Transverse position of the fetus 2 position. Causes of the transverse location of the fetus. How is childbirth and pregnancy

With the approach to childbirth, the fetus takes a certain position in the uterus. The norm is considered cephalic presentation- the child is located head down, pressing his chin to his chest. This position ensures the correct biomechanism of childbirth, reducing the risk of injury to the mother and baby. But sometimes at 37-38 weeks the child remains in a pathological position. It includes transverse and oblique position fetus. This condition occurs 1 time in 200 births, which is 0.5-0.7%.

What is considered a transverse position

The birth axis runs vertically from the uterus to the exit of the genital tract. The axis of the fetus is considered a conditional line that connects its coccyx and the back of the head. At normal delivery these two lines match. But sometimes the axis of the fetus is perpendicular to the axis of the uterus. This state is considered the transverse position. If these two lines are at an angle, they speak of an oblique position.

Transverse presentation

The pelvic transverse presentation of the fetus means that the baby's buttocks are located closer to the exit from the small pelvis. Another situation, when the baby lies slightly higher with the legs, is called the head transverse presentation of the fetus.

Normally, throughout pregnancy, the baby is able to occupy any position in the uterine cavity. The more room for movement, the more likely it is to change position and presentation. But at 34-36 weeks, the baby occupies the final position, which will not change until the moment of birth.

After this period, the number of amniotic fluid, the uterus descends. Women honor that breathing is easier. And the fetus is more pressed against the entrance to the small pelvis. Therefore, he will not be able to roll over on his own.

Therefore, every visit to the doctor long term palpation through the anterior abdominal wall, he determines where the head of the child and his legs are.

Causes of pathological presentation

Myoma

Large nodes can deform the uterine cavity. If the fibroid is located subserous and grows mainly in the abdominal cavity, it is less dangerous than the submucosal or interstitial node. The last two can significantly change the size of the uterine cavity.

It should also be remembered that in women with a small size of nodes that were stable before pregnancy, after conception, accelerated growth. This is due to an increase in progesterone and a large number of receptors for it on myomatous nodes. The child, in an attempt to take a comfortable position, will stumble upon a protruding tight knot and will not be able to roll over with his head down.

High birth parity

The reasons for the transverse position of the fetus may lie in multiple births. This condition is much less common in primiparas, but the frequency increases with 4-5 births. The increased risk is explained by a decrease in the tone of the abdominal muscles, more flabby tissues capable of significant stretching.

Congenital malformations of the uterus

oligohydramnios

With an insufficient amount of amniotic water, the situation is reversed. The child cannot take the correct position due to the limited space in the uterine cavity.

Polyhydramnios

A large amount of amniotic fluid stretches the uterus, allows the fetus to swim freely in its cavity and change its location. occurs due to infection, pathology of the fetus, combined with intrauterine hypoxia. At the same time, it increases physical activity baby, woman hears active movements, increases the likelihood of a transverse or oblique location.

Threat of preterm birth

With a constant or frequently repeated tone of the uterus, the child experiences pressure from its walls. They do not allow him to move to the required position. Therefore, transverse or oblique presentation may not change to the right time to the correct one.

Fetal hypotrophy

Feto-placental insufficiency leads to chronic. This affects the weight of the child: there is a lag in the set of length and body weight, sometimes for several weeks. Lack of weight allows free movement in the uterine cavity and by the time of delivery may maintain an incorrect position relative to the axis.

large fruit

The risk increases in the presence of a narrow pelvis of 1-2 degrees. The child does not have enough space to move, he cannot descend into the small pelvis, so he takes the wrong position.

Multiple pregnancy

With twins, one or both children may take a position that is most convenient for them, but makes childbirth difficult naturally. Sometimes the first baby is located correctly, and the second lies across, forming a kind of belt around it. Natural childbirth in this case is impossible, they will lead to a neglected transverse position and death of the fetus.

Sometimes the transverse position is observed in preterm birth, which occurs at 28-29 weeks and up to 37 weeks. Adnexal tumors located above the pelvic inlet are also a risk factor.

Signs of a change in position

Symptoms cannot be recognized on their own. This condition may be suspected by a doctor who examines a woman when she arrives at women's consultation. Pay attention to the following signs:

the abdomen in the transverse position of the fetus looks stretched to the sides;
with an oblique arrangement, the abdomen is obliquely stretched;
the uterus in shape approaches the ball, instead of the ovoid appearance;
palpation fails to determine the presenting part.

The head, when palpated through the anterior wall of the abdomen, is palpated to the left or to the right of the midline of the abdomen.

Fetal presentation options

During the CTG recording, the sensor will pick up the signals of the baby's heartbeat in an uncharacteristic place - below the navel of the pregnant woman.

Turning technique

Manipulation is carried out by the doctor only by exposure through the abdominal wall, the introduction of hands into the vagina is not required. The procedure requires the following conditions:

good fetal mobility;
normal dimensions of the pelvis (external conjugate 8 cm);
lack of indications for the rapid end of labor (fetal asphyxia according to CTG, placenta previa, bleeding).

In multiparous women with a well-stretched abdominal wall, external rotation is performed without anesthesia. In other cases, a woman in labor is administered a solution of Promedol in 30 minutes. The patient is located on a hard couch, pulling her legs to her. The doctor probes the head and pelvic end of the fetus. He puts his hands in such a way that they are located on top of these parts and grab them.

Then they begin to put pressure on the head, shifting it to the entrance to the small pelvis. The second hand presses on the pelvic end of the fetus and moves it up. Manipulation requires a certain strength and perseverance and at the same time caution. If the uterus began to tone up, then the turn is done during the rest period. When a contraction appears, it must be skipped, but at the same time the hands do not let go of the fetus, thereby fixing its position and not allowing it to slip back.

External rotation of the fetus

After the manipulation, the pregnant woman is prescribed to wear a bandage with special rollers. Outward rotation does not eliminate the cause of the misposition. Therefore, in Lately it is being used less and less high risks complications of the procedure. They may be:

premature effusion amniotic fluid;
Start labor activity;
placental abruption;
bleeding.

delivery

Only the right way end the pregnancy in the transverse position of the fetus is C-section. The operation is carried out as planned. To reduce the risk of complications, a pregnant woman is hospitalized at 36-37 weeks for observation and preparation for surgery.

Before surgery, the doctor may try to change the child's position. To do this, the woman is laid on her side and the presenting part is expected to fall into place. If this does not happen in a hospital setting, then a planned caesarean section is performed.

When the transverse position is started, regardless of the condition of the child, childbirth ends only with a caesarean section and does not wait for a spontaneous turn.

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 correct position 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 period, can not always adapt to a new environment for itself. So, with the immaturity of the lung tissue, there may be problems with independent breathing, acute respiratory failure may develop, and with a low weight of a child born ahead of time, 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 when transverse presentation recommended to give birth surgical intervention– cesarean section operation allows you to remove the baby from their womb without the risk of getting serious 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. Polyhydramnios contributes to such motor activity. If quantity amniotic fluid above the norm, 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 pregnancy, which is why the position and condition of each of the fruits is so careful observation throughout multiple pregnancies.

The baby can take the transverse position as the only convenient one if a woman almost constantly has an increased tone of the uterus during pregnancy, 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, stand in correct posture- cephalic presentation - the baby can not. 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, it is recommended special gymnastics, 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 position 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 future mom she herself will be set for the best, she will remain 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.

You can not skip scheduled visits to the doctor in the antenatal clinic. 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 precautions, a woman begins to premature birth, regular painful contractions appeared, the waters broke, it is important to take a horizontal position in order to prevent the baby’s handle from falling out of the genital gap, which is in a breech presentation. 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.

Transverse ( situs transverses) and oblique ( situs obliguus) the position of the fetus is incorrect.

The oblique or transverse position of the fetus is determined by the ratio of the large part of the fetus to the line connecting the iliac crests. With an oblique position of the fetus, one of its large parts (the head or pelvic end) is located below the iliac crest. In the transverse position, both the head and the pelvic end of the fetus are above the line connecting the iliac crests.

In the transverse position, the axis of the fetus forms a right angle with the longitudinal axis of the uterus, in an oblique position it is sharp.

With high mobility, the fetus can take a longitudinal, and then again be located obliquely or transversely. This condition is called unstable fetal position.

Causes the formation of incorrect positions of the fetus:

Excessive fetal mobility (with polyhydramnios, fetal malnutrition, sagging muscles of the anterior abdominal wall in multiparous);

limited fetal mobility (with oligohydramnios, large fruit, multiple pregnancy, uterine myoma, increased uterine tone with the threat of abortion);

Obstacles to the insertion of the head (placenta previa, narrow pelvis, fibroids in the lower uterine segment);

Anomalies in the development of the uterus (bicornuate, saddle uterus, septum in it);

Anomalies in the development of the fetus (hydrocephalus, anencephaly).

Diagnostics. One of the signs of the incorrect position of the fetus is the transverse-oval or oblique-oval shape of the abdomen of a pregnant woman, the low standing of the bottom of the uterus.

With an external obstetric examination, the presenting part of the fetus is not determined. Large parts are palpated in the lateral sections of the uterus (Fig. 15.1). The position of the fetus in the transverse and oblique positions is determined by the head: when the fetal head is located on the left - the first position, on the right - the second position. The type of fetus is determined in the same way as in the longitudinal position: in relation to the back to the anterior (front view) or posterior (rear view) wall of the uterus. The fetal heartbeat is best heard in the navel.

Rice. 15.1. Transverse position of the fetus. outdoor obstetric research. A - the first reception; B - the second reception; B - the third reception; D - fourth reception

During vaginal examination, the presenting part of the fetus is not determined.

After the outflow of amniotic fluid, you can determine the shoulder or handle of the fetus, the loop of the umbilical cord, sometimes the ribs, the spine of the fetus are palpated.

Ultrasound is of great help in diagnosing the position of the fetus.

The course of pregnancy and childbirth. Pregnancy with incorrect positions of the fetus can proceed without complications. At wrong position fetus one of the frequent complications (up to 30%) are premature births.

The next frequent complication during pregnancy and childbirth is untimely (premature or early) rupture of amniotic fluid, which may be accompanied by prolapse of the umbilical cord, small parts (handles, legs), which contributes to fetal hypoxia and infection. The most formidable complication in the transverse position is loss of mobility fetus - launched transverse position. It is formed after the outflow of amniotic fluid and tight grasp of the fetus by the uterus. When the transverse position of the fetus is neglected, one of the shoulders can be driven into the small pelvis, and the handle falls out of the cervix (Fig. 15.2). As a result of labor activity, the lower segment is overstretched. In this case, at first there is a threat of uterine rupture, and then its rupture occurs if a caesarean section is not performed in a timely manner. The fetus usually dies from acute hypoxia.

Figure 15.2. Transverse position of the fetus. First position, front view. Right handle falling out

With small fetal sizes (prematurity, malnutrition) and large pelvic sizes, fetal self-rotation in longitudinal position or selfishness. Even less often, childbirth occurs with a double body, when the fetus folds in the spine in half and is born in this state (Fig. 15.3). In this case, the fetus often dies.

Rice. 15.3. Launched transverse position of the fetus

Management of pregnancy and childbirth. If a transverse or oblique position of the fetus is detected, the outpatient physician should monitor the patient more carefully, recommending that she avoid excessive physical activity. With a transverse position of the fetus, a woman should lie several times during the day on the side where the head is located, and with an oblique position, on the side below the large part located. The woman is warned to immediate hospitalization in case of outflow of amniotic fluid. In the period of 38-39 weeks, the patient is hospitalized in an obstetric hospital. In the absence of contraindications, an attempt is made to make an external obstetric rotation of the fetus into a longitudinal position. While maintaining the transverse position of the fetus, regardless of the parity of childbirth, the only method of delivery is caesarean section.

Most favorable for operative delivery first stage of childbirth. When the first contractions appear, sometimes there is a change in the position of the fetus to a longitudinal one (self-rotation). Before the onset of labor, a caesarean section is performed with a tendency to overmaturity, placenta previa, prenatal rupture of amniotic fluid, fetal hypoxia, a scar on the uterus, genital tumors (with their subsequent removal).

When small parts of the fetus (umbilical cord, pen) fall out, an attempt to reposition them into the uterus is not only useless, but also dangerous, as it contributes to infection and increases the time before operative delivery. Conducting labor in case of loss of small parts of the fetus through the natural birth canal is possible only with a very premature fetus, the viability of which is highly questionable.

The combined rotation of a viable fetus on a leg with subsequent extraction is used extremely rarely, as it is unsafe for the fetus. Such a turn is carried out mainly in the transverse position of the second fetus in a woman in labor with twins.

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.

The position of the baby in the womb depends on the possibility of natural childbirth. If the baby is in the wrong position, a caesarean section is indicated.

Classification of positions and presentations:

The correct position is longitudinal, oblique, unstable;
Wrong 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.

Quite often, the transverse position of the baby in the womb is called 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, when 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. Often there is a premature outflow of 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. The neglected transverse position with increasing labor activity is dangerous because uterine rupture can 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 and 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 of the abdominal cavity.

The position of the fetus is one of the most important factors in labor. The incorrect position of the baby in the uterine cavity often leads to complications during delivery.

The transverse position of the fetus is different in that the line from the coccyx to the head is perpendicular to the axis of the uterus. In addition, there may be an oblique position when the above line and the axis of the uterus make an angle of less than 45º. In this case, the causes and methods of prevention of these two provisions are the same.

Kinds

There are two types of pathology:

The transverse position of the fetus with abdominal presentation - the longitudinal line of the baby is perpendicular to the axis of the uterus, while the limbs rest against the birth canal;
The transverse position of the fetus with dorsal presentation - the line of the fetus is located at right angles to the axis of the uterus, and the spine is pressed against its entrance.

Causes

The list of causes of the transverse and oblique position of the fetus is extensive:

Insufficient tone of the walls of the uterus leads to the impossibility of the normal position of the child. Most often, such a negative change occurs if the previous birth was complicated or accompanied by a postpartum infection.
Lack of space and limited activity for fetal movement are consequences of multiple pregnancies, heavy weight child, oligohydramnios, increased tone uterus.
Deviations in the anatomy of the genital organs, for example, saddle or bicornuate uterus.
Omission of the placenta and its presentation.
Narrowing of the pelvis 3-4 degrees.
Deformity of the baby's head caused by anencephaly (absence of the brain) or hydrocephalus (dropsy of the brain).
Excess amniotic fluid leads to a significant stretching of the uterine cavity, due to which the baby cannot determine the boundaries of the uterus.
Weakness in the abdominal muscles that occurs in women who have given birth more than three times. The abdominal muscles cannot hold the baby in the right position.

Diagnostics

Recognition of the abnormal location of the child in a singleton pregnancy is not difficult. During palpation of the uterine cavity and examination of the abdomen, the problematic position of the fetus is determined by the following signs:

The girth of the abdomen exceeds the standard for the current period, and the level of standing of the bottom of the uterus is less than normal;
The child's buttocks are palpated on the side of the uterine cavity.

When carrying two or more children or polyhydramnios, this diagnostic method does not work. In these cases, the problem can only be determined by ultrasound. It provides the most accurate information on important factors, How:

head position;
fruit size;
location of the placenta;
polyhydramnios;
entanglement with the umbilical cord;
changes in the structure of the uterus.

dangers

Most often, the transverse position of the fetus can cause a miscarriage, with this pathology, the uterus is constantly in a state of hypertonicity.

The second most common complication is premature rupture of amniotic fluid. It is also possible prolapse of the umbilical cord and one of the limbs of the baby. All this leads to a lack of oxygen in the child and the penetration of infection.

In addition, there is a risk of a double body. This can happen due to premature discharge of water and strong contractions: the walls of the uterus squeeze the fetus too tightly and, as it were, fold it in half, in half. At the same time, it is almost impossible to give birth to a viable child.

Most dangerous complication- this is the neglected transverse position of the fetus. With such a pathology, after the withdrawal of water, the child is too much covered by the contracted uterus, one of the shoulder joints is fixed in the cervix, and the handle is in the birth canal. With the start of the fight Bottom part the uterine cavity is deformed more than allowed. Damage to the walls of the uterus occurs, acute bleeding begins. It is extremely difficult to save a woman in labor. The baby has practically no chance of surviving due to lack of blood flow in the " children's place and hypoxia.

Features of childbirth

All women who are diagnosed with a transverse position of the fetus are advised to wait for delivery in medical institution. In 5% of cases, the baby himself takes the correct position. The remaining 95% are shown caesarean section, the terms of which are determined individually. Urgent CS is carried out in case of:

detection of scar formations in the uterine cavity;
discharge of amniotic fluid;
the appearance of signs of oxygen starvation in a child;
detection of the umbilical cord or limbs of the fetus in the birth canal.

Fact. Before the widespread introduction of caesarean section into medicine, the method of intrauterine fetal rotation was used. Nowadays, it is used only in the case when there is no possibility to perform an operation and it is necessary to save at least a woman. Such manipulations in the vast majority lead to uterine rupture and stillbirth.

Prevention

Gymnastics - the best prevention transverse position of the fetus. It is prescribed if there are no such contraindications as:

omission of the placenta and its presentation;
disorders in the vessels of the umbilical cord;
multiple pregnancy;
cicatricial formations on the uterus;
uterine hypertonicity;
benign tumors;
oligohydramnios or polyhydramnios;
bloody issues.

Obstetricians have compiled a set of exercises that contribute to the coup of the fetus in a transverse position. Due to it, a rhythmic contraction of the muscles of the abdomen and trunk occurs, combined with deep breathing. This method of preventing complications is prescribed from the 32nd week of pregnancy when the transverse position of the fetus is established.

Doctors advise to perform this complex 3 times a day:

Pelvic tilt. You need to lie on the floor and raise the pelvis by about 25-30 centimeters relative to the head. Fix the pelvis in this position for 10 minutes.
Cat. Get on all fours. As you inhale, stretch your stomach to the floor, as you exhale, bend your back up. And so 10 times.
Knee-elbow stand. Press elbows and knees to the floor. Put your head on your hands. You need to stand in this position for 20 minutes.
Half bridge. Lie down on the floor. Place two pillows under the hips so that the height from the floor is approximately 35 centimeters. In this position, you need to raise your legs 10 times.

Usually, thanks to this complex, the child takes the correct position for a week and a half, then he is fixed with a bandage with vertical rollers. This method of fixation is recommended to be used before the onset of childbirth.

Thus, the transverse position of the fetus in the majority of cases can really be changed before the occurrence of complications with timely prevention. But even if the baby does not turn around by the beginning of labor, a cesarean section will reduce possible complications to a minimum.