Presentation of the fetus and its types. Facial presentation of the fetus: consequences and recommendations of doctors Dorsal presentation of the fetus

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

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

Why is the fetus in the wrong position

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

Polyhydramnios or oligohydramnios;

Multiple pregnancy;

Abnormal deviations in the shape of the uterine cavity;

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

Very low position of the placenta (placenta previa);

Short umbilical cord;

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

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

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

Diagnosis of myometrial dystrophy;

Bicornuate or saddle uterus.

What complications are caused by incorrect presentation?

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

Types of malpresentation of the fetus

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

Types of fetal presentation

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

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

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

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

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

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

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

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

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

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

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

Birth options in case of abnormal position of the fetus

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

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

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

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

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

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

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

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

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

Characteristics of the low presentation of the fetus

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

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

Features of childbirth with the wrong position of the fetus

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

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

Medical diagnosis of fetal position

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

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

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

Methods for self-diagnosis of fetal presentation

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

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

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

External rollover of the baby in the womb

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

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

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

Methods for the prevention of malpresentation

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

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

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

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

Kinds

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

pelvic,
head,
oblique,
transverse.

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

Head presentation of the fetus

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

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

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

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

Breech presentation of the fetus

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

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

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

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

Oblique or transverse presentation

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

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

How to determine the type of presentation

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

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

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

Causes

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

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

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

Indications for caesarean section

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

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

The term "posterior placenta previa" is a misnomer. There is no state corresponding to this term. This term was born in numerous forums and discussions as a result of confusion. To understand what can be discussed when a woman mentions "posterior placenta previa", consider the options.

So, according to the results of an ultrasound examination, the doctor determines to which wall of the uterus the placenta is attached. This fact is quite important, since when the placenta is attached to the wall of the uterus, which is not adapted to this, there are high risks of some pregnancy complications.

Normally, the placenta can be attached to the posterior, anterior, superior, or lateral walls of the uterus. Usually, the conclusion of the ultrasound indicates, for example, "the placenta is attached to the back wall" or "the placenta is attached to the bottom (upper wall) of the uterus." Knowing about the term "previa", women believe that it refers to the location of the placenta. As a result of this creative reflection, the long phrase "the placenta is attached to the back wall" is replaced by another, completely new concept - "posterior placenta previa". In fact, the location of the placenta on the back wall of the uterus is normal, moreover, optimal in terms of the course of pregnancy and subsequent childbirth.

But the term "presentation" reflects the pathology. The name of this term reflects the position of the placenta right in the way of the child being born, that is, it literally "lies in front of" him with an obstacle. Previa is the location of the placenta on the lower wall of the uterus, where the entrance to the cervical canal is located, through which the baby is born. That is, placenta previa is indeed a barrier in the birth canal, in the presence of which the child will not be able to be born naturally. Presentation is complete, partial and low, depending on how much the internal cervical os is blocked. However, presentation always involves the location of the placenta on the lower wall of the uterus. Therefore, "rear presentation of the placenta" can not be in principle. Presentation is a pathology, and the location of the placenta on the back wall of the uterus is the norm. Therefore, you should not philosophize and use the term "previa" to refer to the location of the placenta on the walls of the uterus, since it reflects a specific pathological condition.

However, in obstetrics, the concept of "back presentation" is also used to describe the position of the child in the abdomen. Therefore, the term "posterior placenta previa" may be confused with the designation of fetal and placenta previa. So, the posterior presentation of the fetus is the location of the child with the back and back of the head to the woman's spine. The presentation of the fetus plays a role in the biomechanism of childbirth and is necessary for the midwife, but for the pregnant woman herself, this knowledge is completely unimportant. The only thing that may be of interest to the expectant mother is that the posterior presentation of the fetus is a completely normal phenomenon.

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

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

A little information for future parents

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

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

What are the types of pathologies?

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

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

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

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

breech presentation

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

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

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

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

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

Head presentation of the fetus

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

Head presentation can also be divided into several types:

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

Anterior head.

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

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

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

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

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

How is fetal malpresentation diagnosed?

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

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

Why is this happening?

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

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

The mechanism of childbirth with a facial presentation of the fetus

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

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

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

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

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

Reviews of experienced mothers

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

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

How is childbirth with a similar pathology

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

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

Why can the fetus take the wrong position at all?

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

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

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

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

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

Methods for correcting incorrect presentation

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

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

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

Many people confuse the presentation of the fetus with the position. But there is a significant difference between these two definitions. The position of the fetus is determined in relation to the location of the child relative to the axis along the uterus, and the presentation depends on how the child is turned towards the exit from the uterus (cervical pharynx).

Presentation, like the position of the fetus, can change throughout pregnancy, but starting from the 33rd week, the child almost always remains in a certain presentation. This is due to its size, because it is getting harder to spin, there is less and less space every day. And already from 34 weeks the fetus is gradually preparing for birth. The expectant mother begins to feel preliminary (training) contractions, and the baby gradually descends. At the last ultrasound, the presentation of the fetus is determined, in which it will be born.

Consider the types of presentation of the fetus.

Head presentation of the fetus

This is the most common position for giving birth. According to statistics, almost 95% of women give birth to babies head first. The child in head presentation is in a longitudinal position.

This presentation, in turn, is further divided, depending on the level of extension of the head:

occipital;
anterior head;
frontal;
facial.

Occipital cephalic presentation of the fetus is the norm, in which all women give birth on their own, without additional intervention.

Anterior presentation is worse because the head enters the pelvis in the largest size, such childbirth is much more difficult. But there were cases when the child adapted and changed the position of the head during childbirth, facilitating his way into the world. Such a presentation may be an indication for a caesarean section, but this issue is very individual. Each case is considered separately, taking into account other aspects.

Frontal presentation is very rare, it is the average degree of extension of the head. With this position of the fetus, natural childbirth is impossible, only with surgical intervention.

Facial presentation - maximum extension of the head. Technically, such childbirth can take place in a natural way, but with injuries for both the child and the mother, which determines in most cases the tendency to caesarean section.

For a better perception of information, we suggest looking at a photo of the head presentation of a child with varying degrees of extension of the head.

Breech presentation of the fetus

The second name for this type of presentation is gluteal. In this case, the baby is turned with its buttocks towards the exit from the uterus. That is, the butt and legs enter the small pelvis first. A baby is born either with the buttocks or legs forward, so the breech presentation is divided:

pure breech presentation (position a in the picture);
mixed (position b);
foot (position c).

Such presentation during childbirth is not very common (only about 5%). In most cases, when determining the breech presentation, gynecologists give recommendations or perform manipulations themselves to turn the child over.

Childbirth in breech presentation is considered pathological, as it is accompanied by complications. Such childbirth is quite possible to produce in a natural process, but in some cases they decide on a caesarean section.

It all depends on many characteristics of pregnancy:

The size of the pelvis of the woman in labor.
Child's weight.
Gender of the child (in boys, the genitals may be damaged during childbirth).
What kind of breech presentation (breech, mixed or foot).
At what age is the woman.
What are the births, the history of previous births.

Transverse or oblique presentation of the fetus

Transverse and oblique presentation of the fetus is an indication for caesarean section. Naturally, it is impossible to give birth to a child in such a presentation.

Previously, during childbirth, turns were used for the limbs of the child, but in our time it is prohibited, because this procedure can cause irreparable harm to both the child and the mother. The only case when these manipulations can be applied is only at the birth of twins. When the first child is born, and the second has taken the wrong position in the transverse or oblique presentation.

Low fetal presentation

Such a presentation is considered the norm immediately before childbirth, when the child gradually descends, it is also noticeable externally - the stomach drops.

But when a woman finds out about this in the second trimester of pregnancy, you can’t call it good news, but you shouldn’t panic either.

Depending on the general condition of the woman, on the tone of the uterus, the size of the cervix, they can diagnose a threatened miscarriage and prescribe:

ambulatory treatment;
put the expectant mother in the hospital for preservation;
install a pessary;
sew on the neck.

Healthy food;
take medications, vitamins prescribed by a doctor;
spend enough time outdoors;
do not play sports, remove all physical activity;
Enough to drink during the day and not get drunk before bedtime.

Fetal Turning Exercises

Malpresentation of the fetus is not always an irreversible problem. There are a lot of exercises that provoke and help the child roll over into the correct presentation. It is not worth starting exercises on your own, without the knowledge of a doctor, because there are a certain number of contraindications:

Myomas.
Placental presentation.
Previous births by caesarean section.
Many different diseases of the systems and organs of the mother.

The incorrect presentation of the child can be changed with the help of exercises of 50% of women. There are cases when a child changes its presentation almost a couple of days before birth. In this situation, it is worth regularly visiting a gynecologist who will conduct an examination and tell you how to give birth. Even if you have been prescribed a caesarean section, do not be upset, because your child needs a healthy and happy mother who is looking forward to his arrival!

How to independently determine the presentation of the fetus? You will find this information in the video.