Birth in a breech presentation is often accompanied by complications, and if the baby is in a transverse position, you have to go to. Fortunately, malposition can be corrected if you take on this important matter in time.

Position of the fetus in the uterus

Until the 30th week of pregnancy, the baby swims freely in amniotic fluid Oh. And he clearly enjoys this activity! He behaves actively, tumbling like a little dolphin. But by the 32nd week, babies grow up, accumulate muscle mass and, since there is almost no free space left in the uterus, they usually take a position that remains until childbirth. Most of them literally stand on their heads - this is called a cephalic presentation. This is the norm; all other options are considered deviations from it. Is the baby positioned in the uterus with the buttocks forward? We are talking about breech presentation. To be born in this way is difficult, and often impossible, without medical care. Hippocrates believed that children come into this world by pushing their feet from the fundus of the uterus. Now this reasoning looks naive: the “leg thrust” of the fetus is not involved in the mechanism of childbirth. The main problem is that a baby born from the opposite end is forced to follow the path of greatest resistance. Fortunately, at this stage of pregnancy the baby is still able to change position!

Advice: So that the baby takes the correct position position in the uterus, do the Dikan exercise in the morning and then 2-3 more times during the day.

1. After performing your morning toilet, lie on your right side and wait 10 minutes.
2. Roll over your back onto your left side and wait another 10 minutes. Repeat the revolution a total of 6 times.

The baby doesn’t like this kind of gymnastics: as a sign of protest, he performs a somersault in his mother’s tummy. Sometimes this happens almost the first time (an ultrasound will confirm the result). True, it is possible that the little stubborn guy will turn over with his buttocks down again. Immediately put on special maternity underwear with a supportive effect (should be worn from the 4th month) and a bandage to fix the belly and force the baby to maintain cephalic presentation.

Particularly convenient is a model with a supporting belt, reminiscent of an elastic hood, where a rounded tummy can be comfortably placed. Thanks to its features, such a bandage supports him without squeezing and stretches correctly as the baby grows. Put on underwear and a bandage in the morning without getting out of bed.

Sex in the last months of pregnancy

From the 33rd week, 8 weeks before giving birth, you need to give up sex. The baby should not be disturbed: otherwise he may turn around and take a different position that is uncomfortable for childbirth.

Gymnastics for pregnant women in the third trimester

Dikan's exercise loses its meaning after the 34-35th week, when the grown-up baby tightly fills the space inside the uterus. It is already much more difficult for him to turn over from his feet to his head, which is why much more active exercises are needed, for example Grishchenko’s gymnastics, which is specially taught to expectant mothers in childbirth preparation centers. It gives effect from the 34th to the 38th week. If the baby has not changed presentation, the last resort remains - external rotation of the fetus onto its head. It will be performed at 35-37 weeks by a doctor in the maternity hospital (you will have to go to the hospital in advance). By pressing your stomach with his hands, the doctor will try to turn the baby in the right direction. True, this method is not always used - it has many contraindications, for example late toxicosis(gestosis), threat, low or polyhydramnios, scar on the uterus or unsuccessful (to its anterior wall) attachment of the placenta, in vitro conception, age over thirty, if this is the first pregnancy... No matter how hard doctors and mothers try to correct the incorrect position of the fetus, 4% of newborns are still born in a breech position.

If everything goes this way, you shouldn’t beat yourself up in advance. Childbirth can proceed quite normally if the mother is young and healthy, the pelvis is wide enough, and the fetus is not too large. However, even in the most favorable situation, no one will undertake to predict the end result - too many unforeseen accidents lie in wait for a baby who decides to come into this world in an unconventional way! Fortunately, the capabilities of modern medicine make it possible to reduce the risk for mother and child to a minimum. The main thing is to calculate all the options in advance and choose the optimal method of delivery when abnormal fetal position.

Birth with breech presentation

At the beginning, when contractions begin and the cervix gradually opens, breech birth provokes premature birth. Serving as a natural shock absorber, they help the baby to more easily endure the period of dilation and actively participate in it, acting as a hydraulic wedge that dilates the cervix. But this is the case if the role of the “piston” for such a wedge is played by the baby’s head. His legs and buttocks are so small that there is no “piston” of them: too much water rushes into the lower part of the uterus with each contraction and the bladder ruptures prematurely. Then the birth is delayed, the child suffers from overload, and the risk of infection increases. But the worst thing is that the umbilical cord may fall out under the pressure of gushing waters at the wrong time. With each contraction, blood circulation in her vessels will be interrupted, which is fraught with oxygen starvation - fetal asphyxia. The doctor will try to thread the umbilical cord loop back. If this fails, the only way to save the baby - urgently perform an operation C-section. In the second stage of labor, when contractions force the baby out, the main difficulty is due to the fact that the largest part of the child’s body, the head, is born last. The first to appear are miniature buttocks and legs, which are not able to expand the birth canal sufficiently to allow the shoulders and head to pass freely. This is where the problems begin!

The most unpleasant thing is when the head, which is supposed to remain in a bent position, becomes hyperextended during labor and the chin gets stuck under the pubic symphysis - neither here nor there! The baby cuts off his oxygen by squeezing the umbilical cord vessels with his head at the exit from the birth canal. Doctors have only 4 minutes to save the child!

Another possible complication is the throwing back of the arms: instead of remaining pressed to the baby’s body, they can be located on his face, the back of the head or to the side of the head, and it gets stuck in the birth canal, blocking blood flow in the umbilical cord. That is why, when attending such births, doctors prepare for any unexpected events, including emergency caesarean section. Maybe it’s better not to risk the child’s life, but to immediately prepare for a planned operation? To weigh the pros and cons, doctors need to observe you and assess the degree of readiness of your body for childbirth, so you will have to go to the maternity hospital 2 weeks before the end of your pregnancy. It is very difficult to come to an agreement if the mother is a supporter of natural childbirth at any cost, and the doctor insists on a caesarean section. The last word still belongs to him - the specialist knows best! When persuading you to undergo surgery, he takes into account all the nuances, including the sex of the child. If you are expecting a girl, give birth safely; if it is a boy, it is better to opt for a caesarean section to avoid injury to the testicles.

Natural birth with breech presentation

So that, despite breech presentation, the baby was born naturally, it is necessary to behave correctly during the birth marathon.

1. From the very beginning of contractions, do not get out of bed! While you are lying down, there is less risk that your water will break prematurely and the umbilical cord will fall out. No matter how long you have to stay in bed, do not try to leave it until you are given permission.
2. With breech presentation, weakness of labor is often encountered. Delaying labor is harmful for the baby: the uterus needs to be stimulated! Some mothers object to injections, believing that everything should happen naturally. But the situation is abnormal.
3. To make it easier for the child to pass the birth canal, and for the mother to avoid uterine rupture, the doctor may resort to an incision in the perineum and inject a special drug: it will prevent spasm of the cervix when the head passes through it.
4. The most crucial moment comes after the baby comes out waist-deep. This means that the head has entered the pelvis and pinched the umbilical cord. There is no time to hesitate now! If labor does not end in 2-3 attempts, the doctor and midwife use special techniques (manual assistance) to quickly free the baby’s shoulders and head.

How to determine the position of the fetus?

Transverse and oblique position of the fetus complicates childbirth to a greater extent than breech presentation. The tactic here is this: identify the problem early and force fruit with no correct position turn around as needed. You don’t need to be a midwife to suspect something is wrong: just look at your belly in the mirror. Take a closer look at it from the 28th week. You have it right oval shape- resembles a cucumber, stretched along the axis of the body? Amazing! Is it too low and stretches out more than it does up? This happens in a transverse position, but in an oblique position the stomach seems somehow irregular and asymmetrical. To force a lopsided baby to change his position, you should sleep and rest on the side where the large underlying part (head, buttocks) is located. Let's say the head is located in the left iliac region (the doctor will determine this during examination, and the results of the examination will be confirmed by ultrasound) - lie only on your left side! If at oblique position The buttocks are placed lower, it is better to turn to the pelvic end. The transition from an oblique position to a breech position in this case is clearly seen as a great benefit, especially since the child may well then turn head down.

Transfer the baby to longitudinal position sometimes special Dikan exercises help. If all else fails, you will have to go to the maternity hospital at 35-36 weeks. Specialists will try to perform an external rotation of the fetus manually (through the abdomen), and if there is no result, they will perform an internal rotation during labor. Important condition: the amniotic sac should not rupture ahead of schedule. Ideally, until the cervix is ​​fully dilated, through which, in fact, such a rotation is performed. To prevent this from happening, a rubber balloon - a colpeirinterter - will be inserted into the expectant mother's vagina and she will not be allowed to stand up. Well, if internal rotation is impossible, there is only one way out - a caesarean section!

Causes of fetal malposition

The child may take an oblique and transverse position or breech presentation, If:

• frequent pregnancies;
• there are uterine fibroids;
• pelvic bones or uterus of irregular shape (for example, in the form of a saddle);
• placenta previa;
• the pelvis is too narrow;
• pregnancy is accompanied by multiple pregnancy, multiple or;
• the fetus has a very short umbilical cord;
• labor began prematurely.

During the nine months of carrying a baby, a pregnant woman often hears about fetal presentation. Obstetricians and gynecologists talk about it during examinations, specialists ultrasound diagnostics. We will talk about how it happens and what it affects in this material.

What it is?

During pregnancy, the baby repeatedly changes its position in the womb. In the first and second trimester, the baby has enough free space in the uterus to roll over, somersault, and take a wide variety of positions. The presentation of the fetus at these stages is stated only as a fact and nothing more; this information has no diagnostic value. But in the third trimester everything changes.

The baby has little room to maneuver, by the 35th week of pregnancy a permanent location in the uterus is established and a revolution becomes very unlikely. In the final third of the gestation period, it is very important what position the baby is in - correct or incorrect. The choice of delivery tactics and the likely risk of complications for both the mother and her baby depend on this.

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When talking about presentation, it is important to understand what exactly we are talking about. Let's try to understand the terminology. Fetal presentation is the relationship of a large part of the fetus to the exit from the uterine cavity into the pelvic area. The baby can be turned towards the exit either with the head or buttocks, or in an oblique position across the uterus.

The position of the fetus is the ratio of the location of the longitudinal axis of the baby’s body to the similar axis of the uterine cavity. The baby can be positioned longitudinally, transversely or obliquely. The longitudinal position is considered the norm. The position of the fetus is the relationship of its back to one of the walls of the uterus - left or right. The type of position is the ratio of the back to the posterior or anterior wall of the uterus. Articulation is the relationship of a baby's arms, legs, and head in relation to its own body.

All these parameters determine the baby’s posture, and it must be taken into account when deciding which way a woman will give birth - natural, natural with stimulation, or by caesarean section. Deviation from the norm in any of the listed parameters can influence this decision, but presentation is usually decisive.

Kinds

Depending on which part of the body is closest (adjacent) to the exit from the uterus to the pelvis (and this is the beginning of the baby’s journey at birth), there are several types of presentation:

Pelvic

In approximately 4-6% of pregnant women, the baby is positioned towards the exit with its butt or legs. A complete breech presentation is a position in the uterus in which the baby is aimed towards the exit with the buttocks. It is also called gluteal. A foot presentation is considered to be one in which the baby’s legs, one or both, “look” toward the exit. A mixed (combined or incomplete) breech presentation is considered to be a position in which both the buttocks and legs are adjacent to the outlet.

There is also a knee presentation, in which the baby's legs bent at the knee joints are adjacent to the exit.

Breech presentation is considered a pathology. It can be very dangerous for both mother and child. The most common is breech presentation; with it, the prognosis is more favorable than with foot presentation, especially with knee presentation.

The reasons why a baby is in a breech position can be different, and not all of them are obvious and understandable to doctors and scientists. It is believed that children whose mothers suffer from pathologies and anomalies in the structure of the uterus, appendages, and ovaries are most often positioned head up and bottom down. Women who have undergone many abortions and surgical curettages of the uterine cavity, women with scars on the uterus, who often give birth a lot are also at risk.

The cause of breech presentation may be a chromosomal disorder in the child himself, as well as anomalies in the structure of his central nervous system - absence of a brain, microcephaly or hydrocephalus, disruption of the structure and functions of the vestibular apparatus, congenital malformations of the musculoskeletal system. Of the twins, one baby can also take a sitting position, and it is dangerous if this baby lies first towards the exit.

Headlines

Head presentation is considered correct, intended as ideal for a child by nature itself. With it, the baby’s head is adjacent to the opening to the woman’s pelvis. Depending on the position and type of position of the child, several types of cephalic presentation are distinguished. If the baby is turned to the exit with the back of his head, then this is an occipital cephalic presentation. The back of the head will be the first to appear. If the baby is positioned towards the exit in profile, this is an anterior parietal or temporal presentation.

In this position, childbirth is usually a little more difficult, because this size is wider and it is a little more difficult for the head to move along the woman’s genital tract in this position.

Frontal presentation is the most dangerous. With it, the baby “pushes” his way with his forehead. If the baby’s face is turned towards the exit, this means that the presentation is called facial, and it is the baby’s facial structures that will be born first. The occipital version of the cephalic presentation is considered safe for the mother and fetus during childbirth. The remaining types are extension variants of cephalic presentation; it is quite difficult to consider them normal. When passing through the birth canal, for example, with facial presentation, there is a possibility of injury to the cervical vertebrae.

Also, cephalic presentation may be low. They talk about it at the “finish line”, when the stomach “sinks”, the baby presses its head against the opening of the small pelvis or partially exits into it too early. Normally, this process occurs within last month before giving birth. If the head drops earlier, pregnancy and presentation are also considered pathological.

Up to 95% of all babies are usually in cephalic presentation by 32-33 weeks of pregnancy.

Transverse

Both the oblique and transverse position of the baby’s body in the uterus, characterized by the absence of the presenting part as such, are considered pathological. This presentation is rare; only 0.5-0.8% of all pregnancies occur with this complication. The reasons why the baby may be positioned across the uterus or at an acute angle to the opening of the pelvis are also quite difficult to systematize. They do not always lend themselves to a reasonable and logical explanation.

Most often, the transverse position of the fetus is characteristic of women whose pregnancy occurs against the background of polyhydramnios or oligohydramnios. In the first case, the baby has too much space to move; in the second, his motor capabilities are significantly limited. Often, women who have given birth suffer from overstretched ligaments and muscles of the uterus, which do not have sufficient elasticity to fix the position of the fetus even during long periods of pregnancy; the child continues to change body position.

Often the fetus is located transversely in women with uterine fibroids, because the nodes prevent the baby from positioning normally. In women with a clinically narrow pelvis, the baby often cannot fix itself in the correct position.

Diagnostics

Before 30-32 weeks, diagnosing fetal presentation does not make sense. But at this time, an obstetrician-gynecologist can draw conclusions about which part of the body the baby is adjacent to the exit from the uterus during a routine external examination. Usually, if the baby is not positioned correctly in the mother’s womb, the height of the fundus of the uterus exceeds the norm (with a pelvic presentation) or lags behind the norm (with a transverse presentation).

When the baby is positioned transversely, the belly looks asymmetrical, like a rugby ball. You can easily determine this position yourself by simply standing upright in front of a mirror.

If the baby's heartbeat is incorrectly positioned, it can be heard in the area of ​​the mother's navel. On palpation in the lower part of the uterus, a dense round head is not detected. With a breech presentation, it is felt in the area of ​​the fundus of the uterus, with a transverse presentation - in the right or left side.

The doctor also uses a vaginal examination to clarify the information. An indisputable confirmation of the diagnosis is an ultrasound scan (ultrasound). It determines not only the exact position, position, presentation, posture, but also the weight of the fetus, height and other parameters necessary for a more careful choice of the method of delivery.

Possible complications

No one is immune from complications during childbirth and while carrying a child, even if the baby is positioned correctly at first glance. However, breech and transverse presentations are considered the most dangerous.

The main danger of breech presentation of the fetus lies in the likelihood of premature birth. This happens in about 30% of pregnancies, in which the baby is located in the mother's stomach with its head up. Very often, such women experience premature rupture of amniotic fluid; it is rapid in nature; along with the water, parts of the baby’s body often fall out—legs, arms, umbilical cord loops. All these complications can lead to serious injury, which can make the baby disabled from birth.

At the beginning of labor, women with breech presentation often develop weakness of labor forces, contractions do not bring desired result– the cervix does not open or opens very slowly. During childbirth, there is a risk of throwing back the baby's head or arms, injuries to the cervical spine, brain and spinal cord, placental abruption, and the onset of acute hypoxia, which can lead to the death of the child or total disruption of the functioning of his nervous system.

For a woman in labor, the pelvic position of the fetus is dangerous due to severe ruptures of the perineum, uterus, massive bleeding, and pelvic injuries.

Quite often, breech presentation is combined with umbilical cord entanglement, fetal hypoxia, and placental pathologies. Babies in breech presentation often have lower body weight, they are hypotrophic, have metabolic disorders, suffer from congenital heart defects, pathologies gastrointestinal tract, as well as kidneys. By the 34th week of pregnancy, if the baby does not take the correct position, the rate of development of some structures of the child’s brain slows down and is disrupted.

If the baby is positioned in a cephalic presentation with the back of the head facing the exit longitudinally, no complications should arise either during pregnancy or during childbirth. Other variants of cephalic presentation can cause difficulties during childbirth, because it will be more difficult for the head to move along the birth canal, its extension will not occur towards the mother’s sacrum, which can lead to hypoxia and weakness of labor forces. In this case, if there are concerns for the child’s life, doctors use forceps. In itself, it raises many questions, because the number of birth injuries received by children after the application of obstetric forceps is very large.

The most unfavorable prognosis is for frontal presentation. It increases the likelihood of uterine and cervical ruptures, the appearance of fistulas, and the death of the baby. Almost all types of cephalic presentation can be allowed for natural birth, except frontal. Low cephalic presentation is fraught with premature birth, and this is its main danger.

This birth will not necessarily be complicated or difficult, but the baby’s nervous system may not have time to mature independent life outside the mother's belly, just as sometimes his lungs do not have time to ripen.

The danger of transverse presentation is that natural childbirth can hardly be accomplished without severe deviations. If you can somehow try to correct the oblique position of the baby already during the birth process, if it is still closer to the head position, then the complete transverse position is practically not subject to correction.

The consequences of such childbirth can be severe injury to the baby’s musculoskeletal system, his limbs, hip area, spine, as well as the brain and spinal cord. These injuries are rarely of the nature of a dislocation or fracture; usually these are more serious lesions that essentially make the child disabled.

Often children in transverse presentation experience chronic hypoxia During pregnancy, prolonged oxygen deprivation leads to irreversible changes in nervous system and the development of sense organs - vision, hearing.

Which way to give birth?

This issue is usually resolved at 35-36 weeks of pregnancy. It is by this time, according to doctors, that any unstable position of the fetus in the mother’s womb becomes stable and permanent. Of course, there are isolated cases when an already large fetus literally a few hours before birth changes the incorrect position of the body to the correct one, but counting on such an outcome is at least naive. Although it is recommended that both the pregnant woman and her doctors believe in the best.

The choice of delivery tactics is influenced by many factors. The doctor takes into account the size of the pelvis expectant mother– if the fetal head, according to ultrasound, is larger than the size of the pelvis, then with a high degree of probability the woman will be offered a planned cesarean section for any presentation of the fetus. If the fetus is large, then this is the reason for prescribing a planned cesarean section for breech and transverse presentation, and sometimes for cephalic presentation, it all depends on what weight ultrasound specialists “predict” for the baby.

An immature cervix may also be a reason for prescribing a cesarean section, regardless of presentation. In addition, doctors try not to take risks and perform surgery on women who become pregnant as a result of IVF - their birth can present a lot of unpleasant surprises.

With a breech presentation, natural childbirth is possible if the fetus is not large, the birth canal is wide enough, and the size of the pelvis allows the baby’s bottom and then his head to pass through unhindered. Natural childbirth is allowed for women with complete breech presentation, and also sometimes with mixed presentation. If the child is low weight, has signs of hypoxia, or is entangled, they will not be allowed to give birth.

With foot presentation or its knee version in the best possible way delivery is considered to be a caesarean section. It will help avoid birth injuries in the child and bleeding in the mother.

With frontal cephalic presentation, doctors also try to prescribe a caesarean section so as not to risk the life and health of the baby. If one of the two babies is in the wrong position when multiple pregnancy, a caesarean section is also recommended, especially if the baby who will be born first is sitting or lying across the uterus. For transverse and oblique presentations, most often they try to prescribe a planned caesarean section. Natural childbirth is very dangerous.

A planned caesarean section is usually performed at 38-39 weeks of pregnancy, without waiting for the onset of spontaneous labor. Central importance in choosing a method rests on individual characteristics female body, on the anatomical features of her baby. There is no universal risk assessment system. There can be so many nuances that only an experienced doctor can take them into account. Low

11. Physiological changes in a woman’s body during pregnancy.

12. Medical examination of pregnant women in the antenatal clinic. Continuity in the work of the antenatal clinic and the obstetrics and gynecology hospital.

13. Diagnosis of early pregnancy.

14. Diagnosis of late pregnancy.

15. Determination of due date. Providing certificates of incapacity for work to pregnant and postpartum women.

16. Basics of rational nutrition for pregnant women, regimen and personal hygiene of pregnant women.

17. Physiopsychoprophylactic preparation of pregnant women for childbirth.

18. Formation of the functional system “mother – placenta – fetus”. Methods for determining the functional state of the fetoplacental system. Physiological changes in the “mother-placenta-fetus” system.

19. Development and functions of the placenta, amniotic fluid, umbilical cord. Placenta.

20. Perinatal protection of the fetus.

21. Critical periods of development of the embryo and fetus.

22. Methods for assessing the condition of the fetus.

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23. Methods for diagnosing fetal malformations at different stages of pregnancy.

2. Ultrasound.

3. Amniocentesis.

5. Determination of alpha-fetoprotein.

24. Effect of viral and bacterial infections on the fetus (influenza, measles, rubella, cytomegalovirus, herpes, chlamydia, mycoplasmosis, listeriosis, toxoplasmosis).

25. Effect of medicinal substances on the fetus.

26. The influence of harmful environmental factors on the fetus (alcohol, smoking, drug use, ionizing radiation, exposure to high temperatures).

27. External obstetric examination: fetal position, position, position, type of position, presentation.

28. The fetus as an object of birth. The head of a full-term fetus. Sutures and fontanelles.

29. The female pelvis from an obstetric point of view. Planes and dimensions of the small pelvis. The structure of the female pelvis.

The female pelvis from an obstetric point of view.

30. Sanitary treatment of women upon admission to the obstetric hospital.

31. The role of the observation department of the maternity hospital, the rules for its maintenance. Indications for hospitalization.

32. Harbingers of childbirth. Preliminary period.

33. First stage of labor. The course and management of the period of disclosure. Methods of registration of labor activity.

34. Modern methods of pain relief during childbirth.

35. Second stage of labor. The course and management of the period of exile. Principles of manual obstetric aid for perineal protection.

36. Biomechanism of labor in anterior occipital presentation.

37. Biomechanism of labor in posterior occipital presentation. Clinical features of the course of labor.

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38. Primary toilet of a newborn. Apgar score. Signs of a full-term and premature newborn.

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39. Course and management of the afterbirth period.

40. Methods for isolating separated placenta. Indications for manual separation and release of placenta.

41. Course and management of the postpartum period. Rules for maintaining postpartum wards. Staying together between mother and newborn.

Staying together between mother and newborn

42. Principles of breastfeeding. Methods for stimulating lactation.

1. Optimal and balanced nutritional value.

2. High digestibility of nutrients.

3. The protective role of breast milk.

4. Influence on the formation of intestinal microbiocenosis.

5. Sterility and optimal temperature of breast milk.

6. Regulatory role.

7. Influence on the formation of the child’s maxillofacial skeleton.

43. Early gestosis in pregnant women. Modern ideas about etiology and pathogenesis. Clinic, diagnosis, treatment.

44. Late gestosis in pregnant women. Classification. Diagnostic methods. Stroganov's principles in the treatment of gestosis.

45. Preeclampsia: clinical picture, diagnosis, obstetric tactics.

46. ​​Eclampsia: clinical picture, diagnosis, obstetric tactics.

47. Pregnancy and cardiovascular pathology. Features of the course and management of pregnancy. Delivery tactics.

48. Anemia in pregnant women: features of the course and management of pregnancy, delivery tactics.

49. Pregnancy and diabetes mellitus: features of the course and management of pregnancy, delivery tactics.

50. Features of the course and management of pregnancy and childbirth in women with diseases of the urinary system. Delivery tactics.

51. Acute surgical pathology in pregnant women (appendicitis, pancreatitis, cholecystitis, acute intestinal obstruction): diagnosis, treatment tactics. Appendicitis and pregnancy.

Acute cholecystitis and pregnancy.

Acute intestinal obstruction and pregnancy.

Acute pancreatitis and pregnancy.

52. Gynecological diseases in pregnant women: course and management of pregnancy, childbirth, postpartum period with uterine fibroids and ovarian tumors. Uterine fibroids and pregnancy.

Ovarian tumors and pregnancy.

53. Pregnancy and childbirth with breech presentation of the fetus: classification and diagnosis of breech presentation of the fetus; course and management of pregnancy and childbirth.

1. Buttock presentation (flexion):

2. Leg presentation (extensor):

54. Incorrect position of the fetus (transverse, oblique). Causes. Diagnostics. Management of pregnancy and childbirth.

55. Premature pregnancy: etiology, pathogenesis, diagnosis, prevention and pregnancy management tactics.

56. Tactics for managing premature birth.

57. Post-term pregnancy: etiology, pathogenesis, diagnosis, prevention, pregnancy management tactics.

58. Tactics for managing delayed labor.

59. Anatomical and physiological characteristics of a full-term, premature and post-term newborn.

60. Anatomically narrow pelvis: etiology, classification, methods of diagnosis and prevention of pelvic anomalies, course and management of pregnancy and childbirth.

61. Clinically narrow pelvis: causes and diagnostic methods, labor management tactics.

62. Weakness of labor: etiology, classification, diagnosis, treatment.

63. Excessively strong labor: etiology, diagnosis, obstetric tactics. The concept of fast and rapid childbirth.

64. Discoordinated labor: diagnosis and management of labor.

65. Causes, clinical picture, diagnosis of bleeding in early pregnancy, pregnancy management tactics.

I. Bleeding not associated with the pathology of the ovum.

II. Bleeding associated with pathology of the ovum.

66. Placenta previa: etiology, classification, clinical picture, diagnosis, delivery.

67. Premature abruption of a normally located placenta: etiology, clinical picture, diagnosis, obstetric tactics.

68. Hypotony of the uterus in the early postpartum period: causes, clinical picture, diagnosis, methods of stopping bleeding.

Stage I:

Stage II:

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69. Coagulopathic bleeding in the early postpartum period: causes, clinical picture, diagnosis, treatment.

70. Amniotic fluid embolism: risk factors, clinical picture, emergency medical care. Amniotic fluid embolism and pregnancy.

71. Injuries of the soft birth canal: ruptures of the perineum, vagina, cervix - causes, diagnosis and prevention

72. Uterine rupture: etiology, classification, clinical picture, diagnosis, obstetric tactics.

73. Classification of postpartum purulent-septic diseases. Primary and secondary prevention of septic diseases in obstetrics.

74. Postpartum mastitis: etiology, clinical picture, diagnosis, treatment. Prevention.

75. Postpartum endometritis: etiology, clinical picture, diagnosis, treatment.

76. Postpartum peritonitis: etiology, clinical picture, diagnosis, treatment. Obstetric peritonitis.

77. Infectious-toxic shock in obstetrics. Principles of treatment and prevention. Infectious-toxic shock.

78. Caesarean section: types of surgery, indications, contraindications and conditions for the operation, management of pregnant women with a scar on the uterus.

79. Obstetric forceps: models and design of obstetric forceps; indications, contraindications, conditions for applying obstetric forceps; complications for mother and fetus.

80. Vacuum extraction of the fetus: indications, contraindications, conditions for the operation, complications for the mother and fetus.

81. Features of the development and structure of a woman’s genital organs at different age periods.

82. Main symptoms of gynecological diseases.

83. Functional diagnostic tests.

84. Colposcopy: simple, extended, colpomicroscopy.

85. Endoscopic methods for diagnosing gynecological diseases: vaginoscopy, hysteroscopy, laparoscopy. Indications, contraindications, technique, possible complications.

86. X-ray research methods in gynecology: hysterosalpingography, radiography of the skull (sella).

87. Transabdominal and transvaginal echography in gynecology.

88. Normal menstrual cycle and its neurohumoral regulation.

89. Clinic, diagnosis, treatment methods and prevention of amenorrhea.

1. Primary amenorrhea: etiology, classification, diagnosis and treatment.

2. Secondary amenorrhea: etiology, classification, diagnosis and treatment.

3. Ovarian:

3. Hypothalamic-pituitary form of amenorrhea. Diagnosis and treatment.

4. Ovarian and uterine forms of amenorrhea: diagnosis and treatment.

90. Clinic, diagnosis, treatment methods and prevention of dysmenorrhea.

91. Juvenile uterine bleeding: etiopathogenesis, treatment and prevention.

91. Dysfunctional uterine bleeding of the reproductive period: etiology, diagnosis, treatment, prevention.

93. Dysfunctional uterine bleeding of the menopause: etiology, diagnosis, treatment, prevention.

94. Premenstrual syndrome: clinical picture, diagnosis, treatment methods and prevention.

95. Post-castration syndrome: clinical picture, diagnosis, treatment methods and prevention.

96. Menopausal syndrome: clinical picture, diagnosis, treatment methods and prevention.

97. Polycystic ovary syndrome and disease: clinical picture, diagnosis, treatment methods and prevention.

98. Clinic, diagnosis, principles of treatment and prevention of inflammatory diseases of nonspecific etiology.

99. Endometritis: clinical picture, diagnosis, principles of treatment and prevention.

100. Salpingoophoritis: clinical picture, diagnosis, principles of treatment and prevention.

101. Bacterial vaginosis and candidiasis of the female genital organs: clinical picture, diagnosis, principles of treatment and prevention. Bacterial vaginosis and pregnancy.

Candidiasis and pregnancy.

102. Chlamydia and mycoplasmosis of the female genital organs: clinical picture, diagnosis, principles of treatment and prevention.

103. Genital herpes: clinical picture, diagnosis, principles of treatment and prevention.

104. Ectopic pregnancy: clinical picture, diagnosis, differential diagnosis, management tactics.

1. Ectopic

2. Abnormal variants of the uterine

105. Torsion of the pedicle of an ovarian tumor, clinical picture, diagnosis, differential diagnosis, management tactics.

106. Ovarian apoplexy: clinical picture, diagnosis, differential diagnosis, management tactics.

107. Necrosis of myomatous node: clinical picture, diagnosis, differential diagnosis, management tactics.

108. Birth of a submucosal node: clinical picture, diagnosis, differential diagnosis, management tactics.

109. Background and precancerous diseases of the cervix.

110. Background and precancerous diseases of the endometrium.

111. Uterine fibroids: classification, diagnosis, clinical manifestations, treatment methods.

112. Uterine fibroids: methods of conservative treatment, indications for surgical treatment.

1. Conservative treatment of uterine fibroids.

2. Surgical treatment.

113. Tumors and tumor-like formations of the ovaries: classification, diagnosis, clinical manifestations, treatment methods.

1. Benign tumors and tumor-like formations of the ovaries.

2. Metastatic ovarian tumors.

54. Incorrect positions fruit (transverse, oblique). Causes. Diagnostics. Management of pregnancy and childbirth.

Malposition - a clinical situation in which the axis of the fetus forms a straight or acute angle with the longitudinal axis of the uterus, the presenting part is absent.

Incorrect fetal positions include transverse and oblique positions.

Transverse position – a clinical situation in which the fetal axis intersects the uterine axis at a right angle.

Oblique position - a clinical situation in which the fetal axis intersects the uterine axis at an acute angle. In this case, the lower part of the fetus is located in one of the iliac fossa of the large pelvis. The oblique position is a transitional state: during childbirth it turns into either longitudinal or transverse.

Etiological factors:

a) Excessive mobility of the fetus: with polyhydramnios, multiple pregnancy (second fetus), with malnutrition or premature fetus, with flabbiness of the muscles of the anterior abdominal wall in multiparous women.

b) Limited fetal mobility: with oligohydramnios; large fruit; multiple births; in the presence of uterine fibroids, deforming the uterine cavity; with increased uterine tone, with the threat of miscarriage, in the presence of a short umbilical cord.

c) Obstruction of head insertion: placenta previa, narrow pelvis, the presence of uterine fibroids in the lower segment of the uterus.

d) Anomalies of the uterus: bicornuate uterus, saddle uterus, septum in the uterus.

e) Fetal developmental anomalies: hydrocephalus, anencephaly.

Diagnostics.

1. Abdominal examination. The shape of the uterus is elongated in transverse size. The abdominal circumference always exceeds the norm for the period of pregnancy at which the examination is carried out, and the height of the uterine fundus is always less than the norm.

2. Palpation. There is no large part in the fundus of the uterus, large parts are found in the lateral parts of the uterus (round dense on one side, soft on the other), the presenting part is not determined. The fetal heartbeat is best heard in the navel area.

The position of the fetus is determined by the head: in the first position the head is palpated on the left, in the second - on the right. The type of fetus, as usual, is recognized by the back: the back is facing anteriorly - anterior view, the back is backward - posterior.

3. Vaginal examination. At the beginning of labor, with a whole amniotic sac, it is not very informative; it only confirms the absence of the presenting part. After the discharge of amniotic fluid, with sufficient opening of the pharynx (4-5 cm), it is possible to determine the shoulder, scapula, spinous processes of the vertebrae, armpit. The type of fetus is determined by the location of the spinous processes and scapula, and the position is determined by the armpit: if the armpit is facing to the right, then the position is the first; in the second position, the armpit is open to the left.

The course of pregnancy and childbirth.

Most often, pregnancy in transverse positions proceeds without complications. Sometimes with increased fetal mobility there is unstable position- frequent change of position (longitudinal - transverse - longitudinal).

Complications of pregnancy with a transverse position of the fetus: premature birth with prenatal rupture of amniotic fluid, which is accompanied by loss of small parts of the fetus; hypoxia and infection of the fetus; bleeding with placenta previa.

Complications of childbirth: early rupture of amniotic fluid; fetal infection; the formation of an advanced transverse position of the fetus - loss of fetal mobility with intense early rupture of amniotic fluid; loss of small parts of the fetus; hypoxia; overstretching and rupture of the lower segment of the uterus.

Loss of limbs it is necessary to clarify what fell out into the vagina: an arm or a leg. The handle, lying inside the birth canal, can be distinguished from the stem by the longer length of the fingers and the absence of a calcaneal tubercle. The hand is connected to the forearm in a straight line. The fingers are separated, especially the thumb is abducted. It is also important to determine which handle fell out - right or left. To do this, they kind of “hello” the right hand with the dropped pen; if this succeeds, the right handle falls out, if it fails, the left one falls out. The dropped handle makes it easier to recognize the position, position and type of the fetus. The handle does not interfere with internal rotation of the fetus onto the stem; its reduction is an error that complicates fetal rotation or embryotomy. A prolapsed arm increases the risk of ascending infection during childbirth and serves as an indication for faster delivery.

Umbilical cord prolapse. If, during a vaginal examination, loops of the umbilical cord are felt through the amniotic sac, they speak of its presentation. The detection of umbilical cord loops in the vagina with a ruptured amniotic sac is called umbilical cord prolapse. The umbilical cord usually falls out when your water breaks. Therefore, to detect such a complication in a timely manner, a vaginal examination should be performed immediately. Prolapse of the umbilical cord with a transverse (oblique) position of the fetus can lead to infection and, to a lesser extent, to fetal hypoxia. However, in all cases of umbilical cord prolapse with a living fetus, urgent assistance is necessary. In a transverse position, full opening of the uterine pharynx and a mobile fetus, such help is to turn the fetus onto its stem and then remove it. If the pharynx is not fully dilated, a caesarean section is performed.

Management of pregnancy and childbirth.

During pregnancy, measures are taken to correct abnormal positions of the fetus.

2. Corrective gymnastics(see question 1 in the section “Pathological obstetrics”)

If the transverse position is maintained, then the woman is hospitalized at 35,036 weeks to be rotated to a longitudinal position using external methods.

3. External rotation of the fetus into longitudinalposition. Possible with good fetal mobility, compliance of the abdominal wall, normal pelvic size, satisfactory condition of the mother and fetus. An external turn is made on the head or pelvic horse, depending on what is closer to the entrance of the small pelvis. The pregnant woman is emptied of her bladder, placed on a hard couch and asked to bend her legs; in order to anesthetize and relieve the tone of the uterus, 1 ml of a 2% solution of promedol is injected subcutaneously. The doctor sits on the right side, puts one hand on the head, the other on the pelvic end of the fetus. Then, with careful movements, it moves the head to the entrance of the pelvis, and moves the pelvic end of the fetus to the bottom of the uterus. If a turn is made to the pelvic end, then the buttocks are shifted to the entrance of the pelvis, and the head is shifted to the fundus of the uterus. After completing the rotation, to maintain the longitudinal position of the fetus, two rollers are placed along its back and small parts (abdomen, chest) and bandaged in this position to the pregnant woman’s stomach. If attempts to perform an external rotation were unsuccessful, then further delivery is carried out through the natural birth canal by performing a classic external-internal rotation of the fetus on a leg with its subsequent extraction, or cesarean section.

4. Combined external-internal rotation of the fetus onto its stem. It is carried out in case of incorrect positions of the fetus, loss of small parts of the fetus and umbilical cord loops both in the transverse (oblique) position of the fetus and in its cephalic presentation, in case of complications and diseases that threaten the condition of the mother and fetus, and other unfavorable circumstances. To perform this operation, the following conditions are necessary: ​​complete opening of the uterine pharynx, sufficient mobility of the fetus in the uterine cavity, correspondence of the size of the fetus to the size of the mother’s pelvis, an intact amniotic sac or just broken water.

Operation stages: inserting a hand into the vagina and uterus, finding and grabbing the fetal leg, turning and then removing the fetus. The hand that the doctor controls better is inserted into the vagina and into the uterine cavity. However, it is recommended to insert the left hand in the first position, and the right hand in the second, which makes it easier to find and grab the fetal leg. The fingers are folded into a cone, inserted into the vagina and carefully moved towards the pharynx. As soon as the ends of the fingers reach the pharynx, the outer hand is transferred to the fundus of the uterus. Then the amniotic sac is ruptured and the hand is inserted into the uterus. In the transverse position of the fetus, when choosing a leg, they are guided by the type of fetus: in the anterior view, the underlying leg is grabbed, in the posterior view, the overlying one. To find the leg, they feel the side of the fetus, slide their hand along it from the armpit to the pelvic end and then along the thigh to the shin. The shin is grabbed with the whole hand. Its four fingers clasp the shin from the front, the thumb is located along the calf, and its end reaches the popliteal fossa . Having grabbed the leg, the outer hand is transferred from the pelvic end of the fetus to the head and carefully pushes it upward, to the bottom of the uterus . At this time, the leg is lowered with the inner hand and brought out through the vagina. The rotation is considered complete (the fetus is transferred to a longitudinal position) when the leg is removed from the genital slit to the popliteal fossa . Immediately after turning, they begin to remove the fetus by the stem.

Indications: in elderly primiparous women; when the abnormal position of the fetus is combined with other aggravating circumstances (narrow pelvis, placenta previa, the presence of a scar on the uterus, a large fetus, oligohydramnios); with an advanced transverse position, a living fetus and no signs of infection; with threatening uterine rupture, regardless of whether the fetus is alive or dead; with umbilical cord prolapse, early rupture of amniotic fluid and other conditions.

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Expectant mothers carrying a child remain curious about the correct position of the fetus.

Throughout pregnancy, the baby grows and forms in the woman’s belly. He carries out various movements, changing his position.

The success of the birth depends on what it will be like at the end of the gestation period.

Note! Until a certain time, the baby is positioned differently in the womb.

He swims in amniotic fluid and as the period expires, the embryo occupies one specific position.

This is how the baby prepares to be born. This occurs from 32 to 36 weeks, after which the baby no longer changes location in the uterine cavity.

The location is determined using ultrasound, and in more cases later thanks to the touch of the legs and head.

Let's look at the weekly location of the fetus during pregnancy:

First 6 weeks	The embryo moves through the fallopian tube, attaching to the uterus. Attachment can occur on any wall - back, side, top or front wall. After this, the fetus remains motionless until a certain period - then its body is formed
week 7	Movements are little perceptible and are not characterized by movement
8 week	The embryo begins to actively move, but the mother does not feel this. The size of the embryo does not exceed 2 cm
Week 9	The movements are coordinated, the baby moves throughout the entire space of the amniotic sac
10 week	The baby begins to push off the walls of the uterus with his legs and arms
11 week	It is characterized by active movements of the baby's arms and legs. He grows and floats until the uterus begins to support him
12-23 weeks	At normal course During pregnancy, the baby constantly moves and changes its location. It does not provide functionality, since the baby will move while awake
Week 24	From this moment on, the child stops moving due to gradual increase sizes
Week 26	According to statistics, the majority of expectant mothers with at this moment the location does not change
Week 32	This period is characterized by the fact that doctors can accurately determine the location of the fetus
Week 36	When the due date approaches, the baby's head moves into the birth canal. This low position fetus during pregnancy indicates that the baby will soon be born. Sometimes this moment may come earlier

How to determine the location of the fetus yourself by kicks

Except precise definition position of the baby using ultrasound, you can try to find out on your own where the fetus is.

This must be done carefully so as not to damage parts of the baby’s body. One of the ways to determine this is through the tremors that the baby makes while moving.

As a rule, the baby pushes off the walls with his arms and legs, so it will not be difficult to understand where his head is.

Every mother can feel the position of the baby's back by simply running her hand over her stomach. You can also feel the resting legs, and at the very bottom you can feel a certain bulge - the head of the fetus.

This period is characterized by hand tremors in the sacral area or Bladder. It is with the help of interpretations that it is possible to determine the approximate location of the child.

1. The presence of the baby in the womb, head up, will be characterized by regular tremors above the womb. Where the inguinal folds are located, the movement will be felt most of all.
2. The transverse arrangement is characterized by an unusually wide size of the abdomen. A woman may feel pain in the umbilical area due to its stretching. Also painful sensations occur when the baby straightens his head or moves his legs.
3. The cephalic location of the presenting part is considered the most common. In this case, the baby will put pressure on the area of ​​the mother’s lower ribs.

   This phenomenon occurs at the end of pregnancy. If you run your palm along the anterior abdominal wall, you can feel the baby's head.

4. Too much low presentation will be accompanied by sudden movements of the baby's head, while the mother will feel the urge to urinate more often than usual.

Related Posts

Usually, by the end of pregnancy, the fetus is located in the uterus with its head down (cephalic presentation), rarely with its leg or butt (pelvic) and even less often when the fetus is located across (transverse).

A breech birth is considered an unusual situation, and the doctor is required to determine whether the situation will be risky. In general, they follow the usual program. Butt forward also proceeds according to a natural scenario, but requires great patience and skill from the doctor, composure from the mother, and absolute health and stamina from the baby.

Doctors decide in favor of the usual scenario if:

• the baby arrives on time and is healthy;
• his estimated weight is average (for large and small children, natural childbirth can be unsafe);
• the umbilical cord does not wrap around the neck (otherwise hypoxia may begin - lack of oxygen);
• if there are no anomalies in the structure of the uterus of a pregnant woman;
• the expectant mother is healthy;
• normal pelvic size;
• if the woman had no problems during pregnancy and she is no more than thirty years old;
• labor progresses without interruptions.

The location of the fetus becomes clear in the seventh month of pregnancy when the doctor palpates the abdomen. He must confirm his conclusions with results ultrasound examination and examination through the vagina.

The child is sitting. It is possible to recognize the breech presentation of the baby starting from the 32nd week: the baby’s hard head is felt in the upper part of the uterus, and the soft bottom is in the lower part.

The baby lies across. Feeling the stomach expectant mother, the doctor can “detect” the buttocks and the head of the little trickster on the sides. This position can be determined from the middle of pregnancy, from about the 20th week. You can try to correct this situation by resorting to help special exercise, but this should only be done from the 31st week.

You need to lie down on a hard surface, first turn on your left side, and then on your right, and lie in each position for ten minutes. You should perform this exercise three times, 3-4 approaches each, and be sure to do it before meals. When the position of the fetus is corrected, the doctor advises wearing a bandage to secure the result.

Sometimes babies surprise doctors and mothers by positioning themselves across or diagonally in the uterus. There is a possibility that after the water has broken, the fetus will still be in its proper position by the time labor begins. The only thing that is unknown is the position of the child (butt or head down).

If the baby was forced umbilical cord entanglement lying on your side, a septum in the uterus or the placenta is too low, the doctor will suggest sending the woman in labor for a caesarean section. In the old days, obstetricians tried to turn such babies around, but this required a lot of endurance and considerable skill. But this small manipulation was also unsafe for the child. There was no other choice; a caesarean section was a very risky business at that time.

But with the development of surgery, the advent of drugs and suture material, doctors have an excellent opportunity to preserve the health of both mother and baby. Therefore, today the transverse position is not corrected, but a caesarean section is performed on the expectant mother.

Often yoga classes and standing in the “birch tree” pose help the child roll over. But due to the fact that the pregnant woman heavy weight abdomen and the center of gravity is shifted, it is better to perform such exercises with someone’s help. The best way is with the help of a yoga instructor.

Many pregnant women try to surround themselves with certain “signs” of happiness to give themselves confidence. At the same time, it is desirable that others do not guess what it is and why. A gold horseshoe pendant around your neck can become such a talisman. It will look like just a decoration to others. If such jewelry is given by the husband, during labor it will give the feeling of the presence of the future dad nearby.