diagnosis and treatment of complications during pregnancy, such as the threat of termination;
  • overdue prevention;
  • the use of remedial gymnastics;
  • the correct choice of the method of childbirth;
  • advance preparation for a planned caesarean section;
  • correct management of natural childbirth, prevention of premature outpouring of water, bleeding, violations of uterine contractility;
  • diagnosis of complications in childbirth and a timely decision on an emergency operation;
  • accurate delivery;
  • thorough examination of the born child.

It is important to inform the expectant mother about pregnancy and childbirth tactics. Psychosomatics - disturbances in the functioning of internal organs associated with prolonged stress, anxiety, fear of the unknown - can adversely affect the condition of the baby.

The more a woman knows about her situation, the less likely it is to develop complications. Therefore, it is recommended not only to ask the doctor about all the details of future birth of interest, but also to read more about this pathology. It is necessary to tune in in advance for a positive outcome.

Breech presentation is observed in 6% of pregnant women. During normal pregnancy, the baby is in the right place by the 21st week of gestation. But due to the presence of a number of negative factors, it can remain unchanged until the 3rd trimester.

The abnormal position of the fetus is not dangerous until 22 weeks of gestation. During this period, it is likely that the baby's place will turn over in the womb several times, but if the pathology is observed at a later date, it is dangerous for both the child and the mother.

What does breech presentation of the fetus mean?

Breech presentation is the position of the embryo in the lower part of the uterus, near the fallopian tube. During gestation, the child should be head down, but in some situations it is able to change the position, and the buttocks or legs are below. This pathological condition is most often detected at 25 weeks of embryo development. With a breech presentation of a full-term fetus, the worst prognosis is the death or severe injury of the baby at birth.

Improper placement of the baby in the womb may be due to diseases of the uterus, a small amount of amniotic fluid, or a weak placenta. You can understand the development of pathology by the nature of the baby's movement. Most often, such a deviation is the cause of premature or with the help of a cesarean section. The disease is treatable, which means that there is a chance to leave the baby safe and sound.

Possible causes of the problem

Why does such an anomaly occur?

Doctors identify the following reasons for the improper position of the baby:

  1. Due to the high water, the mobility of the embryo increases, so there is a possibility that it can assume an oblique position.
  2. With high water, the baby cannot fully move and when changing the position, there is a small chance that he will again get into the right place.
  3. When a woman is carrying twins, there is less space in the womb. Babies get cramped and one of them may look for a more comfortable position and therefore turns his head up.
  4. The narrow pelvis of the expectant mother.
  5. Abnormal position of the placenta (along the anterior wall).
  6. The baby is too big.
  7. Myoma of the uterus.
  8. Pathological condition of the ovaries.

If a woman does not have uterine diseases, the placenta is healthy and the embryo develops normally, then there is a chance to avoid high water or low water in the womb. A decrease in fluid is observed as a result of previous abortions, diseases of the genital organs, multiple fertilizations and with problems that arose in a previous pregnancy. In addition, there is a special corrective gymnastics that can help the baby to get into the correct posture.

Diagnostic measures

To identify pathology, two types of diagnostics are used: external obstetrics and vaginal examination. During an external examination, the doctor determines the position of the child, the soft and inactive part of the placenta by the movements. In addition, in this way, an increased standing of the fundus of the uterus is revealed, which may not correspond to the trimester of gestation. The doctor determines the baby's mobility and listens for the heartbeat by listening to the baby in the navel area with a stethoscope.

A vaginal examination of the patient helps to identify a soft and voluminous part with a gluteal abnormality. In this way, it determines where the sacrum, coccyx and inguinal fold in the baby are located. If the girl has a mixed or foot presentation, then the doctor will detect movement of the child's foot.

In addition, ultrasound will help to make an accurate diagnosis of the wrong position of the baby. It will show the location of the fetus and help determine the type of pathology. During the study period, the doctor also determines the posture of the head, since if the presentation is incorrect, there may be complications at birth (the infant may have a damaged cerebellum or cervical spine).

How is the pregnancy going?

The head and pelvic transverse presentation with a mild degree of development does not interfere with the management of pregnancy, it proceeds normally without complications. The girl does not feel discomfort, pain or heaviness either at 10-19 weeks or at a later date. At 33 weeks, a woman is prescribed a special set of exercises that will help change the position of the fetus and facilitate childbirth.

The most commonly prescribed exercise is:

  1. You need to take a recumbent position on the bed.
  2. Turn alternately on the right and left sides with an interval of 15 minutes.
  3. Repeat the exercise 4-5 times in each direction.

Charging in a pathological condition is done 3-4 times a day. With a systematic exercise, the fetus turns its head downward for 7-9 days, if there are no complications. The goal of gymnastics is to increase the excitability of the walls of the uterus. And also the woman is recommended to sleep on her side. If by the end of gestation no changes are visible, then the girl is hospitalized 1.5-2 weeks before the birth of the baby. This is a mandatory procedure for all pregnant women in whom an ultrasound scan showed the disease. The pregnant woman is put on preservation in order to find out exactly how the baby will be born (naturally or with the help of cesarean).

How is labor in breech presentation

How exactly the birth of the baby will take place is decided by the attending physician.

Whether a cesarean is prescribed depends on the following factors:

  1. The age of the girl (after 35 years, natural childbirth can provoke a number of complications).
  2. The size of the pelvis.
  3. The course of pregnancy and its timing.
  4. The body weight of the child and the fetus (if a girl, then, most likely, it will be a cesarean, a boy is a natural child).
  5. The diameter of the vagina.

Most often, problems with childbirth arise due to the immaturity of the vagina, late drainage of waters, vaginal pathologies, fibroids and a difficult period of gestation.

If the baby is born naturally, then before the contractions to relieve tension and minimize muscle spasms, the woman is injected with anesthetic. He is driven when the cervix opens up to 40-50 mm.

Due to the abnormal development of the disease during natural childbirth, the following complications may occur:

  • late discharge of water;
  • prolapse of the umbilical cord loop and placenta particles;
  • development of uterine abnormalities;
  • labor is delayed;
  • the appearance of acute hypoxia;
  • premature detachment of the child's place from the walls of the uterus.

Such complications are dangerous for the fetus and the mother, so the birth takes place under the supervision of obstetricians. After the waters have departed, doctors examine the vagina to find out if the woman in labor will be able to give birth to the baby herself. If there is a loss of loops, then a cesarean section is done.

Most often, childbirth with this diagnosis proceeds normally, but there is a high risk of complications and problems. Therefore, it is important for a girl in a position to take preventive measures to facilitate childbirth.

Is it possible to eliminate the pathological position of the fetus

If the disease develops in the early stages or is mild, there is a chance to eliminate the problem. Preventive gymnastics and medication will come to the rescue.

The main measures that can eliminate the disease include:

  1. In the second trimester of gestation, antispasmodic drugs are prescribed. They are taken at half the permissible dose 3-4 times a week.
  2. The condition of the muscles of the uterus is monitored. Drugs may be prescribed to relieve nervous excitement.
  3. Gymnastic exercises. A complex of movements will help to change the incorrect placement of the embryo. All classes are held in a sitting or lying position for 15–20 minutes. They need to be performed half an hour before a meal. All actions are performed in compliance with the doctor's recommendations.
  4. Bandage. The belt will help support the abdomen and relieve tension from the back, the muscles will be more relaxed, which will help the embryo move more actively.
  5. Sometimes an external transfer of the child to the head is used. But this method of treatment is quite dangerous, as it can harm the fetus and cause complications (hypoxia, trauma to the baby, premature birth).

The real story in this video:

How doctors can help

When diagnosed with oblique breech presentation, doctors can provide a woman with several types of assistance.

Correction of a pathological condition before the birth of a child

The detection of pathology is not always negative. There are times when there is a chance to rectify the situation. If the disease was detected at 32–34 weeks of gestation, then doctors prescribe a special course of gymnastic exercises for the pregnant woman. Exercises can be performed at home, but during the period of therapy, you need to systematically visit a gynecologist in order to minimize the risks of developing the disease.

This method of treatment is contraindicated if a woman has:

  • narrow pelvis;
  • there is a possibility of premature birth;
  • there were miscarriages or turnovers in a previous pregnancy;
  • a lot / little amniotic fluid;
  • diseases of the uterus;
  • 2 or 3 fetuses in the womb;
  • preeclampsia;
  • diseases that prohibit exercise therapy.

Despite the fact that the method has many contraindications, it is very effective and in the early stages of gestation helps the baby to roll over. But in this case, one cannot engage in self-medication, this threatens an even greater deterioration in the situation. All activities must be supervised by a specialist.

Obstetric twist

If the deviation was detected at 6-7 months of pregnancy, then you can make an obstetric turn. The doctor carries out certain mechanical manipulations that help the fetus to turn its head down. Such an action can only be performed by a qualified specialist in a medical institution under the supervision of an ultrasound machine. It helps to monitor the child's condition and track his upheaval.

Before doing the procedure, the girl must undergo certain training. Do not eat at night before the procedure, as it is only done on an empty stomach. In addition, the bladder is emptied and muscle-relaxing drugs are injected intramuscularly. This will reduce the risk of cramping and make the procedure less painful. The obstetric turn is allowed only for certain types of the disease and in the early stages of pregnancy. If the fetus is not in place by the end of pregnancy, then a cesarean is prescribed.

Caesarean section with breech presentation of the fetus

Caesarean is done to make the baby easier to retrieve. With it, the risks of complications are minimized. Most often, it is done if the girl has a narrow pelvis, and the natural birth of a baby is dangerous for the life of two, or the biomechanism of childbirth is impaired.

In addition, the location of the fetus plays an important role. If, with his presentation, it is impossible to give birth on his own, then a cesarean section is performed. The operation prevents possible problems and protects the uterus from damage. The doctors' comments indicate that this is the safest option when staging with such an anomaly.

Conclusion

Breech presentation is observed due to many factors that can negatively affect the fetus and the expectant mother. In the early stages of development, the problem can be eliminated, pregnancy and childbirth will proceed normally.

But there are times when the pathological position of the fetus causes a number of complications and becomes a threat to the life of the mother and child. Therefore, if there are signs of improper location of the baby, you should go to the hospital and undergo a medical examination in order to prevent unwanted consequences.

Breech presentation of the fetus is a very common diagnosis. It can be put to a woman for an ultrasound scan even at 20-22 weeks. For how long this diagnosis has informational value, how dangerous a breech presentation can be and how to return a child to a physiologically favorable cephalic presentation before the onset of labor, read our article.

Let's start, perhaps, with a reminder that it is most favorable, with the least risk of traumatizing the mother and child, childbirth takes place when the baby is head towards the exit from the uterus. But there are often situations when the baby turns over in the uterus in an unfavorable way - with the buttocks or legs down. This obstetric pathology in some cases can cause a caesarean section.

How is the presentation of the fetus in the uterus determined? When the period is short, the position of the fetus can be found out with the help of an ultrasound scan, usually in the second half of pregnancy, at about 20-22 weeks, a routine examination is carried out. But even if the conclusion says "breech presentation of 22 weeks of pregnancy", you should not be upset, since at this time the fetus moves freely in the uterus and can change its position many times a day. It is quite another matter when a diagnosis of "breech presentation of 32-33 weeks" is made, the baby by this time is already long and turns over less willingly. It is necessary to help the child to do this with the help of special physical activity and (in addition, if desired) safe non-traditional methods. For a long period of time, it is much easier to control the position of the fetus, the breech presentation of the fetus has obvious signs for the gynecologist who examines the uterus through the abdominal wall, probes parts of the fetus when the woman lies on the couch. Thus, it is easy to monitor whether or not the breech presentation of the fetus is maintained when exercises are performed. From a period of 34-35 weeks, women with this feature are given the following recommendations.

1. Within 10 minutes, every 3-4 minutes, change the position of the body, turn over to the right side, then to the left.

2. Lie on your back, raise your pelvis with pillows and lie down in this way for several minutes.

3. Get on all fours, the pelvis is level above the head. Stand in this position for 4-5 minutes.

Such gymnastics with breech presentation of the fetus in many cases helps the child to take the correct position in the uterus. If nothing changes, the method of external rotation remains, when the doctor, under the control of ultrasound, tries to turn the child right through the abdominal wall. But not all doctors are able to do this manipulation. In addition, external obstetric coup can have a severe complication in the form of premature placental abruption.

Non-traditional methods of changing the position of the child's body also exist. Moms try to get the baby's attention in the lower abdomen in different ways. For this, music in headphones, and light, and just persuasion are used.

And what causes of breech presentation of the fetus has? After all, as they say, it is easier to prevent a situation than to be treated later. But, unfortunately, it will hardly be possible to prevent. So, the risk category includes women with multiple pregnancies, with neoplasms and various pathologies of the uterus, polyhydramnios, etc. In most cases, it is impossible to establish the exact reason for this, and there is no practical sense in this.