The transverse position of the fetus in the second trimester. Types of fetal presentation. What is called oblique position

Pregnancy is a dynamic process culminating in childbirth. The course of pregnancy affects the course and tactics of delivery. One of important parameters is the position of the baby in the uterus.

The position of the fetus is the ratio of the axis of its body in length to the long axis of the uterus. Presentation - the ratio of the part of the fetus directed towards the exit from the uterine cavity. Position and presentation can be right or wrong.

Childbirth depends on the position of the baby in the womb naturally. When the baby is in the wrong position, it is shown C-section.

Classification of positions and presentations:

• The correct position is longitudinal, oblique, unstable;
• Not correct position- transverse;
• Correct presentation - head;
• Incorrect presentation - gluteal, low, pelvic.

This classification is generalized, since there are several more subspecies of the pelvic and malposition. These subspecies do not significantly affect the tactics of childbirth. An unstable position is a variant of the norm, because it is limited to a time interval in terms of gestation.

Transverse presentation of the fetus

The relationship of the longitudinal axis of the child to the longitudinal axis of the uterus with the formation of a right angle is called the transverse position. IN this case the baby is located across the pelvis.

If such a position is observed before the birth itself, then the latter are possible only by surgery. Pregnancy can proceed favorably, but there is a possibility of premature birth, which poses a threat to the life of the woman and the child.

Often transverse position a baby in the womb is called a transverse presentation. This is not entirely true. Presentation is only head and pelvic.

Causes of transverse presentation (position) of the fetus

This phenomenon can be triggered by a large number of factors. First of all, these include the conditions under which the baby can move excessively actively: hypotrophy of the baby, too a large number of water, weakness of the muscles of the abdominal wall (ex. with repeated pregnancy) etc.

On the other hand, such a condition may also be due to a lack of intrauterine activity, for example, with oligohydramnios, large child, increased tone of the muscles of the uterus, the threat of miscarriage, anomalies in the structure of the uterus (bicornuate or saddle-shaped), fibroma, etc.

In addition, the head or pelvic transverse presentation (position) of the fetus may occur due to anatomical reasons that prevent the formation of its head in the mother's small pelvis. For example, with a clinically narrow pelvis, the location of the placenta along the anterior abdominal wall, tumors of the pelvic bones or the lower segment of the uterus.

In addition, the causes may be hidden in the developmental anomalies of the baby (eg, hydrocephalus, anencephaly).

Diagnosis of pathology

Breech or head transverse presentation of the fetus can be established by obstetric examination, palpation of the abdomen and vaginal examination. In this case, the abdomen becomes transversely stretched (obliquely stretched) of irregular shape.

The uterus has a spherical shape, which should not be. The norm of the abdominal circumference, as a rule, exceeds the norm in accordance with the term, in addition, the height of the fundus of the uterus is insufficient.

In the process of palpation, the doctor cannot determine the presenting part of the crumbs: the head is palpated away from the median axis of the woman's body, and the baby's pelvis is in the lateral sections of the uterus. In this case, the baby's heartbeat is heard in the navel area.

Difficulties with determining the position of the baby can occur with multiple pregnancies, polyhydramnios, and uterine hypertonicity. Confirm or deny existence pathological condition can be done with an obstetric ultrasound.

A standard gynecological examination, which is carried out throughout pregnancy, as well as in the initial period of childbirth with a intact fetal bladder, is uninformative. It allows you to establish only that in the small pelvis of a woman there is no presenting part. After the water leaves and the uterine pharynx opens by 4-5 fingers, with the transverse position of the baby, his shoulder, rib, scapula, armpit, spinous processes of the vertebrae, elbow or hand of the handle may appear.

What is dangerous for a woman and a child transverse presentation of the fetus

Usually pregnancy in this case proceeds favorably. Happens frequently premature effusion water and, accordingly, premature birth. If to all this there is also placenta previa, profuse bleeding develops.

In turn, the sudden discharge of water sharply limits the baby's mobility in the womb, which can lead to the crushing of the baby's shoulder into the woman's small pelvis, falling out of the handle or umbilical cord.

When parts of the child's body fall out, chorioamnionitis, diffuse peritonitis, and sepsis may develop. If the anhydrous interval lasts more than 12 hours, there is a high probability of acute hypoxia and even asphyxia of the child. Launched lateral position with increasing labor activity dangerous in that uterine rupture may occur.

Quite rarely, but it happens that in the process of delivery, the baby spontaneously turns into the head or pelvic position, or the baby is born with a double body. A similar result is very rare and is possible with strong contractions, deep prematurity or a dead fetus.

Childbirth with a diagnosed transverse presentation of the fetus

Until the 34-35th week of pregnancy, the oblique or transverse position is considered unstable, as it can change to the correct one. If such a pathology is detected, it is necessary to carefully examine the pregnant woman and determine the cause of the anomaly, choose the tactics of managing the woman and the method of delivery.

Usually, at a period of 30-34 weeks of pregnancy, special gymnastics is prescribed, which will help the baby turn around.

Contraindications to corrective gymnastics:

• The threat of termination of pregnancy;
• Scar on the uterus;
• Myoma;
• Decompensated heart defects in the expectant mother;
• Bloody discharge, etc.

Approximately 4-5 weeks before the birth, the baby occupies a stable position, therefore, if the pathological condition persists, the woman is hospitalized to determine the tactics of delivery.

Previously resorted to external rotation on the head, but now this is a rarity, since this method is ineffective and can lead to placental abruption, uterine rupture, fetal hypoxia.

The best way to bring a baby into the world under such circumstances is a caesarean section. Indications for the latter are: placenta previa, premature rupture of water, scar on the uterus, oxygen deficiency in the infant, post-term pregnancy. If parts of the body of the fetus fall out, their reduction is unacceptable.

With the opening of the cervix of the uterus by 10 fingers, a live and mobile child can be turned on a leg and further removed. However, such manipulations natural childbirth can be carried out only with multiple pregnancy, prematurity.

If there was a long anhydrous interval, and later an infection joined it, then after operative delivery, the woman is extirpated of the uterus, and there is also a need for drainage abdominal cavity.

The tactics of conducting childbirth depends on the location of the baby in the mother's abdomen. The ideal position is when the fetus lies head down, towards the cervix. This is a natural position for the baby, thanks to which he will easily pass the birth canal. However, due to a number of factors, the fetus may take an incorrect position in the uterus, for example, not along the organ, but across. This dangerous pathology pregnancy that requires close observation from doctors and special tactics of delivery.

What is called transverse presentation of the fetus?

Fetal presentation - what does it mean? This is the position that the baby occupies in the uterus before childbirth. Presentation happens different types, the names correspond to the posture of the fetus in the womb.

Types of presentation during pregnancy:

• Head - head towards the exit from the uterus. Presentation is occipital, when the fetus is located with the back of the head forward, frontal, facial. The occipital location is considered correct and most successful for natural delivery.
• Pelvic - the child lies towards the cervix with the buttocks or legs. During delivery with breech presentation, complications arise, fetal mortality is 4-5 times higher than in the head position. Usually, women in labor are sent for a caesarean section.
• Oblique - in contrast to the straight position, the fetus is located at an angle of about 45 ° with respect to the longitudinal axis. This position is unstable, and the fetus may eventually take a transverse or direct position.
• Transverse - the child is located across the axis of the uterus. There is no presenting part, and the head and buttocks are located on the sides of the uterus, and not above and below. When the child is turned away with his back, this is called the I position, the front side is the II position.
• Low presentation of the fetus. With a low location, the head descends too early to exit the uterus.

In addition to the type of presentation, in obstetrics they also determine the type of position. Posterior presentation is called a position in which the child is turned with his back to back wall uterus. This situation often causes prolonged labor. Anterior position - the fetus is turned with its back to the anterior wall. How different presentations look like, you can see in the photo above.

Diagnosis of the transverse position

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Diagnosis of fetal presentation is carried out in several ways. Types of diagnostic methods:

• Visual inspection. At the end of the term, the transverse position of the fetus is visible to the naked eye. His sign is the belly round shape with protrusions on the sides. The protrusions on the abdomen become clearly visible even with oblique presentation.
• Palpation. When palpating the patient, the presenting part is not determined, but the head is palpated on the side of the central line of the abdomen. When you try to listen to the heartbeat, it is determined not on the left or right of the abdomen, as in a straight position, but near the navel of the pregnant woman. Diagnosis by palpation will not help determine the position of the fetus with polyhydramnios or uterine hypertonicity.
• Ultrasound is the main method for determining the position of the fetus during gestation. Every pregnant woman must be sent to ultrasonography before childbirth, to see how the baby is located, and to determine the tactics of delivery. Do not worry if an ultrasound scan up to 20 weeks shows a transverse or oblique presentation of the fetus, the baby will still have time to roll over.
• Vaginal examination. An intravaginal examination is carried out before childbirth, when labor has already begun, but the water has not yet had time to move. If the presenting part is not palpable, then they speak of a transverse arrangement. If necessary, vaginal palpation is carried out even after bursting amniotic sac and the cervix began to dilate. The midwife can feel the baby's ribs and arms.

Causes of incorrect positioning of the child in the uterus

Why does malpresentation of the fetus occur in the womb? Factors that lead to the transverse position of the fetus:

• Diseases and anatomical pathologies of the uterus. With a strong growth of the tumor of the myometrium - myoma - the child becomes cramped in the womb. The uterine nodes prevent him from taking the correct position. In addition, partitions inside the uterus can create obstacles for the fetus - an anomaly called "bicornuate uterus".
• Low placenta. The placenta is attached too low, less than 2 cm remains between it and the entrance to the uterus. Low children's place leads to pathological presentation of the fetus.
• abundance amniotic fluid. With polyhydramnios, the motor activity of the fetus increases, he does not feel the walls of the uterus, and it is difficult for him to orient himself in space.
• Multiple pregnancy. If a woman bears two or more children, then they are in cramped conditions inside. The tightness prevents the physiologically correct position, forcing the kids to take other poses.
• Deviation from normal sizes. With a miniature size, the baby becomes hyperactive, it turns over several times in the womb. Too much large fruit on the contrary, he feels cramped, it is difficult for him to move, and this prevents him from taking correct posture.
• Frequent childbirth. With each subsequent birth, the likelihood of incorrect presentation increases. The muscles of the uterus and pelvic floor weaken, which leads to an increase in the activity of the baby.

The course of pregnancy

Until 28-30 weeks of gestation passes without complications. Transverse or oblique presentation, noticed before this time, should not cause much concern, because the fetus can still roll over. If this does not happen, then the third trimester of pregnancy may pass with complications. As a rule, with the transverse position of the baby, premature birth can begin. During this period, amniotic fluid may suddenly depart, thereby provoking the onset of labor. This phenomenon requires immediate hospitalization.

Possible Complications

The transverse position is a very dangerous situation for both the woman in labor and the child, which leads to the following complications:

• Early discharge of amniotic fluids. In 99% of cases amniotic fluid departs earlier due date. The effusion limits the child's mobility, which can cause a limb to prolapse from the uterus. Much more dangerous is the prolapse of the umbilical cord, it is pinched, which leads to impaired blood circulation and death of the fetus.
• Uterine trauma. When the transverse position of the fetus is neglected, a rupture of the genital organs often occurs. After the outpouring of water, the child may be in such a position that his shoulder rests against the uterine wall. The uterus begins to contract intensively, the baby's shoulder hits its wall, which leads to stretching of the lower part of the organ. Without an emergency caesarean section, the uterine wall ruptures.
• Chorioamnionitis - inflammation of the membranes of the fetus and infection of the amniotic fluid. As a result of chorioamnionitis, acute sepsis and peritonitis develop.
• Fetal hypoxia. The long interval between the birth and the outpouring of the waters causes oxygen starvation The child has. Even if the baby is born alive, he will have severe physical and mental pathologies. clinical sign severe acute hypoxia is arrhythmia.
• Infant death due to malposition. Due to strong contractions and high uterine tone, the baby's body bends in the chest. The baby has no chance of surviving with such a birth.

Tactics of conducting childbirth

A few decades ago, in obstetrics during the management of childbirth, the tactics of an external coup were used. It was performed at 37-38 weeks, if the condition of the woman in labor was satisfactory and nothing threatened her health. Now, due to its low efficiency, such tactics have been abandoned.

The combined coup is used only with multiple gestation or prematurity of the fetus, and it is performed during childbirth. With one hand, the midwife penetrates the woman's womb, and with the other she helps herself outside and turns the baby over by the leg. This tactic remains very dangerous, because it can lead to placental abruption and organ rupture, but it is necessary when multiple pregnancy when one child has already appeared, and the second is in a transverse presentation.

transverse or oblique position fetus is an indicator for a caesarean section. The pregnant woman is placed in the hospital at 32-33 weeks of gestation. The absolute indicator for surgical intervention are fetal hypoxia, exfoliation of the placenta, early outflow of fluid.

Corrective gymnastics

Women who have been diagnosed with a transverse presentation of the fetus must perform corrective exercises according to the Dikan method. She is prescribed from the 29th week, during which time the fetus will have time to roll over.

List of corrective exercises:

• Side turns. The woman lies on her back on the floor. She turns to her left side and stays like that for 15 minutes, then to her right. It is necessary to perform 3 such coups per day.
• "Cat". The pregnant woman stands on all fours, resting her palms on the floor. While inhaling, you need to raise your head and pelvis up, and bend your lower back. As you exhale, lower your head and arch your lower back up. A total of 10 approaches are performed.
• Pose on your knees. The woman stands on all fours, leaning on her elbows so that her head is below the pelvis. In this position, you need to stand for 20 minutes.
• Lifting the pelvis. The pregnant woman lies on the floor, legs bent at the knees, arms along the body, palms and feet rest on the floor. On inspiration, the pelvis is raised, held and lowered on exhalation.

List of exercises according to Grishchenko and Shuleshova:

• Starting position lying on your side. Bend your knees, lie down like this for 3 minutes and turn around to the other side.
• From a lying position on your side, alternately bend and unbend the leg. If a woman lies on her right side, then bend her left leg, if on her left, then her right.
• Starting position sitting. Bend the leg opposite the side where the child's head is, bend at the knee and clasp it with your hands. Bend down so that the stomach touches the knee.

As a rule, gymnastics is performed within 7-10 days, after which the position of the fetus should change. After that, an ultrasound is done to check what changes have occurred. If it has fixed a physiologically normal posture, future mom should wear a bandage with rollers on the sides for prevention.

- incorrect location of the fetus in the uterus, in which its longitudinal axis intersects with the axis of the uterus at an angle of 90 °; while large parts of the fetus (buttocks, head) are located above the line of the crests of the iliac bones of the pelvis. The transverse position of the fetus is determined using an external obstetric and vaginal examination, ultrasound. Pregnancy with a transverse position of the fetus can proceed uncomplicated, however, premature birth is possible, which can pose a threat to the life of the mother and fetus. The optimal tactic in the transverse position of the fetus is operative delivery.

The transverse position of the fetus in some cases is a consequence of anatomical reasons that prevent the insertion of the head into the small pelvis, in particular, placenta previa, tumors of the lower segment of the uterus or pelvic bones, narrow pelvis. Fetal abnormalities such as anencephaly and hydrocephalus may contribute to the transverse position.

Diagnosis of the transverse position of the fetus

An incorrect (oblique or transverse) position of the fetus is established during an obstetric examination of a pregnant woman, palpation of the abdomen and vaginal examination. With the transverse position of the fetus, the abdomen acquires a transversely stretched (obliquely stretched) irregular shape. Due to transverse stretching, the uterus has a spherical, and not elongated-oval shape. Attention is drawn to the excess of the norm of the circumference of the abdomen in comparison with the gestational age and the insufficient height of the fundus of the uterus.

In the process of palpation, the presenting part of the fetus is not determined; the head can be felt to the right or left of the median axis of the body of the pregnant woman, and large parts (head or pelvic end) - in the lateral sections of the uterus. With the transverse position of the fetus, the heartbeat is better heard in the navel. Difficulties in determining the position and position of the fetus may arise in situations of multiple pregnancy, polyhydramnios, uterine hypertonicity. Obstetric ultrasound reliably confirms the transverse position of the fetus.

In rare cases, with the transverse position of the fetus during childbirth, self-torsion in the head or pelvic presentation or the birth of a baby with a double body can occur. Such an outcome of childbirth is an exception and is possible in case of strong contractions, deep prematurity of the fetus, or with a dead fetus.

Tactics of conducting labor in the transverse position of the fetus

For up to 34-35 weeks of gestation, the oblique or transverse position of the fetus is considered unstable, since it can independently change to a longitudinal one. When diagnosing the transverse position of the fetus, a complete gynecological examination a pregnant woman to identify the causes of the anomaly, the choice of tactics for further management of pregnancy and the method of delivery.

At a period of 30-34 weeks of pregnancy, corrective gymnastics may be prescribed, which contributes to the reversal of the fetus in cephalic presentation. Special complexes exercises are indicated in the absence of signs of a threatened abortion, a scar on the uterus, fibroids, spotting, decompensated heart defects in a pregnant woman, etc. and are carried out under the supervision of an obstetrician-gynecologist observing the woman. Also, in the transverse position of the fetus, a pregnant woman is recommended to lie on her side for more time, corresponding to the position being determined.

After 35-36 weeks of gestation, the fetus takes a stable position, therefore, while maintaining the transverse position, the pregnant woman is hospitalized in the maternity hospital to determine the tactics of delivery.

The optimal method of delivery for patients with a transverse position of the fetus is a planned caesarean section. Absolute indications for operative delivery is a post-term pregnancy, the fact of the presence of placenta previa, premature discharge amniotic fluid, scarring on the uterus, the development of fetal hypoxia. When the transverse position of the fetus is started with the prolapse of its handle or umbilical cord, the reduction of the fallen parts is unacceptable.

In the case of full disclosure of the cervix, determined by the live fetus and its mobility, it is possible to turn the fetus on the leg and its subsequent extraction. However, the prognosis for the fetus in this case is less favorable. Turning on a leg and natural childbirth is justified in case of prematurity or twins, when one fetus occupies a transverse position.

In a situation of a long anhydrous period, complicated by the development of an infectious process, and the viability of the fetus after a cesarean section, a hysterectomy (removal of the uterus) and drainage of the abdominal cavity are performed. With a dead fetus, a fruit-destroying embryotomy operation is performed.

During pregnancy, babies change their position in the uterus many times. As long as the fetus has enough room to move, it can roll over as it is more convenient for it. But from a certain point, the presentation and posture of the child is important for doctors, because the prognosis for upcoming birth. In this material, we will talk about what the transverse position of the fetus is and what to do if the baby decides to settle down in the mother's womb in this way.

What it is?

They say about the transverse position when the baby is in the uterus across. If you mentally draw a line along the child's spine, then with an oblique presentation it will intersect with the axis of the uterus at a right angle. The thigh and elbow of the baby can thus be turned towards the exit from the uterus. The head will be located in one side, and the butt - in the opposite.

There are several options for the transverse position. If the baby is facing the mother's anterior abdominal wall, then we are talking about the transverse facial presentation if the baby is turned forward with its back, then the transverse position of the fetus is diagnosed with dorsal presentation. In all cases, transverse or oblique transverse presentation (if the axis of the baby does not create a straight line, but sharp corner at the intersection with the central axis of the uterus) are considered pathology of pregnancy.

This pathology is rare. Less than 1% of pregnant women experience a transverse baby in the womb. In 97% of pregnant women, the babies are located in the cephalic presentation, in 2 -2.5% - in the pelvic. And only in 0.5-0.6% of cases do children take an unusual transverse presentation from the point of view of the laws of nature.

Most often, this arrangement of the fetus is typical for women who have given birth a lot and often. In the first pregnancy, transverse presentation is isolated cases. Until 34-35 weeks of pregnancy, there is no talk of pathology, because the baby has practical and theoretical opportunities for an independent coup in the uterus for childbirth, but after 35 weeks, the coup becomes almost impossible, because free space for such wide movements in the uterus there is no longer any

Danger and risks

This situation has little effect on the course of pregnancy itself. However, it should be remembered that any incorrect position of the baby in the uterus is a significant risk factor for preterm birth. In the case of the transverse position, this happens in 40% of cases. A child who will be born much earlier than planned obstetric term, can not always adapt to a new environment for itself. So, with the immaturity of the lung tissue, problems with independent breathing may occur, acute respiratory failure may develop, and with a low weight of a child born prematurely, it will be difficult for the baby to keep warm.

In the event of the onset of spontaneous labor in a child, small parts of the body and loops of the umbilical cord may fall out along with the outpouring of water. This is fraught with the death of the child, injuries, deformities, disability, development severe complications from acute hypoxia. For a woman, such childbirth is dangerous with injuries to the pelvic bones, ruptures of the perineum, cervix and body of the uterus, vagina, heavy bleeding. In severe cases, everything can end in the death of both the child and the woman in labor.

With rapid spontaneous childbirth, the child’s shoulder is often “knocked” into the small pelvis, this is how the neglected transverse position of the fetus develops, in which an independent birth of a child is impossible. It is when the transverse position is neglected that traumatic rupture of the uterus most often occurs.

If the position of the child is oblique, then it is considered transitional. Theoretically, even in childbirth, it can change either to longitudinal or transverse. Naturally, no one will wait for the baby to turn, the risks are too high.

That is why, with a transverse presentation, it is recommended to give birth by surgical intervention - a caesarean section allows you to remove the child from their wombs without the risk of getting severe birth trauma, hypoxia. For the future mother, the operation will also guarantee that her small pelvis and perineum will not suffer from ruptures and fractures.

Causes

Most often, babies are in the transverse position, which is easy and free to move in the uterus, even for long periods. Such motor activity contributes to polyhydramnios. If the amount of amniotic fluid is higher than normal, then the baby may well take this position and “get stuck” in it. Also active movements for long periods, weak and overstretched walls of the uterus contribute. Weakness and some sagging of smooth muscles are characteristic of women who give birth a lot and often.

No matter how strange it may sound, but the transverse position is also facilitated by low physical activity, or rather, the inability for the child to move. This condition is characteristic of low water. Also, large hypertrophied children experience difficulties with movements and coups.

The risk of transverse presentation of one of the children or both at once is present in a woman with multiple pregnancies, which is why the position and condition of each of the fetuses is monitored so careful observation throughout multiple pregnancies.

The baby can take a transverse position as the only convenient one if a woman almost constantly has increased tone uterus, and there are also tumors or other neoplasms in the lower uterine segment. The establishment of the usual head presentation because of this becomes unacceptable for the child. In addition, transverse or oblique presentation is often observed during pregnancy in women with congenital anomalous features of the main reproductive organ- saddle or bicornuate uterus.

Quite often, the placenta interferes with the baby, if it is located low, they have its full or partial presentation. When the entrance to the small pelvis is blocked by something, the baby cannot stand in the correct position - head presentation. Across the womb, a child can also be located in a woman with a clinically narrow pelvis.

Sometimes the reason for the incorrect position of the child lies not in maternal factors, but in the child himself. So, with hydrocephalus (dropsy of the brain) or anencephaly (absence of the brain), the baby does not take the head position, but remains either sitting in breech presentation or lying across the uterine cavity.

Diagnostics

Transverse presentation can be determined by an obstetrician-gynecologist during an external examination of a pregnant woman, as well as during a vaginal examination. Usually, the height of the uterine fundus, which is measured at each scheduled appointment in a consultation, is below normal in the transverse position, and the pregnant tummy itself even visually looks like a torpedo melon. On palpation, the position of the fetus is determined by the location of the head - this is the hardest and most mobile part of the child's body. With head presentation, it is palpable in the lower abdomen, above the pubis, with pelvic presentation - near the bottom of the uterus (in the upper abdomen), with transverse head it turns out either in the right or in the left side of the expectant mother.

The baby's heartbeat is determined near the navel of the expectant mother. Vaginal examination allows you to exclude the presentation of the head or priests. Then the expectant mother is recommended to undergo an ultrasound. Only ultrasound scanning allows you to get the most accurate data about the position in which the child lies, what are the features of his position, which part of the body is located towards the exit to the small pelvis, and also to assume the weight of the baby. All this data is needed so that the doctor can more carefully assess the risks and choose the right delivery tactics, in which neither mother nor child will suffer.

What to do?

If a woman has a transverse presentation at 24-25 weeks of gestation, as well as earlier or later than this period, there is no need to panic. Up to 35 weeks, the baby has time to turn over. The expectant mother needs to try with all her might to help her child take the right position in the uterine cavity.

For this, special gymnastics is recommended, in which each exercise is thought out in such a way as to relax the muscles of the uterus as much as possible, to give the baby the opportunity to turn around. The set of exercises includes sets of exercises by Dikan, Shuleshova, Grishchenko. There are other complexes developed by gynecologists specifically for women who need help turning their baby around. It should be noted that with a positive attitude and daily exercises, the effectiveness of gymnastics reaches about 70-75%. It is this percentage of babies from an unstable transverse or oblique arrangement that nevertheless passes into the head one.

Gymnastics for the coup of the fetus is not recommended for everyone. So, exercises are forbidden for women suffering from diseases of the heart and blood vessels, kidneys, liver. A scar or several scars on the uterus from a previous caesarean section or other surgical operations are also a contraindication.

If a pregnant woman has edema, signs of preeclampsia, the threat of abortion, bloody issues, presentation or low location of the placenta, gymnastics can not be done.

It is advisable to do gymnastics for those to whom it is not contraindicated from 30 to 36 weeks of pregnancy. If the baby stubbornly does not want to take another position, doctors can offer an obstetric coup in Arkhangelsk. It is done in a hospital under ultrasound control. The baby is unwrapped by hand. But such an intervention is quite dangerous, it can provoke a break. membranes, outflow of amniotic fluid, the onset of preterm labor, as well as trauma to the fetus. That is why doctors themselves rarely decide on an obstetric reversal.

I would like to emphasize the importance positive attitude pregnant. Many experts say that the methods of persuading the baby, affectionate persuasion, combined with corrective gymnastics, give amazing results.

If the expectant mother herself is set up for the best, keeps calm, harmonious mood, then her baby's chances of an independent coup closer to childbirth will increase significantly.

With a transverse presentation, it is important to prevent premature birth. That is why a woman should be extremely careful - do not lift weights, do not jump, do not make sharp inclinations of the body.

Care should be taken to have sex, because an orgasm and even the usual sexual arousal in a woman cause short-term spasms of the smooth muscles of the uterus. If a low position or placenta previa is diagnosed simultaneously with a transverse presentation, then it is recommended to refuse sex altogether, as well as masturbation. Stress should be avoided.

Additionally, a woman should wish only on her side, completely repeating the position of her baby. How to do this correctly, the doctor will tell after the ultrasound, as he will see the exact location of the body and body parts of the child.

Don't skip scheduled doctor visits women's consultation. Most likely, the attending physician will suggest an early hospitalization - at 36-37 weeks of pregnancy, and this will be the only reasonable solution to avoid unwanted complications. Under no circumstances should you refuse it.

If, despite all the precautions, a woman began to give birth prematurely, regular painful contractions appeared, the waters broke, it is important to take a horizontal position in order to prevent the baby’s handle, which is in a breech presentation, from falling out of the genital gap. After that, you need to immediately call an ambulance.

The woman will be given urgent Care, with a probability of 99%, she will have an emergency caesarean section immediately after she is delivered to the hospital.

Can you give birth on your own?

Childbirth with a transverse presentation can be dangerous, we talked about this above. In this position of the baby, in 99% of cases, a caesarean section is performed. It is better if it is carried out before the onset of spontaneous labor, which is why early hospitalization in the maternity hospital is recommended.

Absolute indications for surgery are post-term pregnancy in transverse or oblique presentation, fetal hypoxia, as well as the presence of scars on the uterus. If a pregnant woman was taken to the maternity hospital in an "ambulance" with a discharge of water, doctors will definitely make sure that parts of the child's body have not fallen out. If a prolapse is detected, it is forbidden to set the pen or umbilical cord back.

If the anhydrous period (the time that has elapsed since the water has passed) is prolonged, then the likelihood of infection of the uterine cavity and the development of fetal hypoxia increases. The critical time is considered to be 12 hours.

If a woman is brought to the ambulance after a long waterless period, caesarean section will be carried out in any case, regardless of the degree of cervical dilatation.

Late treatment is dangerous for a woman's life by the occurrence of sepsis. Often in such situations, after a caesarean section, you have to perform another operation - a hysterectomy (complete total removal of the uterus). A woman will never be able to become a mother.

Considering the high risks, a planned caesarean section at 37-38 or 38-39 weeks of pregnancy looks like a more reasonable way out of the situation.

The transverse position of the fetus is called finding it in the fruit space across and this position is a pathology. In this case, the longitudinal line of the fetus crosses the longitudinal line of the uterus, forming a right angle, and large parts (pelvis, head) are located above the iliac crests.

note

Pathology is extremely rare, approximately 1 birth out of 200, which corresponds to 0.4-0.7%.

The transverse position of the fetus - what does it mean?

The tactics of delivery and pregnancy management depend on the location of the fetus. In obstetrics, they operate with such terms as the axis of the fetus - this is a line that continues from the buttocks to the large fontanel and the axis of the uterus (long) - a line stretching from the uterine fundus to the cervix.

Accordingly, the position of the fetus is the ratio of its axis to the uterine. The correct (physiological) position is longitudinal, when the axes of the fetus and fetus coincide, with one large part resting on the bottom of the organ, and the other directed downward. It is this arrangement that naturally prevents trauma to the woman in labor and the baby during childbirth, ensuring their normal biomechanism. The wrong positions include the transverse and its variety - oblique . They speak of an oblique position when the length of the uterus intersects with the axis of the child at an angle of 45 degrees or less.

For a long part of pregnancy, the embryo is very mobile, as a result of which its position is constantly changing. The stable presence of the child in the uterus is observed by the 34-week period, to judge its pathological position V early dates impractical. However, in some cases, the fetus can turn over after 34 weeks or during childbirth.

In addition, obstetricians allocate precarious position fetus , which is noted with its extreme mobility and low weight. The embryo at times passes from the longitudinal localization to the transverse / oblique and again to the longitudinal one.

Presentation is determined by the ratio of the head or pelvis of the embryo to the bone pelvic ring. Distinguish head - the head is directed to the pelvic ring and - the pelvic end is directed downwards. In the transverse position, presentation is not spoken due to its absence.

The position for this pathology is determined by the location of its head: if it is on the left, the first one is installed, if on the right - the second one.

Causes

According to statistics, this pathology is often diagnosed in women who have given birth. Maternal factors, complications of gestation and / or fetal pathology can provoke a transverse position, which increases or reduces its mobility:

• . The presence of multiple nodes in the organ, their significant size and location in the lower segment of the fetus, in the isthmus or in the neck, make the fetus unnaturally located. Also, pregnancy can provoke the growth of the myomatous node, which deforms the uterine cavity.
• Anomalies of fruit-place. The pathological shape of the organ (saddle-shaped, bicornuate), its small size (infantile uterus) or the existing intrauterine septum.
• Pathological location of the placenta. low position placenta ( internal os does not overlap, but is located 5 cm or less from it) or it often causes pathology.
• narrow pelvis. A significant degree (3 - 4) of narrowing not only becomes an obstacle to normal delivery, but also the cause of the pathological position of the embryo. Also, an asymmetric shape can cause pathology. pelvic bones after their fractures, rickets and other things.
• Intrauterine malformations. Absence of the brain (anencephaly) or, which is accompanied by a significant head size, and lead to transverse arrangement germ.
• Amniotic fluid volume. contributes to a significant expansion of the cavity of the fetus, which leads to a high motor activity of the embryo. In such a cavity, the fetus does not feel its boundaries and can be located across its axis or diagonally. , on the contrary, sharply limits the baby's mobility, which makes him "lie down" incorrectly.
• Pregnancy. In the presence of 2 or more fetuses in the womb, they are often pathologically located due to tightness and limited mobility.
• Large (over 4 kg), giant (over 5 kg) fruit. The pathological position is associated with a decrease in the motor activity of the embryo.
• . The constant threat of interruption causes compression of the fetus by the walls of the organ, limiting its mobility and transverse localization in the fetus.
• Numerous genera. Women who have given birth many times have a flabby and overstretched anterior abdominal wall, the fetus does not feel an obstacle from the abdominal muscles and becomes excessively mobile.
• Fetal hypotrophy. Light weight, dimensions cause frequent upheavals and high mobility of the embryo in the fetus.
• Pathology of the vestibular apparatus of the fetus.

Transverse position: diagnostic methods

Diagnosis of pathology includes:

note

In the presence of polyhydramnios or uterine hypertension, there are difficulties in establishing the location and heartbeat of the child.

• . Gives a 100% guarantee of detecting a pathological situation at any time. The diagnosed transverse position at 22-25 weeks is not considered a pathology.
• Vaginal examination. It is performed with extreme caution with whole waters at the end of pregnancy or when contractions appear. Allows you to determine the absence of the presenting part of the child. With the passage of water, palpation of the fetal side (ribs and spaces between them), scapula and / or armpit, in some situations, the elbow or hand is possible.

Transverse position: what is dangerous

Gestation in this pathology often proceeds without features. Due to the transverse location of the fetus, the division of water into anterior / posterior does not occur, therefore, the entire mass of amniotic fluid presses on the membranes of the fetal bladder and the internal pharynx, and leads to premature rupture of the membranes and onset.

Prenatal discharge of water takes the first place among the complications of the transverse position of the embryo, and in a third of cases provokes the start of premature birth.

In extremely rare cases, the end of childbirth in a physiological way with the birth of a live child is possible. A positive result causes the fetal self-torsion in utero and its transition to the breech / head presentation. Such a turn can take place with either a small weight of the fetus.

Possible complications:

Management of pregnancy

Obstetric tactics for managing gestation in a pathological position consists in carefully monitoring the pregnant woman, limiting weight lifting, physical activity, performance special gymnastics. Obstetricians of the last century widely used the external rotation of the fetus; today, its production is practically abandoned due to high risk the occurrence of complications (damage to the uterus, prenatal outflow of water, intrauterine hypoxia, placental abruption) and inefficiency.

Exercises for a coup in the transverse position of the fetus

• low placentation, placenta previa;
• pathology of the umbilical cord (presence additional vessels, lack of necessary, false / true knot of the umbilical cord, );
• multiple pregnancy;
• severe general pathology;
• uterine hypertension;
• excess/lack of water;
• uterine fibroids;
• blood secretions;
• transferred operations on the uterus.

note

Obstetricians recommend resting in a transverse position on the side in which the head is palpated, which stimulates the fetus to lie longitudinally.

A set of exercises:

After reaching positive result(gymnastics is performed for about 10 days) wearing a bandage is prescribed, which helps to fix the result. The bandage must be worn until the head is pressed against the pelvis or until the onset of labor.

Birth management

Hospitalization is scheduled for the 36th week, in the maternity hospital the pregnant woman is examined and prepared for. Independent childbirth with the implementation of the external-internal rotation are real only in case of deep prematurity or childbirth with twins when the second child is peppered.

Indications for abdominal delivery:

• scar on the uterus;
• chronic hypoxia,;
• prenatal discharge of water;
• pathological localization of the placenta;
• delayed pregnancy;
• uterine neoplasms.

In a diagonal position, the woman in labor is assigned bed rest on the side, from below which the head / pelvis of the fetus is palpated. When a limb/umbilical cord prolapses, their reduction is prohibited, the woman is operated on an emergency basis.

The neglected transverse position requires immediate abdominal delivery in the interests of the woman, regardless of the condition of the child. When symptoms of infection of the uterus, fetal membranes appear, the caesarean section ends with the removal of the uterus.

Conditions for the production of external-internal rotation:

• indwelling urinary catheter;
• full opening of the cervix;
• written consent of the mother;
• estimated fetal weight less than 3600 gr.;
• live fetus;
• the presence of a deployed operating room;
• correspondence of the size of the head to the indicators of the pelvis.

Sozinova Anna Vladimirovna, obstetrician-gynecologist