Foot presentation of the fetus. Breech presentation of the fetus: causes, childbirth, exercises, photos

Tactics of conducting labor in breech presentation. Ways to turn the baby in the mother's belly.

Many women look forward to their third ultrasound at 32 weeks. At this time, it is already possible to determine with 100% probability the gender of the child, look at his arms and legs.

Many pregnant women manage to capture how the baby sucks his finger and swallows the amniotic fluid. But on the third ultrasound, there may be reasons for frustration. A woman finds out what position her baby is in relative to the birth canal. Not always the child's head presses on the mother's pelvis.

What does breech presentation mean?

This is the wrong position of the baby inside the uterus. In this case, the baby does not rest on the head of the woman's bosom, but on the booty or knees. This situation significantly complicates the course of childbirth, since the child cannot come forward with the booty. In breech presentation, forceps and caesarean section are often used.

What is dangerous breech presentation of the fetus?

There are many dangers associated with breech presentation. First of all, not always a pregnant woman can carry a baby and give birth to him on time. During pregnancy, the following complications are possible:

• Fetal hypoxia
• placental insufficiency
• Preeclampsia
• Varicose veins in a pregnant woman
• Defects of the heart and internal organs in the fetus

During childbirth, even greater difficulties can arise. Most often, a woman is recommended a planned caesarean section. But the doctor carefully examines the card of the woman in labor and may recommend natural childbirth. At the same time, it should be understood that the likelihood of birth injuries increases significantly.

Complications during childbirth:

• Insufficient opening of the cervix, clamping of the head. The fetus may suffocate because the legs are in the pelvis and the head is still in the mother's abdomen. The birth canal suffocates the baby. In this case, an episiotomy is shown - a dissection of the perineum
• Prolonged and difficult childbirth due to prolapse of the umbilical cord. No nutrient flow due to constriction. The child develops hypoxia
• Damage to the spine in a baby as a result of the fact that doctors pull him by the legs
• Possible clavicle fracture

There are several types of breech presentation:

• Gluteal. In this case, the baby's legs are directed along the body, and the heels are at the level of the head. It looks like it's bent in half.
• Foot. In this case, the heels of the child rest against the mother's womb. During natural delivery, the legs appear first.
• Mixed. In this case, one leg of the baby is bent and presses on the birth canal, and the second leg is directed to the head or butt and legs are directed to the uterine pharynx

All this the doctor takes into account when choosing the tactics of childbirth. The simplest is the breech presentation. In this case, there is a chance, with the correct course of childbirth, to get a healthy baby.

Breech breech presentation of the fetus

With a breech presentation, the baby's booty presses on the mother's womb. During natural childbirth, the baby's bottom is born first. The child comes out bent. In this case, after the birth of the torso to the neck, the legs of the child straighten. And he literally hangs, stuck in the uterine ring. The most crucial moment is the birth of the head.

Usually, women are prescribed a caesarean section, especially if there are concomitant ailments. During breech presentation, there is a high risk of cord clamping. The child may choke or suffocate inside.

Breech foot presentation of the fetus

With foot presentation, in almost 100% of cases, a caesarean section is required. The difficulty lies in the fact that soft and small legs quickly go out through the cervix. In this case, the opening is insufficient to remove the head. The child can hang and suffocate between the insides of the mother and her vagina for a long time. Doctors recommend a planned caesarean section.

Breech mixed presentation of the fetus

With a mixed presentation, a caesarean section is also recommended. It occurs in 20% of cases of breech presentation. In this case, the child, as it were, squats inside the mother. Often, during childbirth, it turns into a true breech presentation, when the legs are straightened.

Breech presentation of the fetus: how to turn?

There are several methods for turning the baby:

• In the hospital "external turn". Conducted by a doctor. The specialist turns the child over by pressing and rotating
• Through gymnastics. There is a whole range of exercises in which the baby can roll over on his own.

External rotation is carried out in a hospital with a prepared operating room. A woman is having an ultrasound. After that, the doctor determines in which direction the fetus is deployed. The woman's stomach is sprinkled with talcum powder and by grasping the buttocks of the child through the mother's stomach, they unfold it, gradually moving the head and buttocks. Manipulation should be carried out by a very experienced doctor. Otherwise, rupture of the fetal sac and premature birth is possible. The procedure is performed at 37 weeks of gestation.

VIDEO: External rotation of the fetus

Gymnastics with pelvic presentation of the fetus

If the period is short, up to 36 weeks, then the baby can roll over in the stomach. You must help him with this. To do this, perform special exercises that increase the vibration of the abdomen. Exercises are performed from the 29th week of pregnancy.

• Bridge. You should lie on the floor with your back firmly pressed against it. Pillows are placed under the buttocks. Your hips should be 40 cm higher than your shoulders. You can put your knees on your husband's shoulders
• Birch. This is a common and simple exercise, however, in a position with a large belly, it is not easy to do it. Lie on the floor and raise your legs. Grab your pelvis with your hands and straighten your knees. Stay in this position for a while.
• Triangle. Stand next to the bed with your feet on the bed. It is necessary that the knees touch the bed or sofa. Head and hands on the floor. So you do the body slope

All these exercises should be repeated 2-3 times a day. They are aimed at shifting the baby's buttocks from the uterine pharynx. Thus, a space is formed between the womb and the booty of the child, the baby will be able to roll over without hindrance.

Birth in breech presentation

Now about 80% of births with breech presentation end in a caesarean section. In this case, the tactics of conducting childbirth is chosen exclusively by the doctor. The health of the mother and the type of breech presentation are taken into account.

The most beneficial can be considered a true breech presentation. Since the circumference of the priests and legs together is approximately equal to the circumference of the head. If the buttocks pass with sufficient opening, the head must also leave the woman's womb unhindered. With foot and mixed presentation, in almost all cases, a cesarean is used.

• It is necessary to try to make the baby roll over in the stomach itself. To do this, exercise and lead a healthy lifestyle.
• If at 37 weeks your baby is still in a breech position, ask your gynecologist which hospital can turn the baby around with pressure on the abdomen
• Do not despair, agree to a caesarean section if an experienced specialist insists on it. The health of the child is above all

Stay healthy and worry less. Everything will be fine with your child.

VIDEO: Childbirth with breech presentation of the fetus

Expectant mothers, having learned from the doctor that their baby is head up in the tummy, begin to worry, because this position of the fetus is considered incorrect. It is called breech presentation. The baby should be head down in the uterus as it is the widest part of the fetus.

It is best if the head appears first during childbirth, and then the rest of the body. However, in 3-5% of women, childbirth occurs with a breech presentation of the fetus, which is fraught with complications.

The location of the child in the uterine cavity is classified as follows:

1. foot- both hips are unbent or only one of them, and one leg is located at the exit from the uterus. This type of presentation is observed in 10-30% of pregnant women (most often in multiparous women).
2. Gluteal- the legs of the fetus in the hip joints are bent, and the knees are pressed to the tummy and straightened. This presentation occurs in 50-70% of women in position (most often in primiparas).
3. mixed(gluteal-leg) - knees and hips are bent. This type of presentation occurs in 5-10% of cases.

Causes of breech presentation of the fetus

Up to 32 weeks, the fetus can take various positions in the mother's tummy. The presence of free space in the uterus allows it to move. As the child grows, he tends to lie head down.

For the following reasons, the breech presentation of the fetus may persist until delivery:

• oligohydramnios or;
• placental pathology: location in the area of ​​tubal corners,;
• pathology of the uterus: violation of tone, fibroids;
• fetal pathology: anencephaly, hydrocephalus;
• multiple pregnancy;
• consequence of a caesarean section.

Signs of breech presentation of the fetus

Many women are concerned about the question of what the breech presentation of the fetus means, and by what signs it can be determined. Pregnant women do not feel at all that their baby is lying incorrectly in the uterus. There is no discharge or pain. Breech presentation can only be determined by a doctor during an examination.

Experts note that when the baby is positioned head up, there is a higher standing above the pubis of the uterine fundus, which does not correspond to the gestational age. In the region of the navel, the heartbeat of the fetus is more clearly audible.

With a vaginal examination, the doctor may identify signs of a breech presentation of the fetus. With a mixed and foot position of the child, his feet are probed, and with the gluteal position, the sacrum, inguinal fold, soft bulk part, coccyx are felt. Despite all the signs, the exact diagnosis is determined only by ultrasound.

Delivery with pelvic presentation of the fetus

A child can be born in a breech presentation naturally or as a result of a caesarean section.

The choice of a particular method of delivery depends on the following factors:

• the age of the pregnant woman;
• duration of pregnancy;
• history data;
• existing diseases;
• the size of the pelvis;
• type of breech presentation;
• sex and weight of the fetus, the degree of extension of his head.

Childbirth with a breech presentation of the fetus can take place naturally if: the gestational age is more than 37 weeks; the average estimated weight of the fetus is 2500-3500 g; the size of the mother's pelvis is normal; it is known that a girl will be born, not a boy; the presentation is breech or breech.

If the above conditions are not met, then it is required. Besides, operation is necessary in the event that: childbirth is premature; fetal weight is less than 2500 or more than 3500 g; male fetus; breech presentation is foot, ultrasound revealed hyperextension of the fetal head.

The doctor, having begun to take birth in a natural way, may decide to perform a caesarean section. It will be called an emergency. Indications for immediate surgery may include:

• weak generic activity;
• prolapse of the baby's legs, arms or umbilical cord;
• discoordination of labor activity (contractions are observed, and the cervix does not open).

Possible complications during childbirth with a breech presentation of the fetus

Breech presentation of the fetus in the longitudinal position absolutely does not affect the course of pregnancy. Complications may occur during childbirth.

First, labor activity can be weak. This is due to the fact that the pelvic end of the fetus is smaller than the head in volume. It weakly presses on the uterus, and as a result, it contracts worse, its neck opens more slowly.

Secondly, during childbirth, the baby's head may tilt back. Her appearance will be difficult. There is a risk that the child will be injured.

Thirdly, often with a breech presentation of the fetus, the umbilical cord is clamped between the wall of the birth canal and the head. Because of this, the flow of oxygen will be difficult. The fetus will go into hypoxia.

Fourthly, during childbirth, throwing back of the handles is possible. It is also fraught with various injuries.

Can breech presentation be corrected?

Many new mothers start to panic too early when they find out that their baby is in the wrong position in the tummy. For example, some women find out on ultrasound about the breech presentation of the fetus at 20, 21 or 22 weeks and are already starting to look for ways to correct his position. However, it is still too early to think about this. In most pregnant women, the baby takes the correct position by 32 weeks or even later.

If at 32 weeks, an ultrasound scan showed that the fetus did not roll over and remained in the head-up position, then special exercises can be started. They are effective, and in most cases, thanks to them, the breech presentation of the crumbs is replaced by the head.

Exercises can be started with a breech presentation of the fetus from 33 weeks. You should first consult with your doctor. In a pregnancy with complications, you may have to give up exercise altogether so as not to harm the baby. Only a doctor will tell you whether it is possible to perform physical exercises, and whether they will negatively affect the condition of the expectant mother and fetus.

All classes are recommended to start with a warm-up. Within a few minutes, a pregnant woman can walk with a normal step, and then on her toes and heels. Hand movements (rotation, raising and lowering), raising the knees to the side of the abdomen will not be superfluous. Below are some examples of simple exercises that can be done after 32 weeks with a breech presentation.

Exercise 1

Stand up with your back straight and legs apart. The arms should hang freely along the body. Then you should stand on your toes and spread your arms to the sides, bend your back, take a breath. After that, exhale and take the starting position. Do the exercise 4-5 times.

Exercise 2

Pillows are required for this. They are necessary in order to raise the pelvis. The pregnant woman should lie on the floor with a few pillows. The pelvis as a result of this should rise above the level of the shoulders by 30-40 cm. The pelvis, knees and shoulders should form a straight line. This exercise is recommended to be performed a couple of times a day for 5-10 minutes, but not on a full stomach.

Exercise 3

Get on all fours with your head down. While inhaling, round your back. Then return to the starting position. Exhale, bending in the lumbar and raising your head up.

Exercise 4

It is necessary to lie on your back, spreading your legs shoulder-width apart and bending them. The feet should rest on the floor. Hands need to be relaxed and stretched along the body. When inhaling, you should raise your back and pelvis, resting on your shoulders and feet, and when exhaling, take your starting position. Then you need to straighten your legs, take a breath, drawing in your stomach. The muscles of the perineum and buttocks should be tense. When exhaling, return to the starting position. This exercise is recommended to be repeated 6-7 times.

If you want to start exercising early (for example, at 30 weeks with a breech presentation of the fetus), then you should definitely consult a doctor.

Not only exercise can affect the position of the fetus. Great importance is played by proper nutrition, walks in the fresh air.

It is advisable for pregnant women to sit on chairs with a firm and straight back and a hard seat. When sitting on upholstered furniture, it is recommended to spread your legs a little so that your stomach lies freely. If possible, you should buy a fitball and perform special exercises on it that can affect the position of the child in the mother's tummy.

Thus, you should not panic if you learn from a doctor about a breech presentation of the fetus before 27 weeks. The baby can change its position several times before giving birth. If desired, from 30-32 weeks in the absence of contraindications, you can begin to perform special physical exercises.

If they do not affect the position of the fetus, then the doctor will select the best delivery option (caesarean section or natural childbirth), which will not harm either the woman herself or her child.

Answers

In the vast majority of cases, by 34-36 weeks of pregnancy, the baby settles head down. Obstetricians call this position - head presentation. It is easier and easier to be born with a head, both for mother and baby. But from 3 to 5% of children are in a breech presentation. With a breech presentation, the baby's head is at the top, in the bottom of the uterus, and the pelvic end is located above the entrance to the small pelvis.

It is customary to distinguish between several types of breech presentation: pure breech, mixed breech, foot, knee presentation is extremely rare. In a pure breech presentation, the baby's legs are raised and the stacks are near the baby's head. With a mixed breech presentation, the baby seems to be squatting. And with a foot presentation, the baby’s legs are unbent, he “stands” on both legs (full foot presentation) or one (incomplete foot presentation). The most common pure breech presentation is 65%, less common is mixed breech presentation - 22%, foot presentation occurs in approximately 13% of cases. Obstetricians note a decrease in the number of breech presentations as the gestational age progresses. This is quite understandable, because nature seeks to place the child in the most convenient position for childbirth. From a scientific point of view, this fact is explained as follows: the shorter the gestational age, the less mature the child's vestibular apparatus is, the higher the frequency of breech presentations.

The reason for the formation of breech presentations is not well understood. Normally, the uterus has the shape of an ovoid (egg) with a more significant oval at the bottom. The contour of the baby is also similar to an ovoid with a large oval at the pelvic end. Thus, by being installed head down, the baby adapts to the shape of the uterus.

That is why one of the reasons for the formation of breech presentation is the irregular shape of the uterus (saddle, bicornuate, etc.). In addition, breech presentation can occur for the following reasons:

• increased mobility with polyhydramnios, premature pregnancy, multiple pregnancy;
• a reduced amount of amniotic fluid limits the baby's mobility;
• placenta previa, when it "blocks" the baby in the birth canal;
• too large size of the fetus or narrowing of the bone pelvis, i.e. violation of the correct ratio between the size of the head and the size of the entrance to the small pelvis.

The most common reason for the formation of breech presentation is the lack of readiness of the body for childbirth, which is manifested by a violation of the tone of the uterus. It can be either low, or high, or uneven. Studies have shown a high frequency of menstrual irregularities and various gynecological diseases, which leads to a violation of the neuromuscular apparatus of the uterus and, as a result, breech presentation.

Diagnosis of breech presentation usually does not cause difficulties. With an external examination, the obstetrician-gynecologist palpates (palpates) the soft presenting part, and the head is determined in the bottom of the uterus - it is more solid, rounded, ballots (shifts relative to the neck of the fetus). With breech presentation, there is a higher standing of the uterine fundus in relation to the gestational age. The baby's heartbeat is heard clearly above the navel of a pregnant woman. Helps to establish the diagnosis of pelvic presentation gynecological examination and ultrasound. Ultrasound examination allows you to get additional information about the type of breech presentation, the size of the baby, the position of the head (it is bent or unbent), the location of the placenta, the location of the umbilical cord.

No features of the course of pregnancy in breech presentation were identified. The presence of breech presentation up to 28-30 weeks of pregnancy does not require treatment, dynamic monitoring is indicated, because. cephalic rotation occurs spontaneously in more than 70% of cases. However, starting from the 29th week of pregnancy, special exercises are recommended to help the baby turn correctly. It is very important to talk to the baby, explaining to him why it is better to sit head down. There are several different complexes recommended in this case.

Method I.F. Dikanya applied from 29 to 40 weeks. 3 times a day, a pregnant woman lies alternately on one side, then on the other. Lie on each side 3-4 times, each time for 10 minutes. To do this, you can use a regular couch or bed. When the head is established above the entrance to the small pelvis, it is recommended to lie more on the side corresponding to the back of the child. This method increases the motor activity of the baby, changes the tone of the uterus by increasing the irritation of its receptors with a change in body position. The method is good for its simplicity and accessibility, has practically no contraindications.

Method V.V. Fomicheva used from 32 weeks. This is a special set of exercises that is carried out 2 times a day for 20-25 minutes. First, a warm-up is carried out - this is walking on toes, on the heels, on the outer arch of the foot and the inner one, walking with the knees raised to the side of the abdomen. Exercises are performed at a slow pace in a certain sequence from simple to more complex. You will need a stable chair and mat.

• I.p. - standing, feet shoulder-width apart, arms lowered. Tilt to the side - exhale, return to I.P. - breath. Repeat 5-6 times on each side.
• I.p. - standing, hands on the belt. A slight tilt back - inhale, a slow tilt forward (bend in the lumbar region) - exhale. Repeat 5-6 times.
• I.p. - standing, feet shoulder-width apart, hands on the belt. Spread your arms to the sides - inhale, turn to the side, while connecting your hands in front of you. Repeat 3-4 times on each side. Perform slowly.
• I.p. - standing facing the back of the chair, holding on to it with outstretched arms. Raise the leg bent at the knee joint on the side of the abdomen so that the knee touches the hand - inhale; lowering the leg, bend in the lumbar spine - exhale. Repeat 4-5 times.
• I.p. - standing on the side of the chair, put one leg with your knee on the seat of the chair, hands on the waist. Spread your arms to the sides - inhale, turn the torso and pelvis to the side, slowly bend over, lowering your hands in front of you - exhale. Repeat 2-3 times on each side, changing the supporting leg.
• I.p. - knee-elbow position. Straighten one leg, slowly lift it up. Repeat 4-5 times with each leg.
• I.p. - lying on the right side. Bend the left leg to the side of the abdomen - inhale, unbend - exhale. Repeat 4-5 times.
• I.p. - lying on the right side, the leg is raised low above the floor. Circular movements of the left leg 4 times in each direction. Repeat 3-4 times.
• I.p. - standing on all fours. Lower your head down, round your back - inhale, return to the starting position - exhale. Slowly repeat 10 times.
• I.p. - lying on the left side. Bend the right leg to the side of the abdomen - inhale, unbend - exhale. Repeat 4-5 times.
• I.p. - lying on the left side, the leg is raised low above the floor. Circular movements of the right leg 4 times in each direction. Repeat 3-4 times.
• I.p. - standing on all fours. Straighten your legs, lifting your pelvis up (heels come off the floor). Repeat 4-5 times.
• I.p. - lying on your back, resting on the feet and the back of the head. Raise the pelvis up - inhale, return to the starting position - exhale. Repeat 3-4 times.

We finish the complex with breathing exercises in a lying or sitting position - 4-5 calm, slow breaths.

Tilts of the body in different directions, exercises to activate the oblique muscles of the abdomen increase the tone of the uterus, the motor activity of the fetus and thus contribute to the displacement of the head in the right direction.

• I.p. - knee-elbow position. Slow inhale and exhale. Repeat 5-6 times.
• I.p. - knee-elbow. Slow tilt of the torso down, touch the hands with the chin - inhale, smoothly return to the starting position - exhale. Repeat 4-5 times.
• I.p. - knee-elbow. Slowly raise the straight right leg up, take it to the side, touch the floor with the toe, return to the starting position. Repeat 3-4 times in each direction, breathing is arbitrary.
• I.p. - On knees. Lower your head down, round your back - exhale, slowly bend in the lumbar region, raise your head - inhale. Repeat 8-10 times.

We finish the complex with exercises to strengthen the muscles of the pelvic floor. The most common is the Kegel exercise (tighten the muscles of the pelvic floor, as if stopping the stream of urine, count to 10, relax, tighten, counting to 8, then to 6, 4, 2). This set of exercises additionally helps to improve the condition of the cervix, possibly due to the fact that the blood circulation of the pelvic organs improves.

Before performing any exercises, you should consult with your obstetrician-gynecologist. You should always remember about the presence of contraindications to classes. You can not do gymnastics in the presence of preeclampsia (it is manifested by edema, increased blood pressure, the presence of protein in the urine); serious pathology of the heart, kidneys, liver; the presence of placenta previa (the placenta blocks the exit from the uterus); at risk of preterm birth. In addition, the choice of a set of exercises depends on the state of uterine tone. With increased tone, the Dikan complex is recommended. With reduced and normal - a set of exercises by Fomicheva, and with uneven tone (the tone in the body of the uterus and the lower segment is higher than in the bottom) - exercises according to the Bryuhina method. To determine what is the tone of the uterus and choose the right technique, a doctor observing a pregnant woman will also help.

If, by the time of full-term pregnancy, the baby remains in a breech presentation, it is very important to resolve the issue of childbirth. The fact is that breech births are pathological: they are difficult and dangerous for the baby. During childbirth in cephalic presentation, the head that goes first slowly passes through the birth canal. There is time to adapt to the complex shape of the pelvis, find the largest space, turn around so that it is easier. The shape of the head even changes: in a newborn, it is elongated from the chin to the top of the head. During childbirth in the breech presentation, the pelvic end passes first through the birth canal. When the baby is born before the umbilical ring, the head enters the small pelvis and necessarily presses the umbilical cord. This means that labor should be over in the next 3-5 minutes. Otherwise, oxygen starvation will develop - hypoxia. The head passes through the bone pelvis very quickly, it does not even have time to change its shape. A newborn born in breech presentation has a round head. Such a rapid birth of the head is unfavorable. This is why breech women are considered to be at higher risk.

If by 37-38 weeks the baby has not changed its position, and its head remains at the top, it is necessary to carefully weigh: how to give birth? Usually, a pregnant woman is recommended antenatal hospitalization in order to evaluate all factors in a hospital setting and correctly answer the question posed.

If by 37-38 weeks the baby has not changed its position, and its head remains at the top, it is necessary to carefully weigh: how best to give birth? Usually, a pregnant woman is recommended antenatal hospitalization in order to evaluate all factors in a hospital setting and choose the right method of delivery. To do this, the following factors must be assessed:

• estimated fetal weight. A baby over 3600 g is considered large. His head may be too large for such childbirth, which means it is better to do a caesarean section.
• type of pelvic presentation. The most preferred is purely gluteal. With foot presentation, various complications are more common, such as prolapse of the umbilical cord.
• head position. It is important that the head is bent, while the size of the head with which it enters the small pelvis is the smallest. The more the head is unbent (the child seems to be looking at the stars), the larger the circumference of the head, the more dangerous for her such a quick and unprepared passage through the small pelvis.
• normal size of the bone pelvis of the expectant mother. The narrowing of the bone pelvis will also make it difficult for the birth of the head.
• general condition of mother and baby. The presence of any serious complications of pregnancy (preeclampsia, pathology of the cardiovascular system, etc.) in the mother, signs of chronic intrauterine hypoxia (chronic lack of oxygen) in the baby incline obstetrician-gynecologists to decide in favor of caesarean section
• maturity of the cervix. Closer to the term of childbirth, the cervix ripens (this is a medical term). It shortens, softens, the cervical canal opens. This suggests that the preparation of the female body for childbirth is proceeding correctly.

In addition, other points also matter:

• the age of the primiparous woman is over 30 years old, because statistically more often they have weakness of labor pains and attempts;
• aggravated obstetric history (infertility, miscarriage);
• gestational age. In preterm birth, a caesarean section is more common. The pelvic end is small and can be born with insufficient opening of the cervix, while the head can linger and be injured;
• estimated gender of the fetus. If this is a boy, then the likelihood of a caesarean section increases, because. in spontaneous childbirth, there is a risk of trauma to the testicles with the subsequent development of infertility.

If the council decides on the inappropriateness of spontaneous childbirth, then delivery is carried out by caesarean section in a planned manner. But spontaneous childbirth is also possible.

Childbirth through the natural birth canal has a number of features, and therefore are conducted by obstetricians in a special way. In the first stage of childbirth, such a complication as untimely discharge of amniotic fluid often occurs, so the woman in labor is advised to lie more. It is better to lie on the side towards which the back of the child is facing. Monitoring of the state of labor and the condition of the fetus is often carried out. Weakness of labor during such childbirth of contractions is more common than during childbirth in the head presentation. And careful monitoring of the condition of the child is extremely important in any childbirth. When attempts begin, it is necessary that the woman in labor understand the responsibility of the situation. It is very important to push well after the birth of a child to the umbilical ring, because the umbilical cord has been pressed, which means you need to hurry. The child, if he is born in a breech presentation, is taken by an obstetrician-gynecologist, the midwife helps him. The doctor provides a special obstetric benefit that will allow the baby to be born without problems. The presence of a neonatologist at the birth is mandatory. The condition of children born in breech presentation requires increased attention. These children are more likely to have pathology of the hip joints and nervous system.

Shortly before birth, the baby occupies a certain position in the uterus. In most cases, it is placed head down - towards the exit from the uterus, and turns back to the left. This is the correct, so-called head presentation, the most convenient for childbirth. This is how 90% of babies are born.

Varieties of breech presentations

However, today we will talk about those cases when the presenting part is the legs or buttocks. Frequency pelvic adhesions, according to various estimates, is in the range of 3-5% of the total number of newborns. In 67% of these pregnancies, the baby sits with his buttocks in the mother's pelvic ring, his legs are bent at the hip joints, and his knees are straightened. Less common is a mixed breech (20.0%) presentation, when the child enters the mother's pelvic ring not only with the buttocks, but also with the legs, more precisely, with the feet. Breech presentation includes complete foot presentation when the baby's legs are slightly extended at the hip and knee joints; and mixed foot presentation, when one leg is almost straight and the other is bent at the hip joint; and knee presentation, when the baby is presented with bent knees.

Factors affecting breech presentation

There are certain conditions due to which the baby takes the wrong position. There are the following factors:

• maternal (anomalies in the development of the uterus, limiting the mobility of the fetus and the possibility of turning the head down at the end of pregnancy; tumors of the uterus, a scar on the uterus, a narrow pelvis that prevent the head from being established at the entrance to the small pelvis; the uterus and fetus are not sufficiently fixed, which also leaves the baby with the opportunity to maneuver ; multiple pregnancies and, as a result, weakness of the abdominal muscles; previous births in the breech presentation);
• fruit (congenital malformations of the fetus; prematurity; neuromuscular and vestibular disorders of the fetus; multiple pregnancies, abnormal fetal articulation);
• placental (placenta previa, polyhydramnios and oligohydramnios, due to which the child moves freely, his head cannot be fixed in the mother's pelvic floor or, conversely, does not have the possibility of active movement, entanglement and shortness of the umbilical cord, which also limit mobility).

At the same time, the child, possessing the instinct of self-preservation, occupies the most convenient position for himself. Doctors do not disregard the hereditary factor: if a mother was born in a breech presentation, then there is a risk that her baby will take the same position.

Diagnosis of breech presentation

Breech presentation of the fetus is diagnosed primarily according to external obstetric and vaginal examination. At outdoor study a large, irregularly shaped, softish consistency, inactive part, which is presented to the entrance to the pelvis, is determined, while in the bottom of the uterus a large, round, hard, mobile, balloting part (fetal head) is determined. A higher standing of the uterine fundus above the pubis is characteristic, which does not correspond to the gestational age. The heartbeat is clearly heard at or above the navel. During vaginal examination with a purely breech presentation, a softish volumetric part is felt, on which the inguinal fold, sacrum and coccyx are determined. With a mixed breech and foot presentation, the feet of the fetus are determined.

By using ultrasound it is possible to determine not only the breech presentation itself, but also its appearance. The position of the fetal head and the degree of its extension are assessed. Excessive extension is fraught with serious complications in childbirth: trauma to the cervical spinal cord, cerebellum and other injuries.

coup attempt

Breech presentation, diagnosed before, should not be a cause for concern, enough dynamic observation. With tactics aimed at correcting the breech presentation on the head. There are conservative methods. For this purpose, it is appointed corrective gymnastics, the efficiency of which is 75-85%. However, it cannot be used for abnormalities in the development of the fetus, the threat of miscarriage, a scar on the uterus, infertility and miscarriage in history, preeclampsia, placenta previa, low or polyhydramnios, abnormalities in the development of the uterus, multiple pregnancy, narrow pelvis, severe extragenital diseases. In addition to gymnastics, unconventional methods: acupuncture / acupressure, aromatherapy, homeopathy, as well as the power of suggestion, light and sound effects on the fetus from the outside, swimming.

If breech presentation persists, external prophylactic prophylaxis can be performed at term. fetal head rotation proposed by B.L. Arkhangelsk, the efficiency of which ranges from 35 to 87%.

External prophylactic rotation should be performed by a highly qualified doctor in stationary conditions where, if necessary, a caesarean section can be performed and the necessary assistance to the newborn can be provided. After turning, it is necessary to consolidate the achieved result. For this, they are used bandage and certain exercise, which helps to fix the baby's head in the desired position. However, if the baby, despite all the efforts made, has not turned over, do not despair: even in this case, the possibility remains spontaneous childbirth.

Choice of method of delivery

A woman with a breech presentation of the fetus must go to the hospital for examination and the choice of a rational tactics for the management of childbirth. Method of delivery is determined based on the number of births, the age of the mother, obstetric history, gestational age, the readiness of the female body for childbirth, the size of the pelvis and other factors. Breech presentation of the fetus is not an absolute indication for caesarean section, however, in cases where it is combined with various complicating factors, the issue is resolved in favor of operative delivery.

Indications for caesarean section in a planned manner with a full-term pregnancy, the age of the primiparous is more than 30 years; severe form of nephropathy; extragenital diseases requiring the exclusion of attempts; pronounced violation of fat metabolism; narrowing of the pelvis; estimated fetal weight over 3600 g in primiparous and over 4000 g in multiparous; fetal hypotrophy; signs of fetal hypoxia according to cardiotocography; violation of blood flow during doplerometry; Rhesus conflict; extension of the head of the 3rd degree according to ultrasound; unpreparedness of the birth canal during gestation; overwearing; foot presentation of the fetus; breech presentation of the first fetus in multiple pregnancy and other factors.

Childbirth is through natural birth canal with a good condition of the expectant mother and fetus, full-term pregnancy, normal pelvic size, average fetal size, with a bent or slightly unbent head, the presence of readiness of the birth canal, with a purely breech or mixed breech presentation.

It is best when breech presentation fetal labor has begun spontaneously. In the first stage of labor, a woman in labor must observe bed rest and lie on the side towards which the back of the fetus is facing in order to avoid complications (premature discharge of water, prolapse of the fetal leg or umbilical cord loops). Childbirth is under monitor control fetal heart rate and uterine contractions. In the second stage of labor, it turns out obstetric care in the form of a benefit, the purpose of which is to preserve the articulation of the fetus (the legs are extended along the body and pressed to the chest by the arms of the fetus). First, the child is born to the navel, then to the lower edge of the angle of the shoulder blades, then to the arms and shoulder girdle, and then to the head. When a child is born to the navel, his head presses the umbilical cord, and a lack of oxygen develops, therefore, no more than 5-10 minutes should pass until the child is born completely, otherwise the consequences of oxygen starvation will be very negative. Also produced perineal incision to speed up the birth of the head and make it less traumatic.

Childbirth at foot presentation through the natural birth canal are carried out only in multiparous with good labor activity, readiness of the birth canal, full-term pregnancy, medium size (weight up to 3500 g) and good condition of the fetus, a bent head, a woman's refusal of a caesarean section. At the same time, the obstetric benefit is as follows: the external genital organs are covered with a sterile napkin and the palm facing the vulva prevents the legs from falling out of the vagina prematurely. Leg hold contributes to the full disclosure of the uterine pharynx. The fetus during an attempt, as it were, squats down, and a mixed breech presentation is formed. Opposition to the born legs is exerted until the uterine os is fully opened. After that, the fetus is usually born without difficulty.

The condition of children born in a breech presentation through the natural birth canal requires special attention. Hypoxia suffered during childbirth can adversely affect the child's nervous system, such a pathology as a dislocation of the hip joint is possible. A neonatologist and resuscitator must be present at the birth. With these precautions, babies born this way do not differ in development from other babies.

Svetlana Leshchankinaobstetrician-gynecologist of the highest category,
Candidate of Medical Sciences

Discussion

My personal experience: second pregnancy, fetus in breech presentation, about 4 kg in size as planned. The first girl was born naturally (birth parameters 60 cm and 4540 g). I had a caesarean section. Parameters 56 cm and 4090 gr, according to the doctors - the CS was done correctly, the natural birth of a large fetus in breech presentation would not have gone smoothly

Comment on the article "Pregnancy, childbirth and breech presentation of the fetus. How to fix it?"

Breech presentation.. Medical issues. Pregnancy and childbirth. Pelvic presentation. I’m 36 weeks old, the baby is in breech presentation. I read horror stories on the Internet, I don’t want to give birth myself, I want a cop. I’m afraid for the baby. How to insist or they won’t listen to me during childbirth ...

Discussion

Go to an osteopath, maybe the baby will roll over again

I had a pelvic, but to the pelvic also some problems in gynecology. Until the last, they waited for the EP, when all the deadlines had passed, and the birth had not begun, it was the COP. If childbirth began on her own, she would give birth herself. I would look for a doctor you trust and discuss all the nuances with him.

Osteopath for the coup of a child. ... I find it difficult to choose a section. Pregnancy and childbirth. And so I do not want a caesarean (first pregnancy). I have been doing all sorts of exercises for more than 2 weeks, now Breech presentation at 32 weeks ?. Fetal development. Pregnancy and childbirth.

symphysitis + breech presentation. Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. Breech presentation of the fetus is not an unconditional indication for CS, but during childbirth, the risk of injuries and pathologies for the child is very high. symphysite...

Discussion

Search the internet for exercises and tips for those with pelvic floor problems.
I had a pelvic floor placed a week ago. I was very upset. Rummaged on the Internet. I did exercises for a week, persuaded, swam in the pool. I didn't really expect much, though. BUT! A week later, the doctor after the examination said that he turned over.
Try it! One girl wrote that 4 days before the birth, with the help of massage, she made the baby roll over ...
Good luck!

For my girlfriend, all the doctors she consulted advised CS, agreed with the doctor for CS, got to another maternity hospital by ambulance, so she had CS there. An orthopedist treated a dislocation of one leg and a subluxation of the other.

Childbirth with a breech presentation of the fetus. Many expectant mothers believe that if the fetus is in a breech presentation, a caesarean section is inevitable. Pregnancy, childbirth and breech presentation of the fetus. How to fix? Varieties of pelvic presentations.

Discussion

I just wanted to raise this thread. Until last week, my hryundel was a soldering bunny, and then he suddenly decided to sit down on his ass! (This is at 33 weeks:(:() Has been sitting for a week now:(:(
Can anyone tell me, helped someone in the coup from the priests to the head enti exercises: knee-elbow, torsion from side to side every ten minutes, "birch tree" (if what I depict can be called that). Maybe someone else knows what methods? And in general, is there any chance that he will lie down normally for such a long time?

I flipped at 35 weeks. if it hadn’t rolled over, I would definitely have cesarean :)

And the breech presentation everywhere, except for the post-Soviet space, is considered a NORMAL presentation of the fetus. Childbirth with a breech presentation of the fetus. Many expectant mothers believe that if the fetus is in a breech presentation, a caesarean section ...

Discussion

My neighbor in the ward gave birth, such a young, thin girl. She also did not have much water, including the child could feel almost everything ... She gave birth herself, quickly and, it seems, without breaks. Since the priest is born like the head, the main thing is that there would be no prolapse of the limbs, but the midwife must follow this ...

A week ago I watched a movie about the birth of a boy in a breech presentation, and in the water. Nothing, they gave birth :) True, with asphyxia, but they didn’t drag him anywhere to any intensive care unit (it was in Denmark), and he just swam next to his mother, his legs were directed towards her, finally (after 20 seconds) the “walking” reflex started and the baby came to his senses. A perfectly normal baby was born.
What is your deadline? The baby can still roll over, especially if you are doing gymnastics. You try to discuss this issue with him again, tell him that the head down is more natural and softer, that in this way he will help himself and you. Communicate with him more often, perhaps and agree :))) Good luck!

:(Hope disappears every week. The doctor also immediately said that there was not enough water, it would be difficult for the child to roll over :(

My friend had a rollover at 39. I'm about 35 so don't worry. There's still enough time for that. Only I read that with a breech position, I do not recommend wearing a bandage as it secures the position of the kid. So GOOD LUCK!

Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. breech presentation + entanglement of the umbilical cord. Girls .. tell me who had such a situation ... Rhoda with a breech presentation of the fetus. Pregnancy, childbirth and breech presentation of the fetus.

Discussion

I was diagnosed with breech presentation at 28 weeks. All my efforts to turn over were in vain - my daughter stubbornly sat upside down. Despite this, my doctor, who led the pregnancy and had to take delivery, insisted on natural childbirth. He persuaded, gave examples of how he normally gives birth with a pelvic. I hesitated. A week before the birth, they did an ultrasound - a loop of the umbilical cord in the neck. After that, the doctor said - yes, now I myself am leaning towards a caesarean section. After I woke up after anesthesia, my second question was - was there an entanglement? He answered me that there was a tight loop and we did everything right, otherwise we could lose the baby ... So think carefully, consult a good doctor. Still, in itself, the pelvic is an unpleasant thing, and even entanglement ...

Another case happened to my friend. There was no pelvic, only entanglement. And the maternity hospital is excellent, and they wrapped the sensors around the stomach, and they seemed to be watching. But they didn't follow :(((.

So think well, well. And remember, a scar on the stomach is such garbage compared to a little beloved baby :).

I know that they do caesarean with entanglement of the umbilical cord (some mothers are even happy about this). But you need regular monitoring of the condition of the child. If not, then make sure that she continues to move well. In general, it is difficult to suffocate in the aquatic environment. But giving birth naturally is not recommended.

Breech presentation is not an indication for a caesarean section. Surely there are other reasons for this. Doctors simply do not have Breech presentation, caesarean at the discretion of the doctor on duty, it was Saturday, in the maternity hospital - natural births are welcome, I have ...

Discussion

And no one knows by chance how you can feel or determine by some signs what the child is sitting down with? And another question: upstairs, approximately opposite the solar plexus, sometimes a little lower, almost constantly something sticks out, sometimes like a ball, then something oblong, you can directly see and feel it very much when it starts to move there with this something -here. Does anyone have something similar?

Breech presentation is not an indication for a caesarean section.
Surely, there are other reasons for this. Doctors simply do not have the right to perform a Caesarean section without appropriate indications.

During its development, the baby, which is in the mother's tummy, rolls over several times. And after 22-23 weeks of pregnancy, the baby, as a rule, assumes a head-down position - and this is the location of the fetus that is considered optimal for subsequent births. The head of the fetus is the largest part of its body in diameter, and therefore it is with its passage during delivery that the greatest difficulties are associated. After the baby's head passes through the birth canal, the rest of his body "by inertia" follows almost imperceptibly. If the baby is located vertically in the mother's tummy, that is, head down, in most cases this position does not bring any difficulties. But it also happens that the fetus occupies a transverse position in the womb: legs or buttocks down. In this case, we are talking about breech presentation during pregnancy, which is diagnosed, as a rule, by the 28th week during the next visit to the antenatal clinic. It should also be mentioned that the breech presentation detected at this time will not necessarily remain until the birth - the baby can change position up to 36 weeks. In addition, there are a number of measures that can help "turn" the fetus, thereby giving it a head position.

Causes of breech presentation of the fetus

Breech presentation of the fetus during pregnancy can be due to several factors. One of the main reasons doctors call a decrease in the tone and excitability of the uterus. Also, the causes of breech presentation are called, and abnormalities in the development of the uterus, placenta previa, some malformations of the fetus. Breech presentation can be breech, foot, mixed, knee - each of them is easily diagnosed by the doctor during a routine examination, after which ultrasound confirmation will be necessary. Breech presentation is considered not quite a normal position for both the baby and the mother - although it does not carry direct big threats.

Although natural childbirth with a breech presentation of the fetus is possible, caesarean section often becomes an indication for delivery. If the birth proceeds in a natural way, then constant and enhanced control of the doctor is necessary - childbirth from a breech presentation is much more often accompanied by complications.

Signs of breech presentation of the fetus

Physically, if there is a breech presentation of the fetus, the woman does not feel this pathology in any way. She is not disturbed by any pain symptoms or discomfort, which can clearly signal the "wrong" location of the baby in the uterus.

Breech presentation can only be determined through examinations. So, with breech presentation, experts note a higher standing of the uterine fundus above the pubis, which does not correspond to the gestational age. The fetal heartbeat is heard more clearly in the umbilical region or slightly above it on the right or left (depending on the position of the fetus).

Also, signs of breech presentation of the fetus reveal themselves during a vaginal examination. For example, with a breech presentation, a soft volumetric part, inguinal fold, coccyx and sacrum are probed. With adjacent breech and foot presentation, you can determine the baby's feet with a calcaneal tubercle and short fingers (other than fingers on the hands) located on the same line. To clarify the diagnosis, however, ultrasound will also be required.

Exercises for breech presentation of the fetus

You can “give” the baby a head position in the tummy with the help of special gymnastic exercises. You can use them starting from 32-34 weeks of pregnancy - after consultation with your doctor. Gymnastic exercises involve turning the future mother in a prone position from one side to the other: 3-4 times approximately every 7-10 minutes. This exercise is performed 2-3 times a day. You can also carry out an exercise that involves lifting the pelvis: lying on your back, you should put some kind of roller under your lower back (you can use ordinary pillows) so that the pelvis is 20-30 centimeters higher than the head. In this position, you need to stay from 5 to 15 minutes, but no more. The exercise is performed 2-3 times a day on an empty stomach. Contraindications for performing such gymnastics are scars on the uterus from any operations, late toxicosis. He offers his methods for breech presentation and alternative medicine, for example, acupuncture, homeopathy,.

If the above methods have not brought the desired results, the expectant mother may be offered an external rotation of the fetus. This procedure is carried out at about 34-37 weeks of pregnancy, always in a hospital with monitoring, ultrasound monitoring and using special preparations that relax the uterus. A successful external coup will make it possible later to carry out childbirth in a natural way, but since this procedure is rather difficult, and also has many contraindications (a scar on the uterus, obesity, the age of the primipara is more than 30 years old, gestosis,), it is not suitable for every pregnant woman and they produce it quite rare.

Childbirth with breech presentation of the fetus

If the breech presentation could not be eliminated by any of the methods, this should not become a reason for the disorder. In this case, the pregnant woman will be advised to go to the obstetric hospital earlier: here, after all the necessary examinations, the method of delivery will be chosen.

Without any serious contraindications, childbirth can proceed naturally - under the constant supervision of a doctor. If it is not possible, a caesarean section will be required. Indications for caesarean section with breech presentation are (more than 3.5 kilograms), the presence of a scar on the uterus, a narrow pelvis in a pregnant woman, placenta previa, presentation in a foot or mixed position.

Especially for- Tatyana Argamakova