Breech foot presentation. Breech presentation of the fetus: features of the management of pregnancy and childbirth
Many expectant mothers have heard that breech presentation is a very dangerous thing. It complicates the already difficult and risky process - childbirth. One of the first questions that pregnant patients ask on ultrasound is: “How is the baby, is it lying correctly?” And they exhale with relief if the doctor finds that the baby is positioned as it should. From 3 to 5% - about the same number of cases of childbirth with a breech presentation of the fetus has statistics. And this is only full-term to the term of pregnancy. The numbers are decent. Any expectant mother really does not want to get into this statistic. What is dangerous when the baby is in the womb with legs "on the way out"? Why does the child suddenly decide to sit on the fifth point in his mother's tummy? And is there a way to fix the previa? Let's try to figure it out.
Why is breech presentation considered an unfavorable factor?
The fact is that in a baby ready to be born, the head is the largest part of the body. If it passes through the birth canal, then the baby's body easily squeezes behind it. Otherwise, natural childbirth is much more difficult. For example, there is a high probability of fetal asphyxia, prolapse of the umbilical cord, or dislocation of the baby's legs.
How is breech presentation diagnosed?
It is difficult for the future mother herself to determine how the child is located inside her. Incorrect presentation is not accompanied by pain or other symptoms. To the touch, mom herself is also unlikely to understand where the baby has a head and where are the legs. But the obstetrician, even with an external examination, will be able to tell if the fetus is lying correctly. The doctor will also determine which type of breech presentation is present. There are varieties: gluteal (the most common), foot or mixed. An ultrasound will provide more information.
When to start worrying?
Not earlier than the 32nd week. Until that time, the baby can spin and spin in the womb as he pleases, this will not be considered a diagnosis. The size of the child before this period allows him to arbitrarily change position. From the 32nd week, the fetus becomes large enough and it is already difficult for him to roll over. But "difficult" does not mean impossible. There are many cases when, in the last weeks of pregnancy, the presentation successfully changed to the correct one. But, unfortunately, shortly before the birth, the baby can roll back legs down.
Most at risk groups
Incorrect presentation is often found in multiple pregnancies: one of the babies can be located head down, the other - down heels. Also, breech presentation is often a companion of such diagnoses as oligohydramnios or polyhydramnios. It often accompanies some fetal malformations, such as hydrocephalus or anencephaly. Can play the role of uterine pathology: fibroids, impaired muscle tone; as well as placenta previa. The consequences of a caesarean section in a previous pregnancy can also affect the location of the fetus.
Finally, the child takes position by the 36th week of pregnancy. Before that, it can be positioned arbitrarily. Therefore, preterm labor is often complicated by breech presentation.
Exercises for changing the presentation
The presentation can be changed. But in no case, having learned about such a diagnosis, one should not apply measures on their own. Contraindications to all kinds of methods of stimulating a change in the position of the fetus are, for example, placenta previa, as well as scars on the uterus, preeclampsia.
First of all, you need to consult a doctor. If there are no contraindications, then from about the 32-34th week, the doctor prescribes approximately the following gymnastics:
- turns from a prone position from one side to the other. A turn is made, wait 7-10 minutes, then turn in the opposite direction. It is performed on a flat and solid surface, a sofa or bed will not work.
- lumbar lift. To do this, the expectant mother, lying on her back, puts a pillow or roller under her lower back so that the pelvis is about 30-40 cm above shoulder level. It is necessary to stay in this position for up to 15 minutes.
- pose on all fours. You need to get on all fours, leaning on your elbows. The head should be below the level of the pelvis. Stay in this position for 7 to 10 minutes.
These and other similar exercises are performed 2-3 times a day on an empty stomach. Often such gymnastics helps to achieve the goal.
Outer turn
There is another way to correct the presentation. It is carried out in a hospital and is called "external rotation of the fetus." The name speaks for itself: the rotation is performed from the outside, through the abdominal wall. It is carried out after the 36th week. Previously, it is likely that the child will again return to the wrong position after the procedure.
During the turn, the condition of the mother and child is monitored by ultrasound equipment. A woman is injected with drugs that prevent uterine contractions, as well as drugs that relax the uterus.
Due to the large number of contraindications (including entanglement with the umbilical cord of the fetus), this method is used infrequently. It is usually used in cases where a caesarean section cannot be done for one reason or another.
How is childbirth with breech presentation?
When the incorrect presentation persists for a period of 37 weeks, the doctor gives the expectant mother a referral to the maternity hospital. And there the final decision is made about the way the baby is born.
There are 2 options: natural childbirth or caesarean section. In 90% of cases, doctors insist on surgery. The choice is made, firstly, depending on the type of breech presentation. If it is foot or mixed, then this is a clear indication for a caesarean section. Surgery is indispensable for placenta previa or the presence of a scar on the uterus. The structural features of the pelvis of the pregnant woman are taken into account: if it is narrow, then this is a reason for surgical intervention. The weight of the baby also matters. If it is 3.5 kilograms or more, doctors are likely to refuse to perform a natural birth. The sex of the child may also be a factor. To eliminate the possibility of injury to the scrotum, doctors prefer to remove boys from the womb through surgery.
Of course, when the baby is head down, it is more likely that the birth will take place without complications. But the main thing is to identify the pathology in time and take action. Therefore, do not neglect visits to the doctor and visits to planned ultrasounds, especially when there are only a few weeks left before the birth.
53. Pregnancy and childbirth with breech presentation of the fetus: classification and diagnosis of pelvic presentation of the fetus; course and management of pregnancy and childbirth.
Pelvicpresentation - this is a presentation in which the pelvic end of the fetus is located above the entrance to the small pelvis, and the head of the fetus is at the bottom of the uterus.
Breech presentation refers to pathological obstetrics, and childbirth in breech presentation refers to pathological.
Classification:
1. Breech presentation (flexion):
a) purely gluteal (incomplete)- the buttocks are facing the entrance to the pelvis: the legs are extended along the body, i.e. bent at the hip and unbent at the knee joints and the feet are located in the chin and face;
b) mixed glutes (full)- the buttocks are facing the entrance to the pelvis along with the legs, bent at the hip and knee joints, somewhat unbent at the ankle joints, the fetus is in the “squatting” position.
2. Foot presentation (extensor):
a) full- both legs of the fetus are presented to the entrance to the pelvis, slightly unbent at the hip and bent at the knee joints;
b) incomplete- one leg, unbent at the hip and knee joints, and the other, bent at the hip and knee joints, is located higher; are more common than complete;
in) knee- the legs are unbent at the hip joints and bent at the knee, and the knees are presented to the entrance to the pelvis.
Factors contributing to the occurrence of pelvic presentation:
a) Maternal causes: anomalies in the development of the uterus; uterine tumors; narrow pelvis; pelvic tumors; decrease or increase in the tone of the uterus; multiparous women; scar on the uterus.
b) Fetal causes: prematurity; multiple pregnancy; intrauterine growth retardation; congenital anomalies of the fetus (anencephaly, hydrocephalus); incorrect articulation of the fetus; features of the vestibular apparatus in the fetus.
c) Placental causes: placenta previa; oligohydramnios or polyhydramnios; short umbilical cord.
Diagnosis of pelvic presentation.
1. The diagnosis of breech presentation is made at 32-34 weeks. pregnancy, because after 34 weeks. the position of the fetus is usually fixed.
2. For external obstetric examination, four Leopold techniques should be used:
a) the first reception is determined by: a higher standing of the fundus of the uterus; in the bottom of the uterus, a rounded, dense, balloting head is palpated, often displaced from the midline of the abdomen to the right or left;
b) at the third reception above the entrance or at the entrance to the pelvis, a large, irregularly shaped presenting part of a softish consistency, incapable of balloting, is palpated;
c) at the fourth dose, the presenting part is usually located above the entrance to the small pelvis until the end of pregnancy.
3. The fetal heartbeat in breech presentation is heard above the navel, sometimes at the level of the navel, on the right or left (depending on the position). The position and types of position are determined by the back (as in head presentation).
4. The diagnosis is specified by vaginal examination:
a) through the anterior fornix of the vagina during pregnancy, a voluminous, softish consistency of the presenting part is palpable (in contrast to the rounded dense head of the fetus)
b) in childbirth, you can palpate the coccyx, ischial tubercles, fetal legs with a mixed breech and foot presentation.
Differential diagnosticfoot and handle differences: the leg has a calcaneus, the fingers are even, short, the thumb does not lag behind and does not have great mobility; knee and elbow differences: the knee has a rounded movable patella.
5. In the diagnosis of pelvic presentation, ultrasound scanning is of great importance, which allows you to determine not only the presentation, but also the sex, type, weight of the fetus, the position of the head (bent, unbent), entanglement of the umbilical cord, localization of the placenta, the size and degree of its maturity, the amount of water , anomalies in the development of the fetus, etc.
Distinguish four options for the position of the fetal head in breech presentation fetus (the angle is measured between the spine and the occipital bone of the fetal head):
the head is bent (angle greater than 110°);
the head is slightly extended (military posture) - I degree of extension (angle from 100° to 110°);
the head is moderately extended - II degree of extension (angle from 90 ° to 100 °);
excessive extension of the head ("looks at the stars") - III degree of extension (angle less than 90).
The position of the fetal head is most clearly determined by ultrasound. Clinical signs of extension of the fetal head are a discrepancy between the size of the fetal head and its expected mass (the size of the head appears large), the location of the head in the fundus of the uterus, and the presence of a pronounced cervico-occipital sulcus.
6. When recording a fetal ECG, the ventricular QRS complex of the fetus is directed downwards, and not upwards, as in cephalic presentation.
7. With amnioscopy, it is possible to establish the nature of the presentation of the fetus, the amount and color of amniotic fluid, the possible presentation of the umbilical cord loops.
8. If necessary, use radiography.
The course of pregnancy and childbirth with breech presentations.
Complications of breech presentation:
a) In the first half of pregnancy: the threat of abortion; early preeclampsia
b) In the second half of pregnancy: the threat of abortion; premature birth; preeclampsia of varying severity; entanglement of the umbilical cord; oligohydramnios; fetal hypotrophy; placenta previa; placental abruption
c) In childbirth: premature and early rupture of amniotic fluid; prolapse of umbilical cord loops and small parts; weakness of labor activity; violation of uteroplacental circulation and the development of hypoxia in the fetus; increased incidence of infection of the membranes, placenta, uterus and fetus; driving the buttocks into the pelvis; turning the fetus backwards backwards, when the chin is fixed under the pubic symphysis - the head unbends: there is a threat of hypoxia, trauma to the fetus and mother; tilting of the handles and extension of the head (three degrees: I - the handle is thrown back anterior to the ear, II - at the level of the ear and III - posterior to the ear of the fetus); compression of the umbilical cord; fetal hypoxia; fetal trauma; injuries in the mother: ruptures of the cervix, vagina and perineum; hypotonic bleeding in the afterbirth period.
With breech presentation, the frequency of congenital anomalies in the development of the fetus also increases, among which there are: anencephaly, hydrocephalus, congenital dislocation of the hip, malformations of the gastrointestinal tract, respiratory tract, cardiovascular system, and urinary system.
The biomechanism of childbirth in breech presentation:
1. Insertion of the buttocks (compression and lowering them, l. intertrochanterica is in one of the oblique sizes).
2. Internal rotation of the buttocks (begins at the transition from the wide to the narrow part of the pelvic cavity, ends in the plane of the exit, when l. intertrochanterica becomes in the direct size of the exit).
3. Lateral flexion of the lumbar spine of the fetus. A fixation point is formed between the lower edge of the womb and the iliac wing of the anterior buttock. There is a lateral flexion of the spine in the lumbosacral region, the birth of the posterior buttock, and then the anterior one in a direct size. At this time, the shoulders enter with their transverse size into the same oblique size of the entrance to the pelvis through which the buttocks passed.
4. Internal rotation of the shoulders (from an oblique dimension to a straight one) and the external rotation of the body associated with it. The fetus is born to the navel, then to the lower angle of the shoulder blades. The anterior shoulder is set under the womb, a fixation point is formed between the shoulder (on the border of the upper and middle thirds) and the pubic articulation of the mother.
5. Lateral flexion in the cervicothoracic spine - the birth of the shoulder girdle and handles is associated with this moment.
6. Internal rotation of the head with the back of the head anteriorly (the swept suture passes into the direct size of the exit from the small pelvis, the suboccipital fossa is fixed under the bosom).
7. Flexion of the head around the point of fixation. The chin, mouth, nose, crown and back of the head are born in succession.
With foot presentations, the biomechanism of childbirth is the same, only the legs of the fetus are not the buttocks, but the legs of the fetus are shown first from the genital slit.
The birth tumor in breech presentation is located more on one of the buttocks: in the first position - on the left buttock, in the second - on the right. Often, the birth tumor passes from the buttocks to the external genital organs of the fetus, which is manifested by swelling of the scrotum or labia.
With foot presentation, the birth tumor is located on the legs, which become swollen and blue-purple.
Due to the rapid birth of the subsequent head, its configuration does not occur, and it has a rounded shape.
Management of pregnancy and childbirth in breech presentations.
Breech presentation, diagnosed before 28 weeks of gestation, requires only expectant observation. In 70% of multiparous and 30% of primiparous pregnant women, cephalic rotation occurs spontaneously before delivery and in a small percentage during delivery.
Measures aimed at changing the pelvic presentation to the head:
1) Tocomplex of gymnastic exercises in terms of 29-34 weeks of pregnancy. The simplest set of exercises: a pregnant woman, lying on a couch, alternately turns on her right and left side and lies on each of them for 10 minutes. The procedure is repeated 3-4 times. Classes are held 3 times a day. Fetal head rotation can occur during the first week. A positive effect is observed in 76.3% of cases.
Contraindications: diseases of the cardiovascular system in the stage of decompensation, diseases of the liver and kidneys, late toxicosis of pregnant women, threats of abortion, bleeding from the vagina, a scar on the uterus, anomalies of the pelvis and soft birth canals that prevent delivery.
2) Hexternal prophylactic rotation of the fetus on the head according to Arkhangelsk. The operation of external rotation requires compliance with a number of conditions: it is performed in a hospital at 32-34 weeks of gestation (however, recently it has been proposed to perform rotation after 36-37 weeks) with a sufficient amount of amniotic fluid under ultrasound control; monitoring of the fetal heart activity is necessary before the rotation and within an hour after its implementation; mandatory is the appointment of β-mimetic agents to reduce uterine tone.
Contraindications: threatened miscarriage, narrow pelvis, primiparous age over 30 years, history of infertility or miscarriage, lack of good fetal mobility, late gestosis, cardiovascular diseases in the decompensation stage, oligohydramnios and polyhydramnios, multiple pregnancy, fetal malformations, uterine scar, malformations of the uterus and appendages, anomalies of the pelvis and soft birth canal, preventing delivery through the natural birth canal.
In the absence of the effect of corrective gymnastics and external rotation, hospitalization of the pregnant woman in a hospital at 38 weeks of gestation is necessary.
The choice of method of delivery in breech presentation of the fetus depends on the age of the woman, the duration of pregnancy, the condition and estimated weight of the fetus, the degree of extension of the fetal head, the size of the small pelvis, the "maturity" of the cervix, concomitant extragenital pathology, complications of this pregnancy.
Delivery tactics (determined before childbirth):
spontaneous onset of labor and delivery through the natural birth canal;
labor induction at or before the term of delivery;
planned caesarean section.
To select the method of delivery, all clinical data and results obtained using objective research methods should be evaluated on a point scale for the prognosis of childbirth with a breech presentation of a full-term fetus.
Evaluation is carried out on 12 parameters from 0 to 2 points. If the total score is 16 or more, then childbirth can be carried out through the natural birth canal.
Scale for the prognosis of childbirth in the breech presentation of a full-term fetus.
|
Parameter |
score |
||
|
0 |
1 |
2 |
|
|
Gestational age |
37-38 weeks and more 41 weeks | ||
|
Estimated fetal weight, g |
4000 and more | ||
|
Kind of breech presentation |
mixed |
Pure gluteal |
|
|
Position of the fetal head |
Excessively extended |
Moderately extended |
bent |
|
"Maturity" of the cervix |
"Immature" |
"Not Mature Enough" |
"Mature" |
|
Fetal condition |
chronic suffering |
Initial Signs of Suffering |
Satisfactory |
|
Small pelvis dimensions, cm: Direct Entry Transverse entry Straight cavity Interosseous Bituberous direct exit |
Less than 11.5 |
Over 12.0 |
|
Conducting childbirth through the natural birth canal suggests in the first stage of labor prevention of untimely rupture of the fetal bladder and prolapse of small parts and the umbilical cord of the fetus (strict bed rest; laying on the side where the back is facing, i.e. corresponding to the position of the fetus).
With the development of regular labor and the opening of the cervix by 3-4 cm, the introduction of painkillers and antispasmodics is indicated.
During childbirth, monitoring of the fetal heart rate and uterine contractions is mandatory. To assess the dynamics of the birth process, it is necessary to conduct a partogram.
It is necessary to carry out the prevention of fetal hypoxia according to Nikolaev, use 1% solution of sigetin (2 ml), chimes 0.5% solution (2 ml), galascorbin (0.5 g), cocarboxylase (0.05 g).
After lithium amniotic fluid, the fetal heartbeat should be heard and a vaginal examination should be performed to exclude or confirm prolapse, small parts and the umbilical cord. You can try to fill the fallen loop of the umbilical cord with a purely breech presentation of the fetus, if the attempt fails, it is necessary to perform a caesarean section.
Important tasks are the timely diagnosis of labor anomalies and their treatment (oxytocin, prostaglandins).
In the second stage of labor for prophylactic purposes, the introduction of oxytocin or prostaglandin intravenously is indicated. By the end of the second stage of labor, to prevent cervical spasm, it is recommended to introduce 2 ml of a 2% solution of papaverine hydrochloride, 2 ml of a 1.5% solution of ganglerone, 1.0 ml of a 1% solution of atropine sulfate or other antispasmodics.
When eruption of the buttocks, it is necessary to perform an episiotomy.
To avoid pressing the head of the fetus on the umbilical cord after the birth of the trunk to the lower angle of the scapula, the further birth of the fetus should not last more than 5 minutes. At the same time, due to untimely intervention, complications such as tilting of the handles, spasm of the internal pharynx, rear view, and fetal hypoxia may occur.
Indications for caesarean section in breech presentation: post-term pregnancy, lack of biological readiness for childbirth at full-term pregnancy, anatomically narrow pelvis, anomalies in the development of the genital organs, fetal weight more than 3500 g and less than 2000 g, severe chronic fetal hypoxia, excessive extension of the fetal head, aggravated obstetric anamnesis, prolonged infertility, age of primiparous older than 30 years, umbilical cord previa, placenta previa and abruption, scar and abnormal development of the uterus, severe forms of preeclampsia, extragenital pathology, twins with breech presentation of the first fetus, etc.
Obstetric benefits for pelvic presentation of the fetus.
1. RA manual for purely breech presentation using the Tsovyanov method. It is started at the moment of eruption of the buttocks, the buttocks being born are supported without any attempts to extract the fetus. primary goal- contribute to the normal articulation of the fetus, prevent the legs from being born prematurely, for which they are held with their thumbs pressed against the body of the fetus. The remaining 4 fingers are placed on the sacrum of the fetus. As the fetus is born, the hands move along the body to the posterior commissure of the woman in labor. In oblique size, the body is born to the lower angle of the anterior scapula, the shoulder girdle is set in direct size. At this point, it is advisable to direct the buttocks towards yourself in order to facilitate spontaneous birth from under the pubic arch of the anterior shoulder. For the birth of the rear handle, the fetus is again lifted anteriorly. Having entered the small pelvis in an oblique section, the fetal head delays its internal rotation, sinks to the pelvic floor with good labor activity and is born independently.
2. Manual aid for leg presentations according to the Tsovyanov method. With this method, the legs of the fetus were held in the vagina until the uterine os was fully opened.
In case of difficulties that arose during the birth of the shoulder girdle, and even more so when throwing back the handles, you should proceed to the release of the handles and the head of the fetus with the help of classic manual aid. The latter is also used for mixed breech and foot presentations of the fetus. The provision of this benefit should begin after the birth of the fetus to the lower angle of the anterior scapula. The back handle of the fetus is released first, and the obstetrician's hand of the same name is inserted from the side of the back of the fetus, two fingers of it slide along the shoulder, reaching the shoulder fold. The torso of the fetus, set aside to the side opposite to the position when the elbow bend is reached, is brought to the middle position by pressing on the elbow bend, the handle is removed from the genital slit with a washing movement. The palms of both hands, together with the released handle, cover the sides of the body of the fetus with a “boat” and rotate it so that the front handle moves from under the womb to the rear position. In this case, the back should pass under the bosom in order to maintain the front view. Similarly release the second handle.
3. Removal of the head according to Mauriceau-Levre-Lachapelle: the fetus is seated in the "rider" position on the obstetrician's left hand, the fetal head at this time goes into a straight size. The middle finger of the left hand is inserted into the fetal mouth and with a slight pressure on the lower jaw, the head is flexed. The index and middle fingers of the second hand grasp the fork-shaped shoulder girdle of the fetus from above (carefully, collarbones!). With the same hand, traction is made towards oneself and down (until the scalp appears and a fixation point is formed between the suboccipital fossa and the womb), and then up.
4. Extraction of the fetus by the leg used for incomplete foot presentation. To do this, the leg (usually the front one) is grabbed by the hands, and the thumbs should be located along the length of the lower leg, and the remaining fingers should cover it in front. Thus, the entire lower leg lies as if in a splint, which prevents the leg from breaking. Then produce traction down. As the birth progresses, the leg is grasped as close to the genital slit as possible. From under the symphysis, the region of the anterior inguinal fold and the wing of the ilium appear. This area is fixed under the symphysis so that the posterior buttock can be cut through. To do this, the front thigh, captured with both hands, is strongly raised upwards. The posterior buttock is born and the posterior leg falls out with it. After the birth of the buttocks, they clasp the fetus with their hands so that the thumbs are on the sacrum, and the rest clasp the inguinal folds and thighs. In order to avoid damage to the abdominal organs, it is impossible to mix hands on the stomach during traction. By traction on themselves, the body is pulled to the lower angle of the anterior scapula and proceed first to the release of the handles, and then the head, as this is done with the classic manual aid in breech presentation.
5.Extraction of the fetus by both legs. If the fetus is in full foot presentation, extraction is started from both legs. To do this, each leg is grasped with the same hand so that the thumbs lie along the calf muscle of the fetus, and the rest cover the lower leg in front. As the extraction proceeds, both hands of the obstetrician should gradually slide upward along the legs, being all the time near the vulva. Further eruption of the buttocks, extraction of the trunk, arms and head occurs in the same way as when extracting the fetus by one leg.
6.Extraction of the fetus by the inguinal fold. The necessary conditions for this operation are: full disclosure of the uterine os, correspondence of the size of the fetus to the size of the small pelvis, finding the buttocks on the pelvic floor. With a high standing of the buttocks and their sufficient mobility, a purely gluteal presentation is transferred to an incomplete foot position by lowering the legs, and then the fetus is removed. Extraction by the inguinal fold to the umbilical ring is carried out with the index finger inserted into the inguinal fold. Tractions are produced during attempts downwards. To strengthen the thrax, the hand performing the operation is grasped with the other hand in the wrist area. In this case, the assistant presses on the bottom of the uterus. The anterior buttock is removed to the lower edge of the pubic symphysis. The fetal ilium becomes the point of fixation. Then the finger of the second hand is inserted into the posterior inguinal fold and the posterior buttock is removed. After that, the obstetrician places both thumbs along the sacrum of the fetus, clasping his hips with the rest of the fingers, and removes the fetus to the umbilical ring. After the birth of the buttocks, the operation proceeds in the same way as when extracting the fetus by the legs.
The course and management of the third stage of labor does not differ from that in cephalic presentation.
The postpartum period in most puerperas proceeds normally.
The prognosis for the fetus is less favorable than with head presentations in terms of immediate and long-term consequences.
Maria Sokolova
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During the entire period of pregnancy, children turn over in the uterus several times. At 23 weeks of gestation, the fetus assumes a head-down position and is in this position until delivery. This is the correct position. But there are situations when the baby is head up - this position of the baby in the uterus is called breech presentation of the fetus.
What does breech presentation mean?
Breech presentation of the fetus can be diagnosed only by an experienced obstetrician-gynecologist with a full examination . It can be detected by vaginal examination, after which it is confirmed or refuted using ultrasound .
Such an arrangement of the fetus is not abnormal, but, however, does not pose a big threat to the medical supervision of the expectant mother and the right tactics of childbirth.
Why is breech presentation dangerous for a child and mother?
With breech presentation, you can distinguish the following consequences that can affect not only the child, but also the mother:
- Cesarean section in breech presentation may leave scar on uterus ;
- If you have given birth naturally, the condition of the baby will most likely not be entirely satisfactory. In the future, there may be nervous disorders in children ;
- During natural childbirth, the baby may dislocate the hip joint ;
- After childbirth, the mother may have health problems .
In breech presentation, it is recommended to do the necessary exercises which will help the child to take the correct position. In addition to exercise, doctors recommend that pregnant women wear special bandage, sleep on the left side and even have sex. It has been observed that regular sex life can induce the baby to roll over. 
If you have been diagnosed with a breech presentation of the fetus, be sure to see a doctor . With observation and medical control, the risks of improper placement of the fetus are reduced to almost zero. The doctor will give the necessary recommendations on time gymnastics and select the optimal tactics of childbirth.
Timely hospitalization and competent assistance from gynecologists will help prevent the consequences of improper location of the fetus in the uterus. Never refuse hospitalization when it is offered by the attending physicians, and everything will be fine with you!
Site site warns: self-medication can harm you and your child! Only a doctor can make an accurate diagnosis and prescribe the right treatment!
The content of the article:One of the most common pathologies in obstetric practice is breech presentation. This problem occurs in about 3-5% of cases, and over the past decades, its frequency has not changed significantly.
The main causes of breech presentation
The location of the fetus is influenced by many factors, so so far only a few of the reasons leading to the occurrence of breech presentation have been clarified. The most obvious factors are:
A variety of obstacles that prevent the head from being in the right position (near the entrance to the small pelvis). Fibroids, tumor formations in the small pelvis, improper location of the placenta, too large a head (for example, if the fetus has hydrocephalus) can become such interference. Also, an obstruction can be created by the structural features of the pelvis, when it is too narrow or has an atypical shape.
Pathology of uterine contractions. There are cases when the lower sections of the uterus are in hypertonicity, while the tone of the upper sections is reduced. For this reason, the baby's head is pushed away from the entrance to the pelvis, and it is located at the top. Such pathologies are usually associated with long-term inflammation of the myometrium, frequent pregnancies and difficult childbirth. And the tone of the muscles of the uterus is badly affected by curettage and postoperative scars.
Restriction of the fetus in movements. It is due to the peculiarities of the structure of the uterus (it can be bicornuate, saddle-shaped, or with partitions). Also, fetal movements may be limited due to the fact that the umbilical cord is wrapped around one or another part of the body or due to oligohydramnios.
Excessively high activity of the child. This happens with such disorders as polyhydramnios, prematurity and delayed fetal development. In addition, excessive mobility of the child may be associated with malformations of his head. First of all, we are talking about anencephaly or microcephaly. (That is, when the head is too small).
But there are often cases when these pathologies are present, but breech presentation does not occur. It happens the other way around - breech presentation has formed, but there are no visible reasons at all. And then it becomes quite difficult to understand the situation to the end.
All breech presentations can be divided into two main groups, depending on the placement of the fetus in the uterus - breech presentations and foot presentations. It is customary to refer to the gluteal glute proper (it can also be called incomplete), as well as the gluteal mixed. When the child's buttocks are directed towards the entrance to the small pelvis, and the lower limbs are stretched along the body, they speak of a purely gluteal variant. But when the child, not only with the buttocks, but also with the legs, turns to the entrance, then the presentation is already considered mixed. The legs of the fetus in this situation are bent at the knees and hip joints.
Leg presentations are classified as follows: full version (with both legs facing the entrance to the small pelvis), incomplete (with only one limb facing the entrance) and knee presentation.
More or less favorable purely gluteal form. If the weight of the fetus does not exceed the allowable values, then there is a chance of successful natural childbirth. But in other cases, the risks of complications, unfortunately, increase significantly. So, the foot version is considered very unfavorable due to the fact that during childbirth it leads to serious consequences - traumatization of the child, asphyxia, prolapse of umbilical cord loops.
Normally, the fetus constantly changes its location inside the uterus. Therefore, presentation is formed already in the later stages - by about the 35th week of pregnancy. This means that there is simply no point in drawing any conclusions, and even more so diagnosing one of the forms of pathological presentation before this period. A premature medical opinion may be incorrect and have a bad effect on the emotional state of the pregnant woman. In addition, a misdiagnosis can mislead other physicians consulting a pregnant woman and cause them to make poor decisions about delivery.
Methods for diagnosing breech presentation
Medical diagnosis begins with a medical examination and vaginal examination. A more accurate picture can be obtained through ultrasound. Sonography gives good chances not only to confirm the fact of breech presentation, but also to accurately determine its type. The technique of three-dimensional echography is very informative in this sense.
During the examination, it is important not only to find out the location of the fetal head, but also to assess how it is unbent. If the degree of extension is too great, the risk of serious consequences increases, since during childbirth the fetus may suffer from severe injuries of the cervical spine, cerebellum.
So, presentation pathologies worsen the course of pregnancy, and there is a high probability of various complications. The most common consequences: early delivery or their threat, as well as fetoplacental insufficiency and preeclampsia. Against the background of these pathologies, a state of hypoxia often develops or there is a delay in the development of the fetus. In addition, there is a high probability of cord entanglement or an abnormal volume of amniotic fluid. You can study the condition of the child using functional assessment through Dopplerography and CTG.
Breech presentations are known to be associated with an increased likelihood of malformations. In breech presentation, they are diagnosed about three times more often than in the case of the head presentation. First of all, these are anomalies of the digestive organs, nervous system, heart, blood vessels and musculoskeletal system.
According to the results of dopplerography in pregnant women with a breech presentation of the fetus, pathologies of the uteroplacental blood flow are often noted. Fetoplacental insufficiency is diagnosed in more than 50% of cases.
Childbirth with breech presentation
Breech presentation involves the mandatory hospitalization of the expectant mother in the maternity ward (for a period of 38 weeks of pregnancy). In the hospital, a woman undergoes all the necessary diagnostics and prepares for the upcoming birth. Doctors determine the approximate date of birth of the child and select the most appropriate method of delivery in this situation.
Examination of a pregnant woman with a breech presentation of the fetus
During the stay of a woman in a hospital, diagnostic measures are carried out. First, they find out what diseases the pregnant woman suffered in the past, and analyze the history data. At the same time, the presence of previous pregnancies is taken into account and the peculiarities of their course are taken into account. Then they study the general condition of the pregnant woman's body and evaluate her well-being, determine the psychosomatic status. They carefully study the obstetric situation, accurately assess the gestational age, conduct a detailed diagnosis of presentation. In addition, they study the state of the uterus, determine what degree of “maturity” its neck has, evaluate the parameters of the pelvis, and take into account the peculiarities of its structure.
Ultrasound diagnostics is used to assess the condition of the child. It is very important to timely calculate how much weight the fetus will have. In breech presentation, this is of great importance - a fetus weighing more than 3500 g can lead to complications during childbirth. Malformations of the fetus and the volume of amniotic fluid are well determined by echography. Also, this method allows you to detect the presence of neoplasms in the uterus or its appendages.
Placentography plays an important role in the diagnosis. With its help, doctors examine the structure of the placenta, clarify its location, determine the thickness and degree of maturity. Another important diagnostic method is dopplerography. It allows you to study the features of blood flow (fetal, fetal-placental and utero-placental). The effectiveness of Doppler sonography is enhanced when it is combined with color mapping. Then it becomes possible to detect anomalies of the umbilical cord and assume its entanglement around any part of the child's body.
It is important not only to confirm the presence of breech presentation, but also to accurately diagnose its type. It is also necessary to assess the degree of extension of the fetal head. In addition, you need to take into account the gender of the child. After all, as you know, girls better endure the stressful situation that occurs during childbirth. The most accurate picture in the diagnosis of breech presentation can be obtained using the three-dimensional echography method.
Possible methods of delivery in breech presentation of the fetus
When planning a method of delivery, the doctor must carefully consider everything and take into account the peculiarities of the course of pregnancy in a particular patient. After all, a cesarean section operation can not always guarantee a successful result without complications, despite the wide indications for this procedure in breech presentations. Surgical intervention can lead to trauma to the fetus. The chance of injury is especially high if the baby is premature or too large. It is also dangerous to perform a caesarean section if there is an untimely outflow of water or when the baby's head is in an unbent position. The optimal frequency of surgical interventions is approximately 60-70%.
It should be noted that the mere fact of breech presentation is not always the basis for making a decision on surgical intervention. The indication for surgery is the presence of other factors that adversely affect the course of pregnancy. The decision on the need for a caesarean section is made in cases where the risk of complications during childbirth is high.
The main indications for a planned caesarean section (even if the pregnancy proceeds without additional complications) are the following pathologies: extension of the fetal head, posterior view with breech presentation, foot presentation.
Foot presentation threatens with serious complications during childbirth. As soon as the waters pour out, the rapid advancement of the legs of the fetus, its buttocks and torso begins along the birth canal. And the cervix at this time did not have time to prepare for the birth of a child. It is not yet fully disclosed and not sufficiently smoothed. The baby's head is too large to pass through the canal unprepared for childbirth without complications. The consequences can be very severe, including asphyxia, traumatic injuries and even death of the fetus.
No less dangerous is a significant extension of the head. During the passage of the fetus through the birth canal, the extension becomes even greater, as a result of which the child can be severely injured.
The posterior view of the breech presentation leads to a violation of the natural mechanism of childbirth. Because of this, childbirth proceeds too slowly, and the fetus is in serious danger - damage and asphyxia.
Other indications for operative delivery are associated with the presence of additional complicating factors. So, a planned cesarean is performed when breech presentation is combined with such pathologies:
Irregular shape of the pelvis or its narrowness;
Too small (up to 2000 g) or, conversely, very large (over 3500 g) fruit;
Pathology of the location of the placenta;
Presentation of the umbilical cord;
Elimination of a fistula in the past (intestinal and genitourinary);
The presence of scars on the uterus;
Cicatricial changes in the perineum, as well as the vagina and cervix;
Manifestations of varicose veins in the area of the vulva and vagina;
intrauterine growth retardation;
Large fibroids;
Various developmental disorders of the uterus;
Insufficient readiness of the cervix for childbirth, unpreparedness of the mother's body for the birth of a child;
preeclampsia;
Fetoplacental insufficiency;
Hemolytic disease in the fetus;
The first childbirth in adulthood - from 30 years.
Also, a caesarean section is recommended in cases where pregnancy has occurred as a result of the use of medical reproductive technologies (IVF). Another indication for surgical intervention is a burdened anamnesis of a pregnant woman, if in the past there have been: the birth of a dead child, repeated miscarriage, the birth of a sick child, childbirth with fetal trauma, premature birth with a non-surviving child, infertility. The decision in favor of the operation can also be made with a mixed option, if the woman is nulliparous.
If the fetus is male, there is an additional danger for him. It is associated with the presentation of the scrotum. According to many years of medical practice, boys who are in the breech presentation and were born naturally in the future often face the problem of infertility. The cause of this pathology is injury to the testicles during the passage of the fetus through the birth canal. Therefore, if the gender of the fetus is male, and at the same time there are other adverse factors, it would be reasonable to decide on childbirth with the help of surgical intervention. But, unfortunately, in some cases the situation becomes more complicated due to the inability to accurately determine the sex of the fetus, which is in breech presentation. If the issue was resolved in favor of natural childbirth, it is necessary not to allow their second period to drag on for a long time. The fruit is removed very carefully and as quickly as possible. Then the newborn is given the necessary medical care.
In many cases, with a breech presentation (both mixed and purely gluteal), a favorable obstetric situation develops when childbirth is allowed without surgical intervention. A caesarean section is not indicated if the woman is in good general health, when the parameters of the pelvis correspond to the fetus, the body is completely ready for labor, and the baby's head is bent.
If natural delivery is planned, a woman needs to take care of the state of her body in advance and prepare it for the upcoming birth. Prenatal preparation involves taking vitamins, tonic and sedatives, as well as antispasmodics. These drugs will reduce the likelihood of violations of labor and bleeding, improve the condition of the fetoplacental complex.
With a breech presentation, of course, childbirth will be different from the usual, so they are classified as pathological. When conducting such childbirth, it should be borne in mind that they belong to the category of high risk for the occurrence of complications and require a whole range of preventive measures.
In the first stage of labor, it is very important to protect the fetal bladder from damage. It should remain intact until the cervix opens. This will help the strict observance of the woman in labor bed rest, in a position lying on her side (from the back of the fetus).
During childbirth, continuous monitoring of the fetus and contractions of the uterine muscles is carried out (using cardiotocography). In order to prevent pathologies of labor activity, when the cervix is opened by 4 cm, a woman in labor is given droppers with antispasmodic drugs (no-shpa with glucose). Every two hours, intravenous administration of drugs that stimulate microcirculation, as well as uteroplacental blood flow, is carried out. This is necessary to prevent the development of hypoxia in the fetus.
To prevent birth stress and to prevent violations in the contractile activity of the uterine muscles, it is necessary to provide the woman in labor with effective pain relief. Anesthesia measures should be started during the active phase, when the cervix opens by 3-4 cm. Epidural anesthesia is most suitable for such situations, which not only reduces pain, but also helps to relax the muscles of the pelvic floor, normalizes labor activity, and reduces the risk of injury child. It is important to note that in the case of this type of anesthesia, it is necessary to strictly control the contractile activity of the uterine muscles.
Birth complications are more common in breech presentations than in head presentations. Even if the fetal bladder is intact, the opening of the cervix is slower than necessary. For a long time, the buttocks remain above the entrance to the pelvis. In this case, there is no formation of an adjoining belt, which should separate the anterior and posterior waters. Such a pathological situation threatens with dangerous disorders that occur during childbirth in their first period. The most common of them are: various violations of labor activity, too long delivery time, untimely discharged water, falling out small parts of the fetus, a prolapsed umbilical cord, the appearance of severe hypoxia in the fetus, chorioamnionitis, placental abruption.
The probability of untimely discharge of water in such situations can reach 40-60%. Since the waters are not divided into front and back, they are completely poured out. And this often leads to prolapse of small parts, loops of the umbilical cord and forms the basis for the development of the infectious process and chorioamnionitis. Therefore, after the discharge of the waters, a vaginal examination is carried out to find out whether the prolapse of the umbilical cords or small parts of the fetus has occurred. If the suspicions were justified, then it is better to refuse natural childbirth.
If the waters have already departed, and the cervix is prepared for the onset of childbirth, you need to make sure that the child is in a satisfactory condition and expect labor. If after 2 or 3 hours it has not come, you have to resort to labor induction. If the methods of labor induction do not have the desired effect, and labor activity does not develop, doctors decide on a surgical procedure.
Approximately one in four cases of labor anomalies is associated with one of the following reasons:
uterine anomalies,
immature neck,
Problems with the tone of the uterus,
untimely waters,
The presence of fibroids
Narrowness of the maternal pelvis
Errors associated with the conduct of childbirth.
In case of birth weakness, the woman in labor will definitely need medical rhodostimulation. She is put on a drip with drugs that increase the contractility of the uterine muscles. In case of poor fetal condition or insufficient effect from stimulation, a caesarean section is performed. It should be noted that stimulation is indicated only in situations where the cervix is well opened (wider than 5 cm). If this does not happen, the question of a surgical procedure is being decided.
For children in breech presentation, discoordinated labor activity is considered a serious threat. Then the birth takes a protracted nature, the anhydrous period increases, and the child may experience a state of acute hypoxia. And this means that in such cases, the decision on the natural process of childbirth is inappropriate.
So, the main indications for emergency surgery are:
Prolapse of the umbilical cord or small parts of the fetus;
Immature neck after water breaks;
Generic weakness with insufficient neck opening - up to 5 cm;
No result after 3 hours of labor stimulation;
Discoordination of labor activity;
When the fetus has acute hypoxia;
Placental abruption.
In the second period, the cervix is fully opened, the pelvic end of the fetus is located on the pelvic floor. It's time for pushing. They try not to force childbirth until the baby appears up to the navel. Otherwise, the upper limbs may tilt back, and the head will be strongly unbent.
The optimal position for a woman in labor is to lie on her back, with bent legs resting on special supports. In this position, it is much easier to maintain sufficient straining activity, which is necessary for a successful delivery of the fetus. To reduce the angle of the pelvis and at the same time strengthen the attempts, it is advisable to press the hips to the stomach with your hands. At the end of the birth of the fetus, this posture is important as it facilitates the exit of the head.
During the second period, it is necessary to carefully monitor the condition of the child and periodically monitor his heartbeat. Now, a little bit of original feces can come out of his intestines. With pelvic presentations, its release is a common occurrence.
When the pelvic end erupts, the perineum is dissected. This is necessary in order to facilitate the passage of the fetus, reduce the likelihood of asphyxia and trauma, shorten the second period and prevent ruptures.
As soon as the baby is born before the navel, a very dangerous moment of childbirth occurs. Indeed, after the exit of the pelvic end, the birth canal is not sufficiently stretched in order to freely pass the head. Therefore, during its passage, the loops of the umbilical cord are pressed against the pelvic wall. It is extremely important that the time of such pressing does not last more than 3-5 minutes. Otherwise, serious complications are possible - damage and even asphyxia. If cord clamping persists for more than 10 minutes, the baby may die. Another threat associated with a delay in the passage of the head is the risk of placental abruption, since after the fetal body is born, the volume of the uterus becomes smaller. In this case, it is necessary to use special methods that will help to safely remove the fetus and complete the birth successfully.
Overdose prevention.
Preventing the development of an oversized fetus.
Special exercises.
Consideration of risks and likely consequences.
Timely decision on caesarean section.
Prevention of possible bleeding and disorders in uterine contractions.
Well-thought-out tactics of conducting childbirth, careful delivery.
Proper management of the postpartum period.
Comprehensive diagnosis of newborns (newborn screening).
If a woman is at risk for breech presentation, she is prescribed special preventive measures. Their goal is to prevent premature birth, prevent pregnancy overshoot, and also reduce the likelihood of preeclampsia and placental insufficiency.
It is very important in such cases to adhere to a calm, measured daily routine, get enough sleep at night and find time for daytime rest. The diet of a pregnant woman should be well thought out, since it is very important to prevent the development of an oversized fetus.
If breech presentation is diagnosed, then the pregnant woman needs to master a set of special exercises associated with a change in the tone of the uterus and the anterior abdominal wall. Such gymnastics will help to transfer the breech presentation to the head. It is very easy to do the exercises. You need to lie on a flat hard surface and turn 3-4 times alternately on the left and right side every 10 minutes. You need to do gymnastics a few minutes before meals in the morning, afternoon and evening. The full course lasts from a week to 10 days. For details on how to correct breech presentation for head, read the article: "Position and presentation of the fetus during pregnancy". But it is worth considering that this gymnastics is far from always effective. In some cases, the position of the fetus remains unchanged.
Shortly before birth, the baby occupies a certain position in the uterus. In most cases, it is placed head down - towards the exit from the uterus, and turns back to the left. This is the correct, so-called head presentation, the most convenient for childbirth. This is how 90% of babies are born.
Varieties of breech presentations
However, today we will talk about those cases when the presenting part is the legs or buttocks. Frequency pelvic adhesions, according to various estimates, is in the range of 3-5% of the total number of newborns. In 67% of these pregnancies, the baby sits with his buttocks in the mother's pelvic ring, his legs are bent at the hip joints, and his knees are straightened. Less common is a mixed breech (20.0%) presentation, when the child enters the mother's pelvic ring not only with the buttocks, but also with the legs, more precisely, with the feet. Breech presentation includes complete foot presentation when the baby's legs are slightly extended at the hip and knee joints; and mixed foot presentation, when one leg is almost straight and the other is bent at the hip joint; and knee presentation, when the baby is presented with bent knees.
Factors affecting breech presentation
There are certain conditions due to which the baby takes the wrong position. There are the following factors:
- maternal (anomalies in the development of the uterus, limiting the mobility of the fetus and the possibility of turning the head down at the end of pregnancy; tumors of the uterus, a scar on the uterus, a narrow pelvis that prevent the head from being established at the entrance to the small pelvis; the uterus and fetus are not sufficiently fixed, which also leaves the baby with the opportunity to maneuver ; multiple pregnancies and, as a result, weakness of the abdominal muscles; previous births in the breech presentation);
- fruit (congenital malformations of the fetus; prematurity; neuromuscular and vestibular disorders of the fetus; multiple pregnancies, abnormal fetal articulation);
- placental (placenta previa, polyhydramnios and oligohydramnios, due to which the child moves freely, his head cannot be fixed in the mother's pelvic floor or, conversely, does not have the possibility of active movement, entanglement and shortness of the umbilical cord, which also limit mobility).
At the same time, the child, possessing the instinct of self-preservation, occupies the most convenient position for himself. Doctors do not disregard the hereditary factor: if a mother was born in a breech presentation, then there is a risk that her baby will take the same position.
Diagnosis of breech presentation
Breech presentation of the fetus is diagnosed primarily according to external obstetric and vaginal examination. At outdoor study a large, irregularly shaped, softish consistency, sedentary part, which is presented to the entrance to the pelvis, is determined, while in the bottom of the uterus a large, round, hard, mobile, balloting part (fetal head) is determined. A higher standing of the uterine fundus above the pubis is characteristic, which does not correspond to the gestational age. The heartbeat is clearly heard at or above the navel. During vaginal examination with a purely breech presentation, a softish volumetric part is felt, on which the inguinal fold, sacrum and coccyx are determined. With a mixed breech and foot presentation, the feet of the fetus are determined.
Via ultrasound it is possible to determine not only the breech presentation itself, but also its appearance. The position of the fetal head and the degree of its extension are assessed. Excessive extension is fraught with serious complications in childbirth: trauma to the cervical spinal cord, cerebellum and other injuries.
coup attempt
Breech presentation, diagnosed before, should not be a cause for concern, enough dynamic observation. With tactics aimed at correcting the breech presentation on the head. There are conservative methods. For this purpose, it is assigned corrective gymnastics, the efficiency of which is 75-85%. However, it cannot be used for fetal abnormalities, threatened miscarriage, uterine scar, infertility and miscarriage in history, preeclampsia, placenta previa, low or polyhydramnios, abnormalities in the development of the uterus, multiple pregnancy, narrow pelvis, severe extragenital diseases. In addition to gymnastics, unconventional methods: acupuncture / acupressure, aromatherapy, homeopathy, as well as the power of suggestion, light and sound effects on the fetus from the outside, swimming.
If breech presentation persists, external prophylactic prophylaxis can be performed at term. fetal head rotation proposed by B.L. Arkhangelsk, the efficiency of which ranges from 35 to 87%.
External prophylactic rotation should be performed by a highly qualified doctor in stationary conditions where, if necessary, a caesarean section can be performed and the necessary assistance to the newborn can be provided. After turning, it is necessary to consolidate the achieved result. For this, they are used bandage and certain an exercise, which helps to fix the baby's head in the desired position. However, if the baby, despite all the efforts made, has not turned over, do not despair: even in this case, the possibility remains spontaneous childbirth.
Choice of method of delivery
A woman with a breech presentation of the fetus must go to the hospital for examination and the choice of a rational tactics for the management of childbirth. Method of delivery is determined based on the number of births, the age of the mother, obstetric history, gestational age, the readiness of the female body for childbirth, the size of the pelvis and other factors. Breech presentation of the fetus is not an absolute indication for caesarean section, however, in cases where it is combined with various complicating factors, the issue is resolved in favor of operative delivery.
Indications for caesarean section in a planned manner with a full-term pregnancy, the age of the primiparous is more than 30 years; severe form of nephropathy; extragenital diseases requiring the exclusion of attempts; pronounced violation of fat metabolism; narrowing of the pelvis; estimated fetal weight over 3600 g in primiparous and over 4000 g in multiparous; fetal hypotrophy; signs of fetal hypoxia according to cardiotocography; violation of blood flow during doplerometry; Rhesus conflict; extension of the head of the 3rd degree according to ultrasound; unpreparedness of the birth canal during gestation; overwearing; foot presentation of the fetus; breech presentation of the first fetus in multiple pregnancy and other factors.
Childbirth is through natural birth canal with a good condition of the expectant mother and fetus, full-term pregnancy, normal pelvic size, average fetal size, with a bent or slightly unbent head, the presence of readiness of the birth canal, with a purely breech or mixed breech presentation.
It is best when breech presentation fetal labor has begun spontaneously. In the first stage of labor, a woman in labor must observe bed rest and lie on the side towards which the back of the fetus is facing in order to avoid complications (premature discharge of water, prolapse of the fetal leg or umbilical cord loops). Childbirth is under monitor control fetal heart rate and uterine contractions. In the second stage of labor, it turns out obstetric care in the form of a benefit, the purpose of which is to preserve the articulation of the fetus (the legs are extended along the body and pressed to the chest by the arms of the fetus). First, the child is born to the navel, then to the lower edge of the angle of the shoulder blades, then to the arms and shoulder girdle, and then to the head. When a child is born to the navel, his head presses the umbilical cord, and a lack of oxygen develops, therefore, no more than 5-10 minutes should pass until the child is born completely, otherwise the consequences of oxygen starvation will be very negative. Also produced perineal incision to speed up the birth of the head and make it less traumatic.
Childbirth at foot presentation through the natural birth canal are carried out only in multiparous with good labor activity, readiness of the birth canal, full-term pregnancy, medium size (weight up to 3500 g) and good condition of the fetus, a bent head, a woman's refusal of a caesarean section. At the same time, the obstetric benefit is as follows: the external genital organs are covered with a sterile napkin and the palm facing the vulva prevents the legs from falling out of the vagina prematurely. Leg hold contributes to the full disclosure of the uterine pharynx. The fetus during an attempt, as it were, squats down, and a mixed breech presentation is formed. Opposition to the born legs is exerted until the uterine os is fully opened. After that, the fetus is usually born without difficulty.
The condition of children born in a breech presentation through the natural birth canal requires special attention. Hypoxia suffered during childbirth can adversely affect the child's nervous system, such a pathology as a dislocation of the hip joint is possible. A neonatologist and resuscitator must be present at the birth. With these precautions, babies born this way do not differ in development from other babies.
Svetlana Leshchankinaobstetrician-gynecologist of the highest category,
Candidate of Medical Sciences
Discussion
My personal experience: second pregnancy, fetus in breech presentation, about 4 kg in size as planned. The first girl was born naturally (birth parameters 60 cm and 4540 g). I had a caesarean section. Parameters 56 cm and 4090 gr, according to the doctors - the CS was done correctly, the natural birth of a large fetus in breech presentation would not have gone smoothly
Comment on the article "Pregnancy, childbirth and breech presentation of the fetus. How to fix it?"
Breech presentation.. Medical issues. Pregnancy and childbirth. Pelvic presentation. I’m 36 weeks old, the baby is in breech presentation. I read horror stories on the Internet, I don’t want to give birth myself, I want a cop. I’m afraid for the baby. How to insist or they won’t listen to me during childbirth ...
Discussion
Go to an osteopath, maybe the baby will roll over again
I had a pelvic, but to the pelvic also some problems in gynecology. Until the last, they waited for the EP, when all the deadlines had passed, and the birth had not begun, it was the COP. If childbirth began on her own, she would give birth herself. I would look for a doctor you trust and discuss all the nuances with him.
Osteopath for the coup of a child. ... I find it difficult to choose a section. Pregnancy and childbirth. And so I do not want a caesarean (first pregnancy). I have been doing all sorts of exercises for more than 2 weeks, now Breech presentation at 32 weeks ?. Fetal development. Pregnancy and childbirth.
symphysitis + breech presentation. Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. Breech presentation of the fetus is not an unconditional indication for CS, but during childbirth, the risk of injuries and pathologies for the child is very high. symphysite...
Discussion
Search the internet for exercises and tips for those with pelvic floor problems.
I had a pelvic floor placed a week ago. I was very upset. Rummaged on the Internet. I did exercises for a week, persuaded, swam in the pool. I didn't really expect much, though. BUT! A week later, the doctor after the examination said that he turned over.
Try it! One girl wrote that 4 days before the birth, with the help of massage, she made the baby roll over ...
Good luck!
For my girlfriend, all the doctors she consulted advised CS, agreed with the doctor for CS, got to another maternity hospital by ambulance, so she had CS there. An orthopedist treated a dislocation of one leg and a subluxation of the other.
Childbirth with a breech presentation of the fetus. Many expectant mothers believe that if the fetus is in a breech presentation, a caesarean section is inevitable. Pregnancy, childbirth and breech presentation of the fetus. How to fix? Varieties of pelvic presentations.
Discussion
I just wanted to raise this thread. Until last week, my hryundel was a soldering bunny, and then he suddenly decided to sit down on his ass! (This is at 33 weeks:(:() Has been sitting for a week now:(:(
Can anyone tell me, helped someone in the coup from the priests to the head enti exercises: knee-elbow, torsion from side to side every ten minutes, "birch tree" (if what I depict can be called that). Maybe someone else knows what methods? And in general, is there any chance that he will lie down normally for such a long time?
I flipped at 35 weeks. if it hadn’t rolled over, I would definitely have cesarean :)
And the breech presentation everywhere, except for the post-Soviet space, is considered a NORMAL presentation of the fetus. Childbirth with a breech presentation of the fetus. Many expectant mothers believe that if the fetus is in a breech presentation, a caesarean section ...
Discussion
My neighbor in the ward gave birth, such a young, thin girl. She also did not have much water, including the child could feel almost everything ... She gave birth herself, quickly and, it seems, without breaks. Since the priest is born like the head, the main thing is that there would be no prolapse of the limbs, but the midwife must follow this ...
A week ago I watched a movie about the birth of a boy in a breech presentation, and in the water. Nothing, they gave birth :) True, with asphyxia, but they didn’t drag him anywhere to any intensive care unit (it was in Denmark), and he just swam next to his mother, his legs were directed towards her, finally (after 20 seconds) the “walking” reflex started and the baby came to his senses. A perfectly normal baby was born.
What is your deadline? The baby can still roll over, especially if you are doing gymnastics. You try to discuss this issue with him again, tell him that the head down is more natural and softer, that in this way he will help himself and you. Communicate with him more often, perhaps and agree :))) Good luck!
:(Hope disappears every week. The doctor also immediately said that there was not enough water, it would be difficult for the child to roll over :(
05/30/2001 03:21:54 PM, KatyaMy girlfriend turned over at 39. I'm about 35 so don't worry. There's still enough time for this. Only I read that with a breech position, I do not recommend wearing a bandage as it secures the position of the kid. So GOOD LUCK!
Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. breech presentation + entanglement of the umbilical cord. Girls .. tell me who had such a situation ... Rhoda with a breech presentation of the fetus. Pregnancy, childbirth and breech presentation of the fetus.
Discussion
I was diagnosed with breech presentation at 28 weeks. All my efforts to turn over were in vain - my daughter stubbornly sat upside down. Despite this, my doctor, who led the pregnancy and had to take delivery, insisted on natural childbirth. He persuaded, gave examples of how he normally gives birth with a pelvic. I hesitated. A week before the birth, they did an ultrasound - a loop of the umbilical cord in the neck. After that, the doctor said - yes, now I myself am leaning towards a caesarean section. After I woke up after anesthesia, my second question was - was there an entanglement? He answered me that there was a tight loop and we did everything right, otherwise we could lose the baby ... So think carefully, consult a good doctor. Still, in itself, the pelvic is an unpleasant thing, and even entanglement ...
Another case happened to my friend. There was no pelvic, only entanglement. And the maternity hospital is excellent, and they wrapped the sensors around the stomach, and they seemed to be watching. But they didn't follow :(((.
So think well, well. And remember, a scar on the stomach is such garbage compared to a little beloved baby :).
I know that they do caesarean with entanglement of the umbilical cord (some mothers are even happy about this). But you need regular monitoring of the condition of the child. If not, then make sure that she continues to move well. In general, it is difficult to suffocate in the aquatic environment. But giving birth naturally is not recommended.
09/14/2000 17:58:27, LenaOBreech presentation is not an indication for a caesarean section. Surely there are other reasons for this. Doctors simply do not have Breech presentation, caesarean at the discretion of the doctor on duty, it was Saturday, in the maternity hospital - natural births are welcome, I have ...
Discussion
And no one knows by chance how you can feel or determine by some signs what the child is sitting down with? And another question: upstairs, approximately opposite the solar plexus, sometimes a little lower, almost constantly something sticks out, sometimes like a ball, then something oblong, you can directly see and feel it very much when he starts moving it there with something -here. Does anyone have something similar?
08/03/2000 10:27:46, XeniaBreech presentation is not an indication for a caesarean section.
Surely, there are other reasons for this. Doctors simply do not have the right to perform a Caesarean section without appropriate indications.