Facial presentation of the fetus: consequences and recommendations of doctors. Head presentation of the fetus: a fine line between the norm and pathology Embryo presentation

The longer the gestational age, the less the child has the opportunity to actively move, since there is very little space in the uterus. Therefore, by the beginning of the eighth month, as a rule, the fetus already takes a stable position, that is, it turns a certain part of the body towards the exit of the birth canal. It can be: head, buttocks, legs, knees, shoulder or handle. In the later stages, in addition to the general condition of the mother, gynecologists are concerned about the presentation of the fetus and its size (approximate height and weight).

All expectant mothers dream of natural childbirth. But there are a number of factors that determine the way a child is born: by caesarean section or by natural means. One of these factors is the presentation of the fetus. What is it? Fetal presentation is the accepted position of the fetus in the last weeks of pregnancy or right before the onset of labor, that is, which large part of it is closest to the pelvic floor.

Kinds

Depending on which part of the body the child has turned to the exit of the birth canal, the following types of fetal presentation are distinguished:

pelvic,
head,
oblique,
transverse.

With oblique or transverse - a woman is always performed a caesarean section, with a headache, if there are no other indications, childbirth takes place in a natural way, and with a breech presentation, doctors usually recommend surgery, but a woman can safely give birth on her own.

Head presentation of the fetus

The most optimal and correct presentation is the head one. In almost all cases of such an arrangement of the fetus, childbirth occurs naturally. The delivery process is most favorable and easy for a woman when the child is facing the birth canal with the occipital region. But in obstetric practice, there are other positions of the fetal head, which depend on the flexion or extension of the neck.

In the case of anterocephalic presentation, the baby's head passes through the birth canal for the most part. In such a situation, a woman is allowed to give birth on her own, but the risk of birth trauma to the baby and mother increases. To prevent undesirable consequences, it is better for a woman to resort to a caesarean section.

Head presentation of the fetus can be frontal. In this position, the child's neck is strongly extended, the head area is too large, and it cannot pass through the birth canal. If the fetus took a frontal presentation during childbirth, then the woman is shown an emergency caesarean section, and if before childbirth, then planned.

The most dangerous is considered to be facial presentation, since the neck is completely extended and the fetus passes not with the back of the head, but with the face. In this position, during natural childbirth, the baby's neck can be severely injured or, in general, break. As a rule, a woman is offered to resort to a caesarean section.

Breech presentation of the fetus

The position of the baby in the uterus with legs or buttocks down is called breech presentation of the fetus. In obstetric practice, it is customary to distinguish between two of its varieties: breech presentation and foot presentation. Depending on the complexity of the proposed natural childbirth, gynecologists recommend that a woman choose a caesarean section as the main method of delivery.

With breech presentation, it is the breech presentation that is most common, it occurs in 35% of cases. With this arrangement of the fetus, its buttocks are facing the exit of the birth canal, the legs are unbent at the knees and bent at the hip joint. As a rule, there are two types of breech presentation: mixed and pure breech. If the baby is in a breech presentation, then a natural birth is possible, but there is a possibility of a number of complications. For example, prolapse of umbilical loops, asphyxia in a child and other serious injuries. In turn, the birth of a child with such a presentation will certainly lead to ruptures and tissue damage in the mother.

Incomplete or pure breech presentation occurs when the child's legs are extended along their torso, and flexion occurs only at the hip joint. And it is in this position that the baby is preparing for birth. With a mixed presentation or full presentation, the buttocks face the exit of the small pelvis of the mother together with the legs. In this case, flexion is observed both in the knee joints and in the hip joints.

Leg presentation is less common than breech presentation and usually occurs during active labor. There are several types of this presentation: complete, incomplete and knee. It is called complete when two legs are slightly extended at the hip and knee joints and facing the bottom of the woman's small pelvis. With an incomplete presentation, one leg is completely bent at the hip joint, and the other is straight, that is, it is unbent at both the hip and knee joints. Knee - extremely rare. It is characterized by the presentation of both legs bent at the knee joint, facing the exit of the birth canal.

Oblique or transverse presentation

The presentation of the fetus during pregnancy can change repeatedly. It depends on the activity of the child and the anatomical structure of the mother's body. With oblique presentation, there is a possibility that the child will change position during active labor, but doctors recommend that a woman not take risks and give birth by caesarean section.

If the transverse presentation of the fetus, then delivery in a natural way is impossible. In this case, the axis of the child and the axis of the woman's uterus intersect at a right (90 degrees) angle, and the largest anatomical parts of the fetus are located above the crests (edges) of the ilium. In very rare cases, with the help of doctors, the child can be turned around, but this usually leads to injury to the fetus.

How to determine the type of presentation

Diagnosis of fetal presentation before the onset of active labor is carried out in the antenatal clinic and maternity hospitals. Doctors make the most reliable conclusion about the presentation of the fetus after 35 weeks, since before this period there is a possibility that the child will independently take the proper position before childbirth. In case of incorrect presentation (oblique, pelvic, transverse), gynecologists advise the woman to perform special exercises that can contribute to the rotation of the fetus. After the 36th week of pregnancy, there is practically no room for the baby to move, and he assumes a position in which he will be born.

How to determine the presentation of the fetus? The diagnosis is made by a gynecologist according to the results obtained. The expectant mother must undergo a vaginal and obstetric examination. In addition to objective data, a woman needs to do an ultrasound, preferably a three-dimensional echography. This type of study is most important in breech presentation, to determine its type.

Determination of fetal presentation is an integral point in the management of pregnancy. This is necessary to make a decision on the method of delivery, as well as to prevent the occurrence of complicated childbirth. It is very important for breech presentation to determine what type it is. With a headache, doctors pay attention to the position of the head and the degree of extension of the neck, since its excessive extension can lead to serious injuries during passage through the birth canal. For example, trauma to the spinal cord, cerebellum and other injuries.

Causes

The causes of malformation of the fetus are very diverse. The following factors lead to this pathology:

polyhydramnios or oligohydramnios;
rather narrow pelvis of a woman;
too low presentation (location) of the placenta;
double or triple entanglement of the neck with the umbilical cord;
very short umbilical cord;
tumors in the uterus (myoma, fibroma);
the presence of a postoperative scar on the uterus;
abnormal development of the uterus;
hypotension of the uterus (low tone);
multiple pregnancy or repeated;
myometrial dystrophy;
saddle or bicornuate uterus.

All of the above reasons are predisposing factors to breech or transverse presentation.

Indications for caesarean section

Delivery by caesarean section can be caused by disorders or diseases in both the woman and the fetus. Indications on the part of a woman: genital cancer or herpes, myopia, pronounced symphysitis, narrow or deformed pelvis, pronounced scars on the uterus or vagina, tumors in the uterus, severe diseases of the heart, kidneys, lungs, the presence of transplanted organs, eclampsia.

On the part of the fetus or placenta: malformations of the child (omphalocele, gastroschisis), chronic hypoxia, developmental delay, transverse or pelvic presentation of the fetus, as well as incorrect head, Siamese twins or twins, triplets, etc., large fetus, as well as complete or incomplete detachment of the placenta.

All pregnant women dream of an easy natural birth. To understand whether you can give birth on your own, it is important to know the presentation of the fetus. With ultrasound, they look, the head or buttocks of the baby is directed to the entrance to the birth canal. In addition, attention is paid to how the imaginary axis passing through the fetal spine correlates with the longitudinal axis of the uterus, parallel to the woman's back. The most difficult is the transverse position with the intersection of the axes at an angle of 90 °. There is not much time left to change the position of the fetus in the uterus; after the 36th week of pregnancy, it cannot be rotated.

Information about the position of the child in the uterine cavity is needed by the obstetrician-gynecologist to determine the strategy for prenatal preparation. Only the head presentation suggests childbirth, conceived by nature. The birth of a child with the buttocks forward is associated with various complications.

Location of the fetus in the uterus

In medicine, the following provisions are classified:

Longitudinal (head or pelvic) - the axes of the mother and child are almost parallel.
Transverse presentation is characterized by the intersection of the axes at an angle of 90 °.
The oblique position has an acute angle between the axes.

Another important indicator is the type of presentation position, that is, where the back of the baby is facing.

If the back of the baby is facing the mother's abdominal wall, then this indicates an anterior position.

If its back is pressed against the mother's spine, this is a posterior presentation.

For example, the sonographer in the results of the examination indicates that the fetus is located in a longitudinal position in the posterior view of the occipital presentation. This will tell the gynecologist that such an arrangement may delay the time of childbirth.

head presentation

This is the most common position of the fetus in the womb and occurs in about 97% of pregnancies. The most comfortable is the occipital position of the head, when the baby's chin is pressed against the chest. Then, when he is born, he moves forward with the back of his head.

There are anterior and posterior views of the occipital presentation. In a woman in labor, lying on her back, the baby comes out with the back of her head up, and her face is turned down. In the rear, it's the other way around. A baby lying face up will be born later than if he was lying upside down. True, when passing through the birth canal, the child is able to turn from the front position.

If necessary, a vaginal ultrasound is performed to clarify during childbirth. In addition to the occipital head presentation, there are several more types of positions depending on the degree of neck extension:

This is anterior parietal presentation, when the child moves forward with a large fontanelle. This hole is located in the skull at the junction of the frontal and parietal bones. Childbirth in this position lasts longer and is more difficult than with the occipital advancement. This is due to the fact that the head is large. With anterior parietal presentation, a caesarean section is often performed, especially if the doctor notices a threat to the life of the child or the woman in labor.
A more rare case is frontal presentation, when the baby enters the birth canal with his forehead. A fetus of normal or large size cannot be born on its own in this position, so surgery is necessary.
The maximum degree of extension of the neck occurs with facial presentation. You can give birth on your own, but no one knows how it will turn out for the child. The mother may also have problems: severe perineal and cervical tears. Because of this, the doctor may suggest surgery. Women in labor with a wide pelvis and a small fetal size during active labor can do without surgical intervention.

breech presentation

This type of presentation occurs in less than 5% of cases. It is subdivided into:

foot;
pure gluteal;
mixed.

With a foot presentation, both legs are turned down, slightly bent at the knees - the so-called full foot position. In an incomplete foot version, one leg, bent at the knee, faces the pelvis; the second, straightened, directed towards the head.

With a pure breech presentation, the baby's buttocks are closest to the exit from the uterus. Straightened legs lie along the body. With a mixed presentation, the legs are crossed, bent at the knee and hip joints.

When a child is born in a breech presentation, a large number of complications arise: congenital dislocation of the hip, throwing back of the arms, extension of the head, craniocerebral trauma, hypoxia, and even death of the child. Childbirth is accompanied by certain pathologies and is dangerous for the life of the woman in labor. She may have a rupture of the uterus and perineum, accompanied by severe bleeding.

According to the instructions, the doctor at the stage of expulsion of the fetus in the foot presentation should delay the exit of the child until he himself “squats down”. The obstetrician prevents the legs from falling out, then the buttocks will come out first.

Breech presentation of the fetus does not deprive a woman of natural childbirth, but it is very difficult. Before making a final decision, the doctor considers several factors:

Narrow or wide pelvis in the mother.
The estimated size of the fetus (in this case, the maximum weight is 3.5 kg).
The fetus is directed towards the pelvis with the legs or buttocks.
Gender of the baby (the birth of a boy with a breech presentation is associated with damage to the genitals).
The age of the mother.
Pathologies of previous pregnancies and childbirth.

If, after screening at 28-30 weeks of pregnancy, a breech presentation of the fetus is found, doctors recommend performing a couple of simple exercises daily. They contribute to the coup of the child in the head position. Please note that they cannot be performed by pregnant women with uterine fibroids, placenta previa, having a scar on the uterus from a previous cesarean section, as well as those who had a threat of premature birth and preeclampsia during this pregnancy.

If the fetus is not positioned correctly

The most favorable location for natural childbirth is the head presentation of the occipital type. All other species are pathological.

Natural childbirth with a breech presentation will entail serious complications, so a pregnant woman is recommended to have a caesarean section, especially when the baby is male.

Although a congenital dislocation of the hip will not decorate a girl either. It can be quite difficult to independently determine how correct the position of the baby in the stomach is. It is easier to do an ultrasound or dopplerography at 30 - 32 weeks of pregnancy, feel your stomach well, remember the sensations and wear a prenatal bandage.

In this case, you can not bend so that the head falls below the pelvis. Otherwise, the baby may accidentally roll over. In addition, you need to stand in a knee-elbow position for 15 to 20 minutes daily. This exercise relieves the pressure on the lower abdomen and helps the baby to take or maintain the correct position. By 36 weeks, it is almost impossible to turn the baby over or it is associated with a risk of injury.

Oblique and transverse presentation of the fetus

This pathology occurs in less than 1% of women in labor, but it becomes more frequent with subsequent pregnancies. The pregnancy itself is normal, but with the next ultrasound, the wrong location of the baby may be detected.

Such a pathological situation can cause premature birth, which, without qualified medical care, often ends in the death of the mother and child. If the baby has taken an oblique or transverse position before childbirth, the woman in labor is laid on her side and they try to change the presentation to the pelvic or head. True, this does not always work, then an operation is necessary.

The main causes of the transverse and oblique position of the fetus

These reasons include:

oligohydramnios or polyhydramnios;
pregnancy with twins or triplets;
anomalies in the configuration of the uterine cavity;
the presence of postoperative sutures on the uterus;
fibroids and other neoplasms inside the uterus;
placenta previa;
flabbiness of the muscles of the anterior abdominal wall.

All pregnant women need to be aware of the fetal presentation and the possible dangers of natural childbirth in this position. Not only the doctor, but also you are responsible for the life of your baby. Information about a possible caesarean section during childbirth should not cause hysteria or panic.

How the fetus is located in the mother's tummy during pregnancy depends on how and how easy the birth will be. When the child has a normal position, a woman can give birth on her own, in a natural way. When the location of the baby is not as intended by Mother Nature, there is a high probability that a caesarean section will be necessary. Among the characteristics of the intrauterine posture: the presentation of the fetus, the position of the fetus and the type of position. Let's figure out what these terms mean for the expectant mother and her baby.

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

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

Fetal presentation determined depending on which part of the body the child is directed to the area of \u200b\u200bthe internal pharynx of the female cervix - the place where the uterus passes into the cervix, in medicine it is called the presenting part. The presentation of the fetus can be head - when the head is directed to the exit from the uterus, or pelvic - when the baby lies with his buttocks towards the exit. With a transverse arrangement of the fetus, the presenting part is not determined.

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

head fetal presentation

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

In cephalic presentation, the baby's buttocks and legs may deviate to the left or right, depending on where the back of the fetus is facing.

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

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

And finally, the maximum extension of the head is facial presentation of the fetus- the baby's face is born first (this occurs in 0.25% of all births). At the same time, natural childbirth is possible (the resulting birth tumor is located in the lower part of the child’s face, in the area of \u200b\u200bthe chin and lips), but they are quite traumatic for both the woman in labor and the fetus, which often adds “points” in favor of a caesarean section.

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

Pelvic / gluteal fetal presentation

This arrangement of the fetus during pregnancy occurs in 3-5% of births. Breech presentation is foot, when the legs are presenting, and gluteal, when the child, as it were, squats down, and is positioned with buttocks towards the exit. Breech presentation of the fetus is more favorable for childbirth.

When does it take place pelvicfetal presentation, childbirth are considered pathological due to the large number of complications in the woman in labor and the fetus. Since the smallest pelvic end of the fetus is born first, it is often difficult to remove the head. In the case of a foot presentation, the obstetrician delays the birth of the child, prevents his advancement with his hand, preventing the leg from “falling out” until the baby squats down. Thus, they achieve that the buttocks are born first. Of course, this complicates the process of childbirth and brings additional pain.

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

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

2. the size of the mother's pelvis;

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

4. the gender of the fetus (childbirth in a breech presentation for a girl is much less risky than for a boy, since damage to the genital organs can occur in a boy);

5. the age of the woman in labor;

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

· What to do so that the child turns from the pelvic to headpresentation ?

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

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

3. The rotation of the fetus is facilitated by classes in the pool.

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

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

Previously, they tried to correct the breech presentation of the fetus, which they call manually, by externally turning the fetus - through the stomach, the doctor tried to move the baby's head down. To date, this has been abandoned, since the method has low efficiency and a high percentage of complications, such as premature birth, premature placental abruption, and a violation of the child's condition.

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

oblique and transverse

The transverse and oblique location of the fetus is an absolute indication for a caesarean section, the passage of natural childbirth through the birth canal is impossible here. Presentation in this case is not defined. Oblique and transverse position occur in 0.2-0.4% of pregnancies. The twists that were previously used during childbirth are not used today, since they are very traumatic for the mother and child. However, occasionally such a rotation of the fetus is used for multiple pregnancy - twins, in cases where, after the birth of the first, the second baby took a transverse position.

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

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

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

· The position of the fetus with twins

With twins, natural childbirth is possible if both children occupy the head presentation, or the first baby (located closer to the exit from the uterine cavity and will be born first) takes the head presentation, and the second pelvic presentation of the fetus. The opposite situation - the first fetus in the breech, and the second in the head presentation - is unfavorable, because after the birth of the pelvic part of the first fetus, babies can catch their heads.

In cases where the transverse position of one of the children is determined, the issue is unambiguously resolved in favor of a caesarean section, that is, delivery occurs by surgery.

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

Yana Lagidna, especially for mymom . en

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

From the moment of conception to the very birth, the expectant mother is constantly in fear for her little miracle, which has been in her womb all these 9 months. After all, the baby will have to go through a huge difficult path from a tiny cell to a little man, and on it he faces many problems.

If the pregnancy is going well, the fetus is developing correctly and no problems have been identified, then the woman may well give birth without any extraneous manipulations. But not everything always goes as we would like. One of the frequent pathologies that are a direct indication for caesarean section is the incorrect position of the fetus before childbirth.

A little information for future parents

A small baby literally from the first weeks of its attachment to the uterus begins to actively move and even push off the walls, since it is still too small and there is enough space for it in the uterus. But this freedom only lasts until the middle of the second trimester. Further, it becomes more and more difficult for the child to change the position. He is forced to take the most convenient position for him and for future births in general, and in this state to wait for the birth.

That is why obstetricians from the antenatal clinic, starting from 30-34 weeks, carefully monitor the location of the fetus in the womb and try to choose the best delivery option. And yet, you should not panic ahead of time: there are cases when a child at the very last moment somehow took the correct position and was born naturally in an absolutely healthy way.

What are the types of pathologies?

Usually an experienced obstetrician-gynecologist can determine the position of the fetus by probing the pregnant woman's stomach, but still the final verdict will be made after the ultrasound examination, and only then will the doctors decide how to deliver. Of course, you should not be very upset, but every expectant mother is simply obliged to know what pathologies can be and what to expect in a particular case.

So, the fetus can be in a breech or head presentation, which, in turn, have separate varieties. We will talk about them below. At the next admission to the LCD, the future mother can hear, in addition to the location of the fetus, about the so-called position. This term is used in medicine to compare the back of the child and the uterine wall. The baby can be located longitudinally, that is, head down or up, or across, respectively, head to the right or left.

With a longitudinal arrangement, natural childbirth without complications is possible if the baby's head is located below, that is, closer to the birth canal. True, even in this case there are small nuances, but in general, a woman in labor is quite capable of giving birth herself.

In cases where the fetus is located transversely, natural delivery is completely excluded. In this case, there is only one way - a caesarean section.

breech presentation

This is the case when the child literally "sits" at the exit. In this case, breech presentation can, in turn, be of several types:

gluteal (baby's head on top, buttocks below, legs raised closer to the face);

foot (the child, as it were, stands on his feet or, perhaps, only on one leg);

mixed (a baby with such a presentation can "sit" on the buttocks, bending the legs at the knees).

Birth in breech presentation is in principle possible, but very risky. During labor, both mother and baby can be seriously injured. Therefore, it is recommended to listen to the doctors and agree to a caesarean section.

Head presentation of the fetus

This is the most correct and safe position, in which injuries for the baby and the woman in labor are minimized. With cephalic presentation, the baby's head is located at the very birth canal and appears first during childbirth.

Head presentation can also be divided into several types:

Occipital - the most ideal and natural position of the child, in which the baby will move through the birth canal with the back of the head forward.

Anterior head.

Frontal - according to doctors, the most dangerous head presentation. In this case, the only way out is a caesarean section.

Facial presentation of the fetus is almost as dangerous as frontal. When moving through the birth canal, there is a risk of injury to the spine. It is on this type of pathology that we dwell in more detail below.

What does facial presentation of the fetus mean and why is it dangerous?

This is the extreme degree of extension of the baby's head. Moreover, initially, when lowering, frontal presentation is observed, and only then it passes into the facial one. Usually, such a presentation occurs immediately at the time of childbirth, but there are cases when such a condition occurs long before the onset of labor and is diagnosed using an ultrasound study.

According to some clinical data, such presentation is observed in approximately 0.30% of all pregnant women. At the same time, multiparous women are prone to such pathologies more often than primiparas.

How is fetal malpresentation diagnosed?

In face presentation, the baby's head leans back strongly and presses against the back, while the baby's chest is close to the walls of the uterus. All these conditions together create a number of characteristic features with which an experienced obstetrician can easily determine the presence of a facial presentation of the fetus.

In the correct diagnosis, it will be useful and which must be carried out very carefully so as not to harm the baby. The doctor can easily feel the chin on one side, and the nose on the other, and in this case, the presence of facial presentation is beyond doubt.

Why is this happening?

Such an malpresentation of the fetus in the uterus is extremely rare, about 1 in 400 births. Multiparous women are more likely to be affected by this pathology. The reasons for the facial presentation of the fetus can be different: the narrow pelvis of the woman in labor, too low tone of the uterus, uneven contraction of its sides.

Facial presentation can be either primary or secondary. The first option is observed extremely rarely, and is noted long before the onset of labor. The reasons may be different, for example, when a thyroid tumor is observed in a child. Secondary presentation is observed more often. It is formed from the so-called frontal. Basically, this happens with a narrow pelvis in a woman in labor.

The mechanism of childbirth with a facial presentation of the fetus

At the very beginning of labor, with facial presentation, the baby's head, instead of bending, unbends backwards. Next comes the internal rotation of the head, this occurs during the transition from the wide part of the small pelvis to the narrow one. Then the chin is extended anteriorly, while the head is located in the pelvic floor. And finally, the eruption of the baby's face occurs. Ultimately, there is a rotation of the shoulders and head in exactly the same way as it happens with the occipital presentation.

The consequences of natural childbirth with facial presentation for the child and mother

The consequences of facial presentation of the fetus (child) as a whole depend on the course of labor and the professionalism of doctors. It should be understood that such a pathology cannot but affect the condition of the baby. Immediately after childbirth, there is severe swelling and hemorrhage on the eyelids, lips of the newborn. The tongue and the floor of the mouth are extremely swollen, which leads to feeding problems in the first days of a baby's life.

The prognosis and consequences of facial presentation of the fetus are relatively favorable. As a rule, 93% of women in labor do not require surgery and only 20% had a perineal tear.

Unfortunately, despite a positive prognosis for face presentation of the fetus, the consequences for the child are not always favorable. Under such circumstances, the number of stillborns increases sharply. The main problem in this case is the entanglement of the umbilical cord, which is observed much more often than with occipital presentation.

Reviews of experienced mothers

If you go through the numerous women's forums on the Internet, we can conclude that the consequences of the facial presentation of the fetus, like the reviews, may differ depending on the specific situation. Often women note that the primary presentation is not yet a sentence, and everything can change, that is, the baby can still turn as it should, at the most unpredictable moment. Many mothers are advised to perform a series of exercises to correct the position of the fetus in the uterus, but before listening to their advice, it would be useful to consult a doctor about this professionally.

But still, it is worth being realistic and not waiting for a miracle to the last. If your gynecologist says that there is a facial presentation of the fetus, the consequences and causes of which force you to resort to a caesarean section, then you should not risk your and your baby's health, but rely entirely on the doctor's many years of experience.

How is childbirth with a similar pathology

If facial presentation is established and there is no labor activity yet, expectant tactics are used. In other words, doctors are likely to put the expectant mother in advance, but will not do anything. In most cases, everything is decided by nature itself and childbirth takes place without any serious consequences for the mother and baby. In the case of facial presentation, natural delivery, although complicated, is still possible. With frontal presentation, especially in combination with normal pelvic sizes and full-term pregnancy, natural childbirth is impossible. They will occur if the frontal presentation turns into a facial or anterior head presentation, with a medium-sized fetus and a capacious pelvis.

If the opening of the cervix has begun, it is necessary to put the woman in labor on her back and try not to damage the fetal bladder. In the presence of a large fetus or a narrow pelvis of a woman in labor and a facial presentation of the fetus, the recommendations of doctors always converge in immediate surgical intervention. Otherwise, there is a risk of missing the most favorable time and causing serious harm to both the mother and the child.

Why can the fetus take the wrong position at all?

As we wrote above, it is laid down by nature in such a way that before childbirth the child takes the most favorable position for himself and his mother, that is, longitudinally, with an occipital presentation. But, alas, there are cases when something does not go according to plan and the baby is not located as it should. There may be several reasons:

After repeated curettage, abortions, multiple births, and even cesarean section operations, hypertonicity of the lower parts of the uterus can be observed, while in the upper sections there will be a significant decrease in tone. Due to this condition, the fetus can push off from the entrance to the pelvis and take an unnatural position for it.

An important role is played by the characteristics of the child himself, for example, a large or too active fetus, prematurity.

Pronounced anomalies of the uterus (bicornuate, saddle uterus, fibroids), narrow pelvis.

The entanglement of the umbilical cord, as a result of which the mobility of the fetus is severely limited.

Methods for correcting incorrect presentation

There is a set of exercises with which you can adjust the location of the fetus even before the onset of childbirth. The complex will be recommended by the attending physician. In addition to gymnastics, such methods as diving into the pool, acupuncture, homeopathy, psychological suggestion, aromatherapy and even music therapy can be used. You can try whatever your heart desires, only with the condition: be extremely careful and do not hesitate to contact your gynecologist for any questions (even the most insignificant ones).

The effectiveness of such exercises, according to some reports, can reach 80%. But it is worth remembering that in no case should you do this without first consulting with a leading doctor. After all, the situation in each case is individual and there may be serious contraindications. So, direct contraindications to such gymnastics include scars and tumors on the uterus, placenta previa, preeclampsia, and severe inflammatory diseases. Thus, you can do significant harm instead of benefit.

And remember: in any case, the doctor must make the final verdict and he knows better how serious everything is. And if the decision is made to do a caesarean section, there is nothing wrong with that. The main thing is that a healthy baby is born, and everything was in order with mom.

The natural course of childbirth largely depends on the position of the fetus in the uterus. With the correct location of the child, the risk of injury and rupture is practically eliminated, and the passage of the fetus through the birth canal itself is quick and easy. But sometimes doctors are forced to surgically remove the baby to keep it healthy and avoid injury. Often, a caesarean section is prescribed after a diagnosis has been made. abnormal presentation of the fetus”, in which its position and position can provoke complications.

As the term increases, the baby grows and becomes less mobile in the woman's stomach, so with 30 weeks pregnant he usually occupies a certain position until the very birth. The fetus approaches the birth canal with one part of the body, such as the buttocks, head, knees, feet, shoulder, or arms. It will move along the birth canal in this position, in connection with which the obstetrician-gynecologist in the last stages of pregnancy takes control of the position of the fetus in the uterus, and also fixes its approximate weight and size. Thanks to these data, the specialist can predict the upcoming delivery and understand how best to carry it out.

Why is the fetus in the wrong position

The location of the fetus in the womb depends on a number of reasons. According to many experts, in most cases, deviations provoke too active movements of the child, as well as reflex activity of the muscles of the uterus. Unfortunately, these two decisive aspects do not depend on the actions and desires of the expectant mother, and therefore cannot be controlled. Other common factors should also be highlighted, due to which the fetus may not be positioned correctly in the uterus just before childbirth:

Polyhydramnios or oligohydramnios;

Multiple pregnancy;

Abnormal deviations in the shape of the uterine cavity;

The constitution of the expectant mother is too narrow a pelvis;

Very low position of the placenta (placenta previa);

Short umbilical cord;

Entanglement of the umbilical cord of the child's neck;

Tumors, scars, fibroids, fibroids in the uterine cavity;

Hypertonicity of the uterus, or vice versa - reduced tone;

Diagnosis of myometrial dystrophy;

Bicornuate or saddle uterus.

What complications are caused by incorrect presentation?

According to statistics, every fifth woman who received a diagnosis of " fetal presentation”, carries and gives birth to a child without complications. Problems usually arise only under the influence of factors due to which the fetus has taken the wrong position in the uterus. Often, with breech presentation, there is a threat of miscarriage, preeclampsia, severe toxicosis, polyhydramnios, oligohydramnios, fetal hypotrophy and cord entanglement.

Types of malpresentation of the fetus

In the first months of the term, the child is still so small that it easily and regularly changes its position in the womb. From about the sixth month of pregnancy, the baby is already beginning to quickly gain weight and increase in size, due to which his motor activity is reduced, and he can hardly change position. A gynecologist at 32 weeks of gestation, when examined by ultrasound, can suggest what position the baby will occupy right up to the very birth. The doctor will fix what exactly the child rests on the lower part of the small pelvis - closer to the birth canal. In some cases, the gynecologist informs the patient about the incorrect position of the child a little earlier than the generally accepted period - at about 20-28 weeks, but so early a woman should not start worrying about possible problems. During the last weeks before the expected date of birth, the fetus may well change its position radically to a more suitable one for passing through the birth canal.

Types of fetal presentation

1. When the baby is located with its pelvic end closer to the lower part of the mother's pelvic floor, the gynecologist fixes the breech presentation. In medicine, it is customary to distinguish several types of breech presentation: gluteal(the head of the child is located at the top of the uterus, and the legs are straightened along the body so that the feet are closer to his face); foot(one of the legs, or both limbs of the fetus are located at the lower edge of the woman's small pelvis); mixed(with the gluteal-leg position of the child, his lower limbs and buttocks lie closer to the small pelvis).

As statistics show, obstetrician-gynecologists often have to deal with the breech type of the child's presentation. Almost 35% of pregnancies are characterized by the fact that the fetus, just before the birth, occupies such an uncomfortable and dangerous position - with straightened legs at the knees, but bent at the hip joint. Regardless of the specific position of the baby - breech or breech presentation before childbirth, his natural birth becomes dangerous, as it increases the risk of serious injury. For example, he may suffer from asphyxia, or umbilical loops will fall out. More serious consequences, up to a lethal outcome, are not excluded. In a woman in the process of such childbirth, the tissues of the uterus and vagina can be severely affected.

In gynecological practice, it is customary to distinguish the following types of foot presentation: complete, incomplete and knee. Leg presentation usually provokes too active labor, and fortunately, it is diagnosed less often than breech. When the fetus occupies a full foot position in the womb, its legs should be extended at the knee and hip joints, and located closer to the woman's pelvis. When fixing an incomplete leg presentation on ultrasound, one leg of the child is completely bent at the hip joint, and the second is unbent at the knee and hip joints. Knee presentation of the fetus is a very rare phenomenon, characterized by legs bent at the knee joint, which are facing the small pelvis.

2. If the baby's head before childbirth is closer to the pelvic floor, this indicates a head presentation - a safe and correct position of the fetus in the womb. In this position, it will be easy for the baby to pass through the birth canal, in addition, this process will not cause severe pain for the woman. Usually, childbirth in this position goes without consequences, and the young mother quickly regains her strength. It is worth noting that if the baby is turned to the birth canal with its occipital part, then the delivery will be as favorable as possible. Head presentation, according to doctors, also has several varieties that affect the birth process in different ways. For example, the back of the head of the child will pass first through the birth canal if the fetus is located in the uterus in the occipital presentation.

The fetus can occupy an anterior head position - the child's head begins to move along the birth canal immediately with a larger diameter than, for example, in the occipital position. In this case, doctors can perform a natural birth, but there are concerns about the possible risk of injury to both the child and his mother. That is why, in this case, the expectant mother is advised to agree to the surgical removal of the child in order to prevent undesirable consequences.

When the baby begins his journey through the birth canal with his forehead, the obstetrician fixes the frontal presentation of the fetus - quite dangerous for many reasons. As a rule, the child's neck is not in a comfortable position for childbirth - it is strongly extended, which causes the head area to become larger. It is natural that with such an arrangement of the child, natural childbirth becomes impossible, so doctors insist on a caesarean section. It is worth noting that very often the fetus takes a frontal presentation during delivery.

The most dangerous obstetrician-gynecologists consider the facial presentation of the child before childbirth. With this arrangement, it begins to pass through the birth canal with the back of the head, risking injuring or even breaking the cervical vertebrae. Cesarean section for such an arrangement of the baby in the womb remains the only safe way to be born.

What are the types of position of the fetus in the uterus

What position the child occupies in the uterus, gynecologists determine with the help of a conditional line drawn from the back of the baby's head to his coccyx through the back, correlating it with the axis of the uterus. In total, there are three types of position of the child: oblique, longitudinal and transverse. The longitudinal position is fixed if the axis of the uterus coincides with the axis of the fetus, which has taken a pelvic or head position. The oblique position of the child is distinguished by the intersection of these lines at an acute angle. With the transverse position of the fetus, the axis of the uterus and the axis of the child form a right angle.

There is also such a thing as the type of position that the fetus takes before childbirth. The gynecologist, in order to determine the position of the baby in the mother's abdomen, determines to which wall of the uterus his back is turned. When the fetus is turned with its back to the anterior uterine wall, the anterior view of the position is fixed, if to the opposite, then this is already the posterior view of the position. For example, an ultrasound gynecologist can determine that the fetus in the womb is located in the occipital presentation, anterior position and longitudinal position. Consequently, the child is located in the uterus along its axis, the back of the head is directed to the small pelvis, and the back is turned to the anterior uterine wall.

As you know, the position of the child in the uterus, throughout the entire period, can change many times, especially if the fetus is quite active. In this case, even with an oblique presentation, there is a chance that the child during childbirth will remain as active and take the desired position. But doctors, in any case, recommend that the expectant mother not take risks and give birth to a baby using a caesarean section. Natural delivery is completely excluded in the transverse position of the fetus - since the largest parts of the child's body are located above the edges of the iliac region. Sometimes doctors make an attempt to turn the child around, which is also fraught with serious injuries.

Birth options in case of abnormal position of the fetus

Regardless of which type of breech presentation the fetus occupies, childbirth with such a diagnosis will be considered pathological. The fact is that a child during natural childbirth, if he took the wrong position, runs the risk of being seriously injured. For example, from acute hypoxia, or pinching and extension of his cervical vertebrae. Caesarean section for a pregnant woman with presentation is the only safe option to give birth to a whole baby, avoiding injuries and ruptures. Of course, in some cases, gynecologists can perform a natural birth, but in medical practice this happens very rarely. In general, the obstetrician-gynecologist, even at the stage of examining the patient, chooses the safest delivery option, taking into account the position of the child, the type of position and the state of health of the woman.

The diagnosis of "breech presentation of the fetus" requires hospitalization of the pregnant woman in a hospital for a period of 38-39 weeks inclusive. During a comprehensive examination of the woman and the fetus, the doctor analyzes the age, number of births, obstetric history, pelvic size, term and readiness of the female body in order to select an effective tactic for the upcoming birth. As you know, malpresentation of the fetus does not always become a reason for a surgical operation, and operative delivery is prescribed only in the presence of complicating factors.

When the baby in the uterus occupies an extension position - frontal, facial or anterior parietal, then natural childbirth is not recommended. An obstetrician-gynecologist with an anterior parietal location of the fetus takes a wait-and-see attitude, and if the birth does not proceed normally, he prescribes a caesarean section. The frontal head position of the child also provokes the appearance of complications, therefore, in order to preserve the health of the woman and the child, doctors deliberately prescribe operative delivery. Natural childbirth with such an arrangement of the fetus is fraught with ruptures of the perineum and uterus, as well as the death of the child from asphyxia.

It is worth noting that a child can be born normally in a natural way, even with a facial presentation. This becomes possible only if the woman has a good constitution - a wide pelvis. It is important that labor activity is active enough from the very beginning, and the fetus is small enough to easily pass through the birth canal. It is very good if labor activity in breech presentation begins arbitrarily, when the child is really ready to be born.

Features of the course of childbirth with breech presentation of the fetus

When childbirth with a diagnosis of "fetal presentation" begins naturally - without stimulants, a woman is advised to stay in bed during the entire first period. It is worth noting that she can lie on the side in which the child turned his back. This avoids complications such as prolapse of the legs of the fetus, premature outflow of fetal fluid, or twisting of the umbilical cord into loops. Directly in the hospital, the specialist will monitor the baby's heart rate and uterine contractions.

In the manual of obstetricians, which are guided by doctors, it is indicated that the legs of the child during normal childbirth should be extended along the body and pressed to the chest with handles. In the second stage of childbirth, the woman receives the help of obstetricians, aimed at maintaining the correct position of the child. In breech presentation, the baby's legs and buttocks are the first to pass through the birth canal. For one attempt, the child may appear up to the navel, after the next his shoulder blades are already visible, then his arms and shoulder girdle, and only the head will appear last. The birth of a child in this order is dangerous due to the occurrence of oxygen starvation. With his head, the baby can squeeze the umbilical cord at the first attempt, so after a maximum of 10 minutes he should be fully born. To speed up the process of passing the baby through the birth canal, the gynecologist can make an incision in the perineum, making the passage of the baby's head less traumatic.

natural childbirth with foot presentation of the fetus possible only in a multiparous mother. In addition, labor activity should take place normally and quite actively from the very beginning, the birth canal should reach full readiness, the term should be full-term, and the size of the fetus should be within the normal range - up to 3.5 kilograms. In this case, the birth will be normal, especially if the child is in excellent condition and the head is bent correctly.

During the delivery process, the obstetrician will cover the woman's external genitalia with a special napkin to prevent the baby's legs from falling out prematurely. With the correct holding of the baby's legs, the uterine pharynx has time to fully open and prepare for the passage of the head. The position of the child during attempts at this time resembles the “squatting” position. The baby's legs must be held until the uterine os is fully opened, and only after that the birth takes place without complications and delay.

Characteristics of the low presentation of the fetus

When the child in the uterus lowered his head into the pelvis before the due date, the pregnant woman is diagnosed with " low fetal presentation". According to established standards, the descent of the fetal head should occur a maximum of 4 weeks before the expected date of birth. In some situations - with certain anatomical features of the female body, this process may occur earlier and not cause concern. Most often, a low presentation of the fetus becomes known during a routine ultrasound examination, or when a gynecologist examines the uterus with the help of palpation. The specialist will easily determine that the child's head is too low, and has also become motionless or inactive.

The expectant mother, thanks to some symptoms, can independently determine the low presentation of the child. This feature is determined by several clear signs: prolonged pain in the lower abdomen, aching pain or bleeding caused by low placenta previa. The main danger of such an arrangement of the child is that he will risk suffering from hypoxia almost all the time before delivery. Oxygen starvation, as you know, disrupts the process of intrauterine development of the fetus, even during the last few weeks before childbirth. In rare cases, the pathological location of the child does not cause the symptoms described above and complications.

Features of childbirth with the wrong position of the fetus

The fetus occupies an incorrect position in the womb if its longitudinal axis does not coincide with the longitudinal axis of the uterus. According to statistics, this pathology is diagnosed in 0.5-0.7% of all pregnancies. It can be noted that most often the wrong position occurs in multiparous women. In gynecological practice, two types of incorrect position of the child are distinguished: transverse and oblique. At the same time, during all nine months of pregnancy, a woman and her doctor may not fix any deviations. For example, a future mother, who has a developed body constitution and a wide pelvis, rarely notices that her child is not located correctly in her stomach.

The fetus, which occupies the wrong position, often provokes the onset of premature delivery. Serious consequences can occur in the absence of medical care, for example, the outflow of fetal fluids will occur earlier than the accepted time, the fetus may lose mobility, its arms and legs fall out, and often all this ends with uterine rupture or death. With an oblique position of the fetus, the woman needs to lie down on her side, stimulating the child to change the position to a longitudinal or transverse one. Of course, this is not always possible to achieve, so operative delivery is most often prescribed.

Medical diagnosis of fetal position

Definition and diagnosis of the location of the child in the uterus It is carried out in the antenatal clinic during a routine examination, or directly in the maternity hospital. A gynecologist can make an accurate diagnosis only at the 35th week of the term, since until this time there are still chances that the fetus will change its position to the correct one on its own. A gynecologist with an incorrect position of the child (pelvic, oblique or transverse) usually recommends that the expectant mother perform special exercises that will stimulate the fetus to take the correct position. But already from the 36th week of pregnancy, it is almost impossible to correct the situation - the fetus is so large that it cannot move, therefore it remains in one specific position until delivery.

The diagnosis is made after the pregnant woman undergoes vaginal and obstetric examinations. In addition, a woman should undergo an ultrasound and, if possible, a three-dimensional echography. The last examination is especially important for determining the type of breech presentation. It is worth noting that during the entire period it is necessary to fix the position of the child in the uterus, and in the last month to control its presentation. Thanks to this, the gynecologist is able to predict in advance the incorrect position of the child, the risk of preterm labor and possible complications.

The doctor, to determine the type of breech presentation - the most dangerous for childbirth, carefully analyzes the position of the child's head. The degree of extension of his neck, exceeding generally accepted norms, often leads to serious injuries when the fetus passes through the birth canal. For example, the vertebrae of the baby's spinal cord, as well as his cerebellum and other parts of the body associated with the neck, are easily injured.

Methods for self-diagnosis of fetal presentation

Pregnant women are often interested in the question: how can you determine the location of the child in the uterus? The fact is that it is not always possible to regularly do ultrasound and visit a gynecologist. In addition, the child often changes his position before a certain period, which is impossible to control. It should be noted right away that it is very difficult to understand on your own what position the fetus occupies in the uterus. To do this, you need to gently feel the abdomen with your palms, while you can use the obstetric palpation technique, but it is not convenient for a pregnant woman. In addition, many expectant mothers are afraid to use obstetrician techniques on their own so as not to harm the child. In this case, it is better to wait for an ultrasound and visit a specialist.

Obstetricians-gynecologists to determine the location of the child in the womb, first analyze which part of the baby's body is located at the bottom of the uterus. To do this, you need to place your palms on the upper abdomen - when the fetal pelvis is located there, the abdomen will feel soft and motionless to the touch. When the head is directed to the upper abdomen, it is possible to feel the dense part. It should be noted that sometimes the bottom of the uterus is empty, so the buttocks and head of the child will be palpated on the sides of the abdomen. In this position, the transverse position of the fetus is diagnosed. If parts of the body are palpable in the iliac region of the abdomen, the child in the uterus occupies an oblique position.

Doctors also use such a technique as grabbing the lower abdomen with the right hand, thereby covering the presenting part with the middle and thumb. With the head presentation of the child, his head will be easily felt, making movements. With an incorrect presentation, pelvic, in the lower abdomen, signs of head movement will be completely absent.

External rollover of the baby in the womb

When diagnosing an incorrect presentation of a child in the womb at 29-30 weeks of the term, specialists may attempt to turn it over so that the fetus takes the necessary position for normal delivery. Conservative methods include special corrective gymnastics, which is effective in 75-85% of cases. Physical exercises are strictly contraindicated in the presence of pathologies and anomalies in the development of the fetus, scars on the uterus, a threat of miscarriage, preeclampsia, placenta previa, oligohydramnios, polyhydramnios, multiple pregnancy, a narrow pelvis in a woman and the presence of serious extragenital diseases.

Non-traditional methods of correcting the position of the child include acupuncture, acupressure, aromatherapy, swimming and homeopathy, and sometimes self-hypnosis methods, sound and light influences on the child from the outside are also used. Specialists in the hospital can perform the so-called turning of the fetus on the head, but only for a period of 35-37 weeks. This preventive action was first used by B.L. Arkhangelsk, but the effectiveness of the reception is relative - it ranges from 35% to 87% of a successful change in the position of the fetus.

It should be understood that the external preventive rotation of the fetus has the right to be carried out only by a qualified specialist in stationary conditions. In the event of any complications, a caesarean section is immediately prescribed and medical care is provided to the newborn. If the coup is successful, you should consolidate the result with a special bandage and certain exercises. Thanks to this, it is possible to fix the baby's head in the correct position before delivery.

Methods for the prevention of malpresentation

Prevention of the incorrect position of the child in the uterus involves ensuring the normal course of the entire pregnancy, regular drug treatment if indicated, as well as the identification and treatment of preeclampsia, FPI and the threat of miscarriage at an early stage. It is important to avoid prolonging a pregnancy with a large fetus, as the baby may take the wrong position. Effective prevention is the implementation of special exercises prescribed by a doctor. In general, it is necessary to choose a safe tactic for childbirth in advance - the gynecologist must take into account all risk factors and consider methods for their prevention.

In any case, the pregnant woman must agree to a caesarean section if there are indications for this. In addition, with the help of the doctor's recommendations, it is necessary to prepare the body for childbirth as efficiently as possible. If the first suspicious symptoms appear, you should immediately consult a specialist. After a natural birth or caesarean section, a young mother is recommended to go through a period of recovery of her body, as well as to provide a complete examination for the newborn using clinical and laboratory diagnostic methods.