Correct fetal position during pregnancy. Birth tactics for cephalic presentation

Until the third trimester, the baby often changes its position and turns over. Due to the growth of the embryo, there is less space, and the position and presentation of the fetus during pregnancy is determined by preparation for labor.
The position of the fetus by week of pregnancy is assessed using ultrasound. This takes into account the ratio of the child’s axis, which runs from the head to the hip joint, to the conventional midline of the uterus. There are longitudinal, transverse and oblique arrangements.

Presentation during pregnancy is a mandatory diagnostic measure in the third trimester. The situation is related to reducing the trauma of a woman during the birth process.

Diagnosis occurs depending on the location of the child’s body and as birth approaches. In more than 90% of cases, a normal, cephalic location is determined, when the head is directed towards the pharynx. Pelvic or gluteal, is considered the most traumatic for both mother and baby.

Until 33-34 weeks, the baby is able to roll over; after this period, activity decreases, the baby takes the position in which he will be born.

Transverse presentation of the fetus during pregnancy

The transverse arrangement does not in any way threaten the course of gestation and normal development. The danger is the premature onset of contractions caused by bleeding.

With this pathology, the water drains very quickly, which immobilizes the baby, who blocks the pelvic area with his shoulder joints. Prolonged dehydration (more than 12 hours) leads to hypoxia and suffocation. Therefore, a complete diagnosis of the woman’s body is carried out in order to identify the causes of this pathology. Also, a decision is made on the method and timing of delivery.

lying down, roll from side to side for 10 minutes;
stands in a knee-elbow position, raising the pelvis;
rest with pillows under your hips.

If there is a threat of miscarriage or interruption, exercises are performed only under the supervision of obstetricians.

In most cases, transverse localization involves birth through caesarean section. The main deciding factor will be the presence of additional threats to pregnancy and the formation of pathologies.

Low presentation of the fetus during pregnancy

Low presentation speaks of the body's preparation for birth. On early stages such a diagnosis threatens to interrupt pregnancy. The reasons are mainly due to diseases of the female body:

infectious processes;
surgical interventions in the past (abortion, caesarean section);
structural features of the uterus;
heredity;
age category over 35 years.

Non-compliance healthy image life and previous diseases of the female genital organs also contribute to the fact that the fetus is low-lying.

The position inside the womb can be corrected with the help of a bandage and special exercises, which should only be done on the recommendation of a doctor, so as not to aggravate the condition. In particularly complicated cases, a decision is made to hospitalize and prescribe drug therapy. Sometimes it requires suturing the cervix or using a special ring.

Longitudinal and oblique position of the fetus during pregnancy

Oblique - involves the baby being diagonally inside the womb, with the head and pelvic bone located on opposite sides of the main axis of the woman’s abdomen. Only after 31 weeks of pregnancy can this situation be considered a pathology.

The cause of the oblique position is considered to be polyhydramnios or, conversely, oligohydramnios, as well as various neoplasms that prevent the baby from coming out. If head down movement does not occur before the 36th week, then delivery by cesarean section is used.

Longitudinal localization means that the fetus is located vertically relative to the line of the mother's abdomen, which is the norm.

The absolute norm is the position of the fetus with its head down, closer to the pharynx. Thus, the birth will be successful, and the fetus will not have any problems on the way to the os. When placed longitudinally in the gluteal position, there is a risk of suffocation or damage to the hip joint. Therefore, the birth of the baby should be as quickly as possible, otherwise a caesarean section is used.

Correct positioning of the fetus during pregnancy

Correct positioning at 30 weeks is important for subsequent delivery. The optimal option would be a longitudinal cephalic presentation; an anterior cephalic presentation complicates and delays labor. Gluteal birth is dangerous for the life of the child; during childbirth there is a risk of injury or stillbirth.

They try to correct marginal or lateral presentation before the baby is born. In the absence of movement and changes in localization in the uterus, doctors are faced with the question of methods of delivery depending on weight, height, head diameter and other parameters. Any decision of specialists will always pursue only one goal - to save the life of the child and ensure best option birth, which will be the safest for the mother in labor.

The term "posterior placenta previa" is a misnomer. There is no state corresponding to this term. This term was born in numerous forums and discussions as a result of confusion. To understand what we might be talking about when a woman mentions “posterior placenta previa,” let’s consider the possible options.

So, according to the results ultrasound examination The doctor determines which wall of the uterus the placenta is attached to. This fact is quite important, since when the placenta is attached to the wall of the uterus, which is not adapted to this, there are high risks of some pregnancy complications.

Normally, the placenta can be attached to the posterior, anterior, upper or lateral walls of the uterus. Typically, the ultrasound report states, for example, “the placenta is attached to the posterior wall” or “the placenta is attached to the fundus (upper wall) of the uterus.” Knowing about the term "presentation", women believe that it refers to the location of the placenta. As a result of such creative thinking, the long phrase “the placenta is attached to the posterior wall” is replaced by another, completely new concept - “posterior placenta previa.” In fact, the location of the placenta on the posterior wall of the uterus is normal, moreover, optimal from the point of view of the course of pregnancy and subsequent childbirth.

But the term “presentation” reflects pathology. The name of this term reflects the position of the placenta directly in the path of the born child, that is, it literally “lies in front” of an obstacle. Presentation is the location of the placenta on the lower wall of the uterus, where the entrance to the cervical canal is located, through which the baby is born. That is, placenta previa is indeed a barrier in the birth canal, in the presence of which the child will not be able to be born naturally. Presentation can be complete, partial or low, depending on how much the internal os of the cervix is blocked. However, presentation always involves the location of the placenta on the lower wall of the uterus. Therefore, “posterior placenta previa” cannot exist in principle. Presentation is a pathology, and the location of the placenta on the posterior wall of the uterus is the norm. Therefore, there is no need to philosophize and use the term “presentation” to refer to the location of the placenta on the walls of the uterus, since it reflects a specific pathological condition.

However, in obstetrics the concept of “posterior presentation” is also used to describe the position of the child in the abdomen. Therefore, in the term “posterior placenta previa,” the designation of fetal and placenta previa may be confused. So, posterior presentation of the fetus is the position of the baby with the back and back of the head to the woman’s spine. Fetal presentation plays a role in the biomechanism of childbirth and is necessary for the midwife, but for the pregnant woman herself this knowledge is completely unimportant. The only thing that might interest you is expectant mother- this is that posterior presentation of the fetus is a completely normal phenomenon.

From this time on, his situation will not change significantly, so the diagnosis is carried out precisely at the 8th month. Fetal presentation is determined by palpating the abdomen; in case of doubt, ultrasound or radiography is used.
For normal course During childbirth, it is very important that the fetus is positioned vertically.

Currently, several variants of fetal presentation are known: cephalic, transverse and pelvic. The location of the fetus in the uterus is determined by direct examination by an obstetrician-gynecologist (at longer stages of pregnancy you can feel where the fetal head is) and by ultrasound examination. Depending on the duration of pregnancy, the position of the fetus in the uterus changes significantly. If during the first 6 months the fetus is still quite small in size and has enough room for movement, then by the time of birth it occupies a stable position and its presentation can already be accurately determined. If we compare ultrasound data performed during pregnancy, we can note that in approximately 25% of women the fetus is first located in a breech presentation, which later progresses to a cephalic presentation.

Head presentation of the fetus

The baby completely occupies the space of the uterus and the best way adapted to its shape. In 95% of cases, the largest part of his body (torso) is located in the widest part of the uterus. This means that the baby is positioned head down, with the back most often facing to the left.

This position is considered the most comfortable for mother and baby during childbirth. It is characterized by the position of the fetus head first (the front part is directed towards the mother's back), which is the most voluminous and plastic part of the fetus, due to the unfused bones of the skull. The baby's head will be the first to pass through the woman's birth canal (this includes the cervix, vagina, external genitalia), which determines a faster course of labor. After the head has passed, the remaining torso and limbs are born without any difficulty. In this case, the child is born with his head bent, pulled into his shoulders and slightly turned to the left side. However, there are cases when a baby who is in a cephalic presentation may have his head turned to the right side, which will significantly complicate childbirth. There is also a frontal and facial position of the fetus in cephalic presentation. The causes of these head positions may be a decrease in muscle tone and weak contractions of the uterus during childbirth, close proximity of the mother's pelvic bones, the size of the fetal head does not correspond to the norm (large or small), a congenital tumor of the child's thyroid gland, as well as difficulty moving when turning the fetal head . The frontal position may be associated with anatomical changes in the structure of the mother’s uterus, with a wide pelvis, and also most often occurs in multiparous women, since the stretched muscles of the uterus cannot ensure a stable position of the fetus. When this situation is determined, the woman in labor is transferred to the operating department. Childbirth in this position of the child is possible only if the fetus is small. In most cases, a caesarean section is used to deliver the baby. The facial position of the fetus can be determined even during the first ultrasound examinations. A characteristic feature of this position is the specific position that the child takes in the womb. By carefully palpating, it is necessary to determine in which direction the chin is directed. If it is directed forward, then labor will proceed independently. During childbirth, passing through the mother's pelvic bones, the baby's head encounters resistance and tilts back, so the front part of the head appears first, not the occipital part. When facing characteristic feature of the born child are the elongated lips and chin of the fetus. If the chin is turned back, during childbirth the head may be pinched by the pelvic bones, which will lead to the impossibility of further delivery. This position of the fetus is very rare, but if it is detected, a caesarean section is always performed.

Breech presentation of the fetus

In preparation for his birth, somewhere between the 32nd and 37th weeks the baby turns over, taking a vertical position with his head down - the so-called cephalic, or occipital, presentation. As a result of this rotation, the baby's head is directed downwards, exactly towards the entrance to the birth canal. The head is the heaviest part of the baby's body. When the baby is almost fully formed, he turns over head down under the influence of the natural law of gravity.

In most cases, this somersault occurs completely unnoticed, especially if the baby turns over during mother's sleep. But the change of position may be delayed if the mother experiences fear and stress, or some circumstances in her life cause her grief.

Some women various reasons cannot release stress, which causes their uterus to remain tense and the baby unable to turn over. The baby simply does not have enough space to make a turn, so he remains in his original position with his head up. The baby's buttocks remain at the entrance to the cervix. This position is called “breech presentation.” Sometimes the baby makes only a partial revolution: his shoulder, arm, one or both legs remain in the lower segment of the uterus.

If no change occurs, breech birth requires important decisions to be made. There are several options: direct all efforts to help the baby roll over; give birth to a breech baby or have a caesarean section. Since not many specialists have sufficient knowledge and skills to perform breech births, in most such cases women are referred to have a caesarean section. But this is not an option that you should think about at the very beginning. Many women give birth to breech babies through the normal vaginal route with home midwives.

The child is in a vertical, but incorrect position: the buttocks are located below, and the head is above. This fetal presentation occurs due to a very small uterus or its irregular shape.

Expulsion of the fetus during labor is difficult and general anesthesia may be necessary.

Breech presentation characterized by the passage first of the fetal legs and buttocks through the birth canal, and then of the head, and difficulties may arise due to the fact that the head is the most voluminous part of the fetal body, and there is also a risk of compression of the umbilical cord between the bones of the mother’s pelvis and the baby’s head.

Risk factors for breech presentation

This position of the fetus most often occurs during repeated pregnancy, when the muscles of the uterus and the front of the abdomen are most stretched and poorly fix the position of the child. However, this can also happen during the first pregnancy, in case low position uterus in the pelvis or with low placenta previa ( children's place) in the uterine cavity, in which it is located in its lower part; at large quantities amniotic fluid, in which the child is more mobile and can often change his position; at narrow pelvis when closely spaced bones prevent the child’s head from positioning correctly. Risk factors also include the abnormal structure of the mother’s uterus and tumor processes located in its lower part, which do not leave enough space for the head to enter the pelvis, and fetal malformations. According to the latest data, it has been possible to prove that heredity is a predisposing factor for breech presentation. It has been found that a mother who is born with this presentation has a 95% chance of having babies in the breech position. In first place among the causes of breech presentation is premature pregnancy (birth of a child starting from the 28th week of pregnancy). In this case, with premature birth, a large ratio arises between the size of the child and the uterine cavity, in which he can move freely. How shorter period pregnancy, during which the birth process occurs, the greater the risk of breech presentation.

With breech presentation, there are several characteristic positions for it: gluteal, leg and knee. Breech presentation It can be true, in which the child is positioned with his buttocks towards the entrance to the pelvis, and his legs, bent at the hip joints, are parallel to the body, and mixed, in which, in addition to the child’s buttocks, the legs bent at the knee joints are also directed towards the birth canal. The leg position can be complete, in which both legs are presented, slightly extended at both the hip and knee joints, and incomplete, when only one leg is presented, while the other remains in a bent position and is located much higher. The kneeling position is characterized by the fact that the child is positioned forward with his legs bent at the knee joints. In most cases, the fetus is breech. Breech presentation occurs in approximately 5% of pregnancies.

If after the second ultrasound examination a pregnant woman is diagnosed with a breech fetus, this does not mean that by the time of birth the baby will not correct position. A set of exercises can help turn the fetus with its head end toward the birth canal. A woman should alternately lie on a hard surface on her left and then on her right side for 10-15 minutes several times a day. Also, the knee-elbow position and the lying position with a raised pelvis have a great effect. To do this, you need to place a cushion or pillow under the buttock area and raise your legs 20-30 cm above your head. All exercises are performed on an empty stomach for several weeks so that their effectiveness can be assessed before the final ultrasound examination. Also, after the first week from the start of exercises, the doctor can evaluate them by palpating the location of the fetal head. Pregnant women are recommended to sleep on the side where the baby's head is located. With correct and constant performance of all the above exercises, the pelvic part of the fetus moves away from the mother’s pelvic bones and increases physical activity, which contributes to the child’s spontaneous turning over. According to reliable research data, exercises, as well as swimming, allow the child to take the correct position before childbirth in 75-96% of cases, and the mother to avoid surgical intervention. However, it should be remembered that you cannot self-medicate; in this case, you must urgently consult with the doctor monitoring this pregnancy, since there are a number of categorical contraindications to performing gymnastic exercises. These include postoperative scars on the uterus, tumor processes in it, severe systemic diseases (not combined with the reproductive system), placenta previa (in the case when it is located in the lower part of the uterus), gestosis during pregnancy (the occurrence of edema, increased blood pressure , visual impairment).

To obtain a positive result, you can combine it with physical exercise use and unconventional methods treatment of breech presentation of the fetus. Before combining these methods, you must consult a specialist. In most cases, acupuncture is recommended - influencing the activity of the child and the uterus by stimulating certain areas with the shallow introduction of special needles and aromatic agents. The mother's psychological influence can also contribute to the child's turning over. A pregnant woman needs to imagine a correctly positioned baby, you can persuade or ask him to turn over, look at drawings and photographs of the child in the womb. The effects of music and light are often used. Many scientists argue that the child, while in the uterine cavity, moves towards a sound or light source. According to this theory, you can place a flashlight or small lamp closer to the lower abdomen or put headphones on this area with calm music. When a positive result is achieved using these methods, it is necessary to fix the correct position of the fetus. This can be done with the help of a special prenatal bandage and exercises aimed at increasing the elasticity of the ligaments and muscles of the pelvis, as well as the correct entry of the fetal head into the pelvic area. The most effective position is sitting with your legs apart, bent at the knee joints and the soles of your feet pressed together. In this case, you need to try to bring your knees as close as possible to the floor and fix this position for 10-15 minutes several times a day. The prenatal bandage provides support for the abdomen, thereby relieving the load on the spine, which prevents or significantly reduces pain in the lumbar region, and also reduces the risk of stretch marks. Currently, the most common bandages are in the form of an elastic band that is worn over underwear. Such a bandage can be worn in any position of the body; it does not put pressure on the uterus, due to the possible change in its diameter (with an increase in the volume of the abdomen) using special “Velcro” on the sides. It is recommended to remove the bandage every 3 hours for 30 minutes. It is also possible to use bandage underwear in the form of panties with a wide support belt. The disadvantage of this type of bandage is that to maintain body hygiene, it requires frequent washing, which makes it difficult to wear it constantly.

If it is not possible to independently correct the position of the fetus, at 36-38 weeks the doctor may perform external rotation of the fetus. This procedure is performed in a hospital setting under ultrasound monitoring and constant listening to the fetal heartbeat. The purpose of this manipulation is for the doctor to gradually move the baby's head down to the birth canal. Absolute contraindications to this measure are: postoperative scars on the uterus, excess body weight (weight increase by more than 60% of the initial condition), threatened miscarriage (increased excitability, increased tone of the uterine muscles), age of the pregnant woman (over 30 years old with first pregnancy), a history of miscarriages or infertility, gestosis in the second half of pregnancy, location of the placenta in the lower part of the uterus, abnormal structure and development of the uterus, large or too small amount amniotic fluid, entanglement of the child with the umbilical cord, close proximity of the pelvic bones, severe internal diseases of the woman, pregnancy achieved through artificial insemination. Currently, the procedure for external fetal rotation is used in isolated cases due to a large list of contraindications and possible serious complications. After this procedure, it is necessary to constantly monitor the condition of the pregnant woman and the fetus.

In cases where the measures taken are not enough, the question arises about the method of delivery. Basically, a caesarean section is performed, but in case of a pregnancy that proceeded safely and occurred naturally, if the child weighs no more than 3500 g, there are no malformations of the female genital organs and the woman has sufficient width of the pelvis, it is performed natural childbirth with a breech presentation of the fetus (in the breech position). Such childbirth will take place in three stages. The buttocks are born first, then the torso, and lastly the head, which is the most voluminous part of the fetus. By combining data from X-ray examinations and a control prenatal ultrasound examination, an obstetrician-gynecologist can determine the method of delivery for a breech fetus. The passage of the child through the mother's birth canal in the pelvic position can be favorable, but more careful monitoring is required here, which requires the presence of a pediatric resuscitator, since birth injuries, suffocation and stillbirth of the fetus are possible. Such births are in borderline state between normal and pathological. The frequency of natural births with a breech presentation is approximately 5%. In the initial stage of labor, the woman in labor must observe strict bed rest. It is advisable to be in a supine position, on the side of the body where the back of the fetus is located. This is done to prevent early discharge of amniotic fluid and loss of fetal parts. A pregnant woman is under the supervision of obstetricians and is being prepared for childbirth. She is given labor stimulants (oxytocin) and anesthetized. All stages of labor take place under monitoring (with constant monitoring of the fetal heartbeat). The final stage of labor remains similar to that of a normal cephalic birth. However, to prevent postpartum hemorrhage, drugs that enhance muscle contractions of the uterus (methylergometrine, oxytocin) are administered intravenously.

Presentation during multiple pregnancy (twins)

Depending on the number of fertilized eggs (female gametes) and fertilizing sperm (male gametes), both fraternal and identical twins can be located in the uterus. Fraternal (developed from two or more eggs) twins occupy separate amniotic sacs (a limited cavity in the uterus that contains the baby, surrounded by amniotic fluid) and have separate placentas. Identical (developed when several sperm enter one egg) twins can also occupy separate amniotic sacs (only in rare cases is there one for two), but they are connected by one common placenta.

The presence of two or more fetuses in the uterus leads to its significant stretching, and therefore the presentation of twins in most cases is incorrect. This is also influenced by the fact that each child must adapt not only to the passage into the pelvis, but also to the position of the other child.

At multiple pregnancy the woman is placed in advance in the maternity hospital, where a control ultrasound examination is performed to assess the condition of the placenta.

Twins can be positioned longitudinally. In this case, both of them can be located either in a cephalic presentation, which is the most optimal for childbirth, or it is possible that one of the children will be in a cephalic presentation and the other in a pelvic presentation. When positioned longitudinally, twins can obscure each other. It is also possible for the fetuses to have different positions in the uterus: one of them occupies a vertical and the other a horizontal position in relation to the birth canal. In rare cases, the transverse position of both twins, as well as their pelvic presentation, is noted. The baby's position may change during labor. In case of cephalic presentation of both twins, after the birth of the first child, the second child may change its position to transverse or oblique due to the increase in space in the uterine cavity. In this case, external or internal rotation of the fetus is performed to correct the position of the child. The rarest occurrence during the birth of twins is their collision (coupling), which occurs when one child is positioned in the pelvic position and the other in the cephalic position. In most cases, the birth of twins occurs through surgery (cesarean section or the use of obstetric forceps to extract the second fetus).

Transverse presentation of the fetus

The child is positioned across the entrance to the pelvis, covering it with his back. During childbirth, the shoulder is shown first. In this case, it is necessary to perform a caesarean section.

Transverse presentation is defined when the baby is positioned horizontally in relation to the woman's birth canal. There are several fetal positions. The first position is in which the child's head is turned to the left, the second - in which the head is turned to the right. If the child's back is turned forward, this is an anterior view, and if it is backward, this is a posterior view.

Most often, transverse presentation of the fetus occurs when a woman’s pelvis is too narrow, with polyhydramnios ( increased quantity amniotic fluid), premature rupture of amniotic fluid, excessive fetal activity, repeated pregnancy (the muscles of the uterus are not able to maintain the vertical position of the fetus), if the fetal head is too large. Transverse presentation of the fetus includes its oblique (shoulder) position. At ultrasound examination It is revealed that the head and pelvic part of the fetus are located in the lateral parts of the uterus, due to which it takes an elongated position in the transverse direction, the fundus of the uterus is below the required level. Upon examination, the baby's heartbeat can be heard only in the navel area. When labor begins, the position of the fetus can be determined by vaginal examination after the discharge of amniotic fluid. In the shoulder position, you can palpate the shoulder, collarbone and rib area (in the posterior view), as well as the scapula and spine (in the anterior view). When in a transverse position, the handle can be felt to fall out.

If one of these positions is detected, it is necessary to perform a cesarean section, since spontaneous childbirth is impossible and complications such as prolapse of the umbilical cord or small parts of the body (upper limbs) often occur. In case of early detection of this type of presentation, the obstetrician-gynecologist can perform external or internal rotation of the fetus. External fetal rotation is performed in a hospital setting. If the shoulder position is maintained, the course of natural childbirth will in most cases be complicated by the loss of small parts of the fetus or part of the umbilical cord. However, despite possible complications, delivery can occur without surgery. Most often, self-inversion occurs or the child appears with his body folded in half.

With spontaneous inversion, a child can be born in several ways. If the fetal head is located above the pelvis, then the shoulder will be born first, followed by the torso and lower limbs, and lastly the head. If the head is in the pelvic area, most often its passage will be hampered by the shoulders; in this case, the torso and lower limbs will appear first, and then the shoulders and head. When folded, the shoulder appears first, then the torso appears with the head pressed into the stomach, and then the buttocks and legs. If the fetus is in a shoulder or transverse position, spontaneous delivery can only be expected in multiparous women or with a low weight of the child. The location of the umbilical cord and small parts of the fetus (upper and lower extremities) below the larger presenting part of the child after the rupture of amniotic fluid is called their prolapse. If the integrity of the fetal bladder is preserved, but small parts are located in the lower part of the uterus near the birth canal, their presentation is established. Only a manual vaginal examination can determine the presenting part of the fetus in more detail. The prolapse of the umbilical cord can be judged by characteristic changes in the condition of the fetus and disturbances in the rhythm of its heart contractions when it is strangulated. If it is impossible to put part of the umbilical cord back and there is no necessary conditions For immediate natural childbirth, surgical intervention is performed. If part of the umbilical cord falls out during the breech presentation of the child and if there are no complications, a natural birth is performed. If one of the upper limbs falls out, the transition of the fetal head to the lower pelvic region, to the birth canal, is impossible. With this position of the child, it is necessary to move the handle behind the child's head into the uterine cavity. If for some reason this is not possible, a caesarean section is performed.

When the lower extremities of the fetus prolapse, the child’s body bends while the prolapsed leg is extended. Most often, this position of the fetus is observed in multiple pregnancies (twins) and premature pregnancy. Also in this case, the prolapsed part of the fetus is repositioned, and if negative result perform a caesarean section.

Occipital presentation of the fetus

This is the most common type of presentation - about 95%. The crown is located at the entrance to the small pelvis. During childbirth, the head will enter the birth canal with the chin pressed to the chest.

Occipital presentation of the fetus: 95% of cases

Facial presentation of the fetus

In this case, the head is completely thrown back. Childbirth often occurs with complications, sometimes resorting to caesarean section.

Frontal presentation of the fetus

In this case, a caesarean section is mandatory, since the head is facing the birth canal large size, and vaginal delivery is impossible.

With this type of presentation, the baby is located horizontally in the uterus. This position prevents him from going down, so a caesarean section is the only option unless the doctor tries to change the baby's position before delivery.

The baby lies across the uterus; head - below, buttocks - above. The position is called “shoulder” or transverse. Sometimes the doctor is able to change the baby's position by applying external pressure to the baby. abdominal cavity. But this technique is not always successful and in some cases is contraindicated.

How and how easily the birth will take place depends on how the fetus is located in the mother’s tummy during pregnancy. When the baby is in a normal position, a woman can easily give birth on her own, naturally. When the baby's position is not as Mother Nature intended, there is a high likelihood that a caesarean section will be necessary. Characteristics of intrauterine position include: fetal presentation, fetal position and type of position. Let's figure out what these terms mean for expectant mother and her baby.

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· What is the location and presentation of the fetus - what is the difference?

Fetal position - this is the so-called ratio of its axis (a conventional line passing through the baby’s head and pelvis) to the longitudinal axis of the woman’s uterus. The position of the fetus can be longitudinal (when the axes of the fetus and uterus coincide), transverse (when the axes of the fetus and uterus are perpendicular), and oblique (the middle location between the transverse and longitudinal).

Fetal presentation determined depending on which part of the body the child is directed to the area of the internal os of the female cervix - the place where the uterus passes into the cervix, in medicine it is called the presenting part. The presentation of the fetus can be cephalic - when the head is directed towards the exit from the uterus, or pelvic - when the baby lies with his buttocks towards the exit. When the fetus is transversely positioned, the presenting part is not determined.

Up to 33-34weeks of pregnancy breech and the position of the fetus may change, the baby may roll over. After 34 weeks pregnant it, as a rule, becomes stable, that is, the baby remains in the position in which it will be born.

· Head fetal presentation

Head presentation occurs in approximately 95-97% of pregnancies. The most optimal is the cephalic occipital presentation of the fetus, when the head is tilted (the baby’s chin is pressed to the chest), and the baby moves forward with the back of the head at birth. The leading point (going first through the birth canal) in this case is the small fontanelle, which is located at the junction of the occipital and parietal bones of the skull. If the back of the child's head is facing forward, and his face is facing backward (in relation to the mother's body) - this is called anterior view of occipital presentation(this is exactly what happens in more than 90% of births), if it is located the other way around, then it is posterior. When posterior view of the occipital presentation of the fetus childbirth is more difficult, the baby may well turn around during the birth process and take the “correct” position, but one way or another, and this usually seriously delays and complicates the birth process.

With a cephalic presentation, the baby's buttocks and legs may deviate to the left or right, depending on which way the fetal back is facing.

In addition, cephalic presentation is divided into extension types, when the fetal head is extended to a certain extent (raised, so to speak). In the case of slight extension, when the leading point becomes the large fontanelle, also located at the junction of the parietal and frontal bones of the skull, this is antecephalic presentation. Natural childbirth in this case is possible, but it is more difficult and longer than in cases of occipital presentation, since the baby’s head is inserted into the mother’s small pelvis with its larger size. In fact, anterior cephalic presentation of the fetus is a relative indication for cesarean section - everything is decided individually, depending on the situation.

The next degree of extension is frontal presentation of the fetus(it happens rarely, literally in 0.04-0.05% of births). If the baby is of normal size, delivery through the natural birth canal is impossible; this situation requires surgical delivery.

And finally, the maximum extension of the head is facial presentation of the fetus- the baby’s face is born first (this occurs in 0.25% of all births). In this case, natural childbirth is possible (the resulting birth tumor is located in the lower part of the child’s face, in the area of the chin and lips), but it is quite traumatic for both the mother and the fetus, which often adds “points” in favor of a cesarean section.

Diagnosis of extensor presentation of the fetus is carried out by an obstetrician during a vaginal examination directly during labor.

· Pelvic/gluteal fetal presentation

This position of the fetus during pregnancy occurs in 3-5% of births. Breech presentation can be foot presentation, when the legs are present, and breech presentation, when the child seems to be squatting and is positioned with his buttocks towards the exit. The breech presentation of the fetus is more favorable for childbirth.

When occurs pelvicfetal presentation, childbirth is considered pathological due to the large number of complications in the mother and fetus. Since the smallest pelvic end of the fetus is born first, difficulties often arise when removing the head. In the case of leg presentation, the obstetrician delays the birth of the baby, prevents its advancement with his hand, preventing the leg from “falling out” until the baby squats. In this way, they ensure that the buttocks are born first. Of course, this complicates the birth process and brings additional pain.

Breech presentation of the fetus is not an absolute, sufficient indication for a cesarean section. The question of how delivery will occur is decided taking into account several factors that determine the method of delivery:

1. fetal size (if the presentation is breech, then a fetus over 3500 grams is considered large; in a normal birth, to be considered large, the weight of the baby must exceed 4000 grams);

2. maternal pelvic size;

3. specific type of breech presentation of the fetus (foot or breech);

4. gender of the fetus (breech birth for a girl is associated with much less risk than for a boy, since the boy may experience damage to the genital organs);

5. age of the woman in labor;

6. the course and outcome of a woman’s previous pregnancy and childbirth.

· What to do to make the child turn from the pelvic to headpresentation ?

To rotate the baby in the uterus after 31 weeks of pregnancy, the following actions are recommended:

1. Lie on your right side, lie there for 10 minutes, and then quickly turn over to your left side and after 10 minutes again to your right. Repeat the exercise 3-4 times in a row several times during the day, before meals.

3. The turning of the fetus is promoted by exercises in the pool.

4. If the baby turns over on his head, it is recommended to wear a bandage for a couple of weeks so that the correct position of the fetus is fixed.

Performing such exercises has contraindications, which include: complications during pregnancy (gestosis of pregnant women, threat premature birth), placenta previa , scar on the uterus as a result of a cesarean section in the past, uterine tumors.

Previously, they tried to correct the breech presentation of the fetus, which they call manually, by externally rotating the fetus - through the abdomen, the doctor tried to move the baby’s head downwards. Today, this has been abandoned because the method has low efficiency and a high percentage of complications, such as premature birth, premature placental abruption, and poor condition of the child.

If the breech presentation of the fetus persists, then the pregnant woman is sent to the hospital 2 weeks before the expected date of birth. There, under supervision, a delivery plan is drawn up that is most favorable in the given situation.

· Oblique and transverse

Transverse and oblique position of the fetus are absolute indications for a cesarean section; natural childbirth through the birth canal is impossible here. Presentation in this case is not determined. Oblique and transverse positions occur in 0.2-0.4% of pregnancies. The previously used turns by the leg during childbirth are not used today, as they are very traumatic for the mother and child. However, occasionally such rotation of the fetus is used in multiple pregnancies - twins, in cases where, after the birth of the first, the second baby has taken a transverse position.

The reasons for the transverse position of the fetus may lie in the formation of tumors in the uterus (for example, uterine fibroids) - they prevent the child from taking a normal position. In addition, this happens when the fetus is large, when the umbilical cord is short or wrapped around the baby’s neck, as well as in multiparous women due to overstretching of the uterus.

In the absence of reasons that prevent the fetus from turning into a cephalic presentation, it is recommended to perform the same exercises as in the case of breech presentation described above. In an oblique position, you should lie for more time on the side towards which the back is predominantly facing.

If there is an oblique or transverse position of the fetus, then the woman is hospitalized 2-3 weeks before the onset of labor to prepare for surgical delivery.

· Position of fetuses in twins

With twins, natural birth is possible if both children are in a cephalic presentation, or the first baby (located closer to the exit of the uterine cavity and will be born first) is in a cephalic presentation, and the second is in a pelvic presentation. The opposite situation - the first fetus is in the breech, and the second in the cephalic presentation - is unfavorable, since after the birth of the pelvic part of the first fetus, the babies can get their heads caught.

In cases where the transverse position of one of the children is determined, the issue is clearly resolved in favor of a cesarean section, that is, delivery occurs surgically.

Even with a favorable position of the fetuses in the uterus, the question of the method of delivery for twins is decided taking into account many factors, and not just based on the location occupied by the babies.

Yana Lagidna, especially for MyMom . ru

And a little more about the position and presentation of the fetus during childbirth, video:

As you know, during pregnancy the future human being undergoes fundamental transformations - from a tiny fertilized egg to a complex organism capable of independent life outside the mother's womb. As it grows, the space in the uterus becomes less and less. The child can no longer move freely inside it and occupies a certain position, more or less constant (as a rule, after the 32nd week it no longer changes).

To describe the placement of the fetus in the uterus on later During pregnancy and immediately before childbirth, specialists use three characteristics. This is the appearance and presentation of the fetus. It directly depends on them how the birth will take place - naturally or via cesarean section, as well as what difficulties may arise during this process. These characteristics will be discussed in the article.

Position type

The following types of fetal position are distinguished: anterior and posterior. With the anterior one, the back of the fetus is turned anteriorly, with the posterior one, respectively, backwards.

What is breech

The term breech is used to describe the way the baby is positioned in relation to the pelvic inlet. The baby's buttocks or head can be turned towards it. Head presentation is the most common, occurring in almost 97% of cases. This is the most favorable, correct position of the fetus for natural childbirth.

Head presentation: types, characteristics

There are several types of cephalic presentation, and not all of them are equally good for spontaneous delivery. The most natural is the occipital one, in which the fetal head is cut through, respectively, by the occiput, with an anterior view of the position, that is, one in which both the back and the occiput of the fetus are facing anteriorly. Some of the types, namely anterior cephalic, frontal and facial, are relative indications for cesarean section. These are the so-called extension presentations.

Their causes may be shortening of the umbilical cord, clinically and anatomically narrow pelvis of the woman in labor, decreased tone of the uterus, small or too large size of the fetus, stiffness of its atlanto-occipital joint, etc.

Extensor type of birth mechanism

Extensor types of presentation, in which the fetal head is moved away from the chin to one degree or another, are diagnosed during an internal vaginal examination of the woman in labor. All of them pose a certain danger to the mother and fetus and lead to protracted labor and complications. There are three types of extension presentations, depending on the degree of extension of the head: anterior cephalic, frontal and facial.

Facial presentation

The opposite case in all characteristics to the anterior occipital presentation is the so-called facial presentation, in which the fetus comes forward with its chin and an extreme, maximum degree of extension of the head is noted. The back of the head can literally lie on the child’s shoulder girdle. Facial presentations are rare (0.5%). Most often, this type of presentation occurs directly during childbirth (secondary); extremely rarely, it occurs during pregnancy (primary). In this case, the head cuts through the so-called facial line, conditionally connecting the center of the forehead to the chin, and, having reached the pelvic floor, extends the chin forward.

Despite the complexity, 95% of such births end spontaneously. In five percent of cases it is necessary emergency help. After birth in the face presentation for 4-5 days, the newborn retains swelling of the face and characteristic extension of the head.

Frontal presentation

This type of presentation is quite rare, occurring in approximately 0.1% of cases. It is extremely traumatic, labor is characterized by a protracted course (up to a day in first-time mothers) and ends in fetal death, according to various sources, in 25-50% of cases. According to statistics, only in slightly more than half of the cases (approximately 54%) is natural childbirth possible without surgical intervention. The severity of their occurrence is due to the fact that in the frontal presentation the fetus must pass through the pelvis flat largest size. For a woman in labor, slow progress of the fetus through the birth canal is fraught with ruptures of the perineum and uterus, the appearance of fistulas and other complications.

Established stable frontal presentation of the fetus is currently considered an absolute indication for a cesarean section, which, in turn, is possible provided that the fetus has not yet managed to fix itself in this position at the entrance to the pelvis. Since most often this position of the fetus is unstable, and is usually transitional from the anterior-cephalic to the facial, during labor it can spontaneously move to both the occipital (rarely) and the facial, so the choice of expectant management of labor makes sense. However, it is extremely important not to miss the time for a caesarean section.

Anterocephalic presentation

With this presentation, the degree of extension of the head is the minimum possible (the chin is slightly moved away from the chest). Primary cephalic presentation is extremely rare; it is caused by the presence of a thyroid tumor in the child. More often it occurs during childbirth.

It can be determined by the palpable large fontanelle, while with occipital presentation, only the small fontanel is accessible upon examination. The head erupts in the area of the large fontanelle, that is, in a circle that corresponds to its direct size. in a child it is usually also located in this area.

Breech presentation

Pelvic presentation is a type of presentation in which the fetus is positioned with its pelvic end towards the entrance to the mother's pelvis. The frequency of this pathology, according to various sources, can be 3-5%. Childbirth in this position is fraught with complications for both mother and child.

There are three main types:

Gluteal - the fetus is positioned with the buttocks down, the legs are bent, the knees are pressed to the stomach (up to 70% of cases).
Leg (can be complete or incomplete) - one or both legs are extended and located near the exit of the uterus.
Mixed - hips and knees are bent (up to 10% of cases).

Breech presentation does not have external signs, by which the pregnant woman could identify him. Only an ultrasound examination after the 32nd week can give an accurate picture. If breech presentation has not been determined in advance, during a vaginal examination during childbirth, the doctor can determine it, depending on the type, by palpable parts - the tailbone, buttocks, and feet of the fetus.

For delivery, a cesarean section is most often recommended. Choice decision surgical method or natural birth is accepted based on several indicators: the age of the expectant mother, the presence of certain diseases, the characteristics of the pregnancy, the size of the pelvis, the weight of the fetus and the type of its presentation, the condition of the fetus. When pregnant with a boy, preference is given to cesarean section, since the likelihood of complications in this case is higher. Most likely, such a decision will be made in the case of leg presentation, as well as if the fetus weighs up to 2500 or more than 3500 g.

If complications occur during natural childbirth in a breech presentation, such as placental abruption, fetal hypoxia, prolapse of body parts or the umbilical cord, a decision is made on an emergency caesarean section. This is also true for situations where labor is weak and labor is, accordingly, delayed.

What is fetal position

There are three types of fetal position: longitudinal, transverse and oblique. In the first case, the axis of the fetal body is located along the longitudinal axis of the woman’s uterus. In the second, accordingly, - across it. The oblique position is intermediate between longitudinal and transverse, with the fruit located diagonally. The longitudinal cephalic position of the fetus is normal and physiological. It is most favorable for childbirth. Transverse, as well as oblique, are classified as incorrect positions of the fetus (photos can be seen later in the article).

Oblique and transverse position of the fetus

They are unfavorable for natural childbirth. With a transverse and oblique position of the fetus, the presenting part is not determined. Such situations are possible in approximately 0.2-0.4% of women in labor. They are usually caused by health problems in the woman (tumors of the uterus), overdistension of the uterus due to multiple births, as well as entanglement of the umbilical cord in the fetus or its large size. A short umbilical cord is another possible reason acceptance of such a provision.

With a transverse position of the fetus, pregnancy can proceed without complications, but there is a risk of premature birth. Complications are also possible: leakage of water, uterine rupture, loss of fetal parts.

The optimal solution for transverse and oblique position of the fetus would be surgical delivery via cesarean section. The woman in labor is hospitalized two to three weeks before the expected date of birth to prepare for the operation.

Ways to correct the situation

In case of breech presentation, oblique and transverse position of the fetus, it is possible for the pregnant woman to perform special gymnastics in order to correct them. Exercises can be approved by a doctor in the absence of contraindications, such as:

Placenta previa.
Multiple pregnancy.
Hypertonicity of the uterus.
Myoma.
Scar on the uterus.
The woman in labor has serious chronic diseases.
Oligohydramnios or polyhydramnios.
Bloody issues
Gestoz et al.

Exercises should be combined with deep breathing. The complex might look like this:

Lying on your back, raise your pelvis above shoulder level by 30-40 cm and hold it in this position for up to 10 minutes (the so-called “Half Bridge”).
Standing on all fours, bow your head. As you inhale, round your back, and as you exhale, bend at the lower back, raising your head up (this exercise is often called “Cat”).
Place your knees and elbows on the floor so that your pelvis is higher than your head. Stay in this position for up to 20 minutes.
Roll over from side to side, holding each position for 10 minutes.

It should be remembered that you can do exercises to correct the position of the fetus only on the recommendation and with the permission of a doctor. He may recommend other exercises. Thanks to corrective gymnastics, the fetus can take the correct position within 7-10 days. Otherwise, it is considered ineffective.

External obstetric rotation to change the position of the child (according to B. A. Arkhangelsky)

In a hospital setting at 37-38 weeks, it is possible to perform the so-called external obstetric turn fetus, which is produced externally, through the abdominal wall, without penetration into the vagina and uterus. In this case, the obstetrician places one hand on the head, the other on the pelvic end of the fetus and turns the buttocks towards the back, and the head towards the child’s abdomen. Currently, this procedure is practically not used. This is due to its low effectiveness, since the fetus can return to its previous position if its causes have not been eliminated. In addition, there is a possibility of severe complications: the development of fetal hypoxia, placental abruption. In rare cases, even uterine rupture is possible. Therefore, fetal rotation can be recommended only if fetal mobility is normal and the amount of fluid is normal, normal size pelvis and the absence of pathologies in the pregnant woman and child.

The manipulation is carried out under the control of an ultrasound machine using injections that relax the muscles of the uterus (ß-adrenergic agonists).

Pedicled turns, which were previously widely used during childbirth, are now practically not used, as they can pose a great danger to the mother and fetus. Their use is possible during multiple pregnancies, if one of the fetuses takes an incorrect position.

After the transition of the fetal position to the head position, the correct one, the pregnant woman is recommended to wear a special bandage with bolsters to secure the child. It is usually worn until childbirth. If the methods described above for correcting the position of the fetus do not produce an effect, two to three weeks before the expected date of birth the woman is hospitalized and the question of choosing a natural or surgical method of childbirth is decided.

Position during multiple pregnancy

When there are several babies in the womb, it may be difficult for them to get into the correct position due to lack of space. During pregnancy with twins, options are possible when both fetuses take the correct position, or one of them is presented with the pelvic end to the exit from the uterus. Much less common are cases when they are in different positions (longitudinal and transverse), or the location of both fetuses is perpendicular to the axis of the uterus.

In the normal course of labor, after the birth of the first baby, there is a pause in labor lasting from 15 to 60 minutes, and then the uterus adapts to the reduced size, and labor resumes. After the birth of the second child, the birth of both placentas occurs.

During childbirth during a multiple pregnancy, the following complications are possible: the waters of the first fetus break before the onset of labor, its weakness, accompanied by prolongation of labor, the so-called clutch of twins, etc. If the position of one or both fetuses is incorrect, the situation is even more complicated. The decision on the method of delivery must be made by the doctor, since in many cases natural childbirth poses a danger for both the mother and the babies.

Finally

As can be understood from the above, the position of the fetus, its position and presentation are the main characteristics that are taken into account by doctors when choosing a method of delivery. It should be understood that in certain situations, natural childbirth is fraught with great complications. Therefore, if a specialist decides to perform a caesarean section, you must trust him. This will protect both mother and child from serious health problems in the future.

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