Transverse presentation of the fetus at the 20th week of pregnancy. Transverse position of the fetus. Exercises for a coup in the transverse position of the fetus

Currently, the presence of a transverse position of the fetus in a pregnant woman in almost 100% of cases means that doctors will deliver her the only way, namely with the help of .

Gradually, such a technique as turning the “fetal on a leg” during childbirth “sank into oblivion”. In addition, the external obstetric turn is performed less and less frequently. Whether such an approach is overly cautious, or is it evidence of a dead end in obstetric art, let's try to figure it out.

To understand the essence of the problem, it is necessary to understand what is called the "transverse position of the fetus"?

The normal position of the baby in the womb is the longitudinal head. In other words, the baby is located in such a way that the position of his torso and head coincides with the ovoid shape of the uterus. In this case, the head should be at the bottom, so it is called the presenting part (literally - "belongs" to the bones of the woman's pelvis).

With a transverse presentation, the fetus is located across, which means that there is simply no presenting part. Also noteworthy is the oblique position of the child, in which the body of the child is not across, but somewhat displaced. In this position, either the head or the pelvic end of the child is slightly lower.

But is it always transverse position is it a pathology? As you know, before the 30th week of gestation, the baby in the womb does not have a stable location. And this means that only in the third trimester is it worth worrying about the incorrect position of the fetus. All the excitement on over early dates are simply useless.

What causes can lead to the transverse position of the fetus?

Of course, during the physiological course of pregnancy in healthy woman the risk of developing such a complication is extremely small. And that's why it's important to know possible reasons leading to this complication:

With the localization of myomatous nodes in the region of the lower segment of the uterus, as well as cervical and isthmus nodes, it is likely that the fetus will not accept correct position. In addition, during pregnancy, some nodes begin to grow especially rapidly (with a proliferating variant of fibroids), which means that the tumor simply prevents the child from turning around correctly and taking physiological cephalic presentation.

Some abnormalities in the development of the uterus that interfere with the correct position of the baby in the womb.

For example, a uterus with a septum is bicornuate.

It is also often the cause of this complication. The placenta, located in the region of the lower segment, is a serious obstacle to the physiological position of the fetus.

With an increase in the volume of amniotic fluid, the child has the opportunity for excessive movement and rotation around its axis. The baby does not feel the walls of the uterus, and this disrupts the work of his vestibular apparatus. As a result, the child takes the wrong position.

If there is more than one fetus in the uterine cavity, then there is a high probability of their incorrect position, since the sizes of these babies are usually somewhat smaller than with a singleton pregnancy. In addition, it can happen, and babies sometimes do not have time to take a longitudinal position.

High birth parity.

After 4-5 births, the tone of the uterus is significantly weakened, therefore, during pregnancy, the overstretched muscle wall allows the child to make intrauterine turns and twists.

The first and second degree of narrowing usually does not interfere with the normal position of the fetus, however, with more pronounced narrowing of the pelvis, this can cause the baby to be positioned transversely.

In rare cases, the cause of the transverse position is the pathology of the vestibular apparatus of the child.

Simply put, the transverse position of the fetus can be in women with the following risk factors:

with tumors of the small pelvis;
narrowing of the bone ring of the pelvis;
uterine anomalies;
with a weak overstretched abdominal wall;
after numerous surgical procedures (abortions, diagnostic curettage), which creates a risk of developing placenta previa during pregnancy.

What dangers are fraught with transverse presentation of the fetus?

This complication creates not only difficulties during childbirth, but also during childbearing, namely:

Risk premature rupture fruit membranes.

This happens for the simple reason that there is no physiological separation of amniotic fluid into anterior and posterior, which means that the lower pole of the fetal bladder is under increased stress and can burst at any time.

The threat of premature birth.

Even if there was no outflow of amniotic fluid, there is still a high probability of onset labor activity ahead of time. There is an explanation for this: one of the theories of the onset of labor is that the fetus is under pressure from the uterus. And with the transverse position of the fetus, this happens early, since the uterus cannot quickly stretch.

The most dangerous complication is the prolapse of the handle or leg of the fetus after the rupture of the membranes.

With a long stay of a small part of the fetus in the area of the exit from the uterus, its motor activity is disturbed, which is called the “launched” transverse position. In this state, the likelihood of intrauterine death of the baby is high.

Diagnostic methods

The transverse position is quite easy to diagnose:

During vaginal examination, the presenting part is not determined, only the lower pole of the fetal bladder is palpated.
On external examination, you can see that the shape of the uterus is irregular, it is expanded in the central sections, taking the form of a fetus.

Moreover, if you put your hands along the uterus, then it is impossible to determine which side the back is on, instead you can feel the head and pelvic ends.

With ultrasound, the position of the fetus at any stage of pregnancy is most accurately visualized. You can reliably determine where the head and pelvic end are located.

Features of pregnancy management

Until the 30th week of gestation, you should not worry about the wrong position of the baby, since he himself can take the desired position at any time.

However, when diagnosing the transverse position after this period, the following rules should be followed:

given the high risk of rupture of the membranes, a woman should more often stay in a horizontal position;
do not perform excessive physical activity.

In order to correct the position of the fetus, a highly qualified obstetrician-gynecologist can perform an external obstetric rotation of the fetus.

For the successful implementation of this procedure, it is necessary to know well not only the position of the fetus, but its position (location of the back). The task of the doctor is not only to achieve a head presentation, but also to prevent the formation of a rear view (turning the back back).

This technique is not performed so often, because there are contraindications to it:

placenta previa;
pathology of attachment of umbilical cord vessels;
multiple pregnancy;
the threat of premature birth;

Childbirth in the transverse position of the fetus

Due to the high traumatic nature of childbirth in this position of the fetus for both the mother and the child, doctors try to fulfill such women.

However, sometimes women with this pathology enter the maternity hospital with active labor activity.

What options for the development of events can be during natural childbirth:

With a small position of the fetus, in rare cases, it takes a longitudinal position and is born without complications (extremely rare).
In premature babies, the following sometimes happens: moving along the birth canal, the fetus can bend "in half" and be born backwards.

This is usually accompanied by the death of the child, as multiple injuries and damage occur.

The handle of the fetus falls out of the birth canal, which prevents natural childbirth from occurring.

A long stay of the baby leads to violations of his movements and the "wedging" of the shoulder girdle into the region of the lower segment of the uterus. At the same time, labor activity intensifies, because the uterus is trying to “expel” the fetus. Meanwhile, the lower segment is increasingly stretched, which can cause uterine rupture. This condition threatens the life of the mother and fetus.

In rare cases, with a small size of the fetus, the baby is turned on the leg.

It is called combined because this technique lies in the fact that one hand of the doctor contributes to the rotation of the baby in the uterus, and the other outside directs his body in the right direction. More often this is done with multiple pregnancy, provided that the first child has already been born, and the position of the second fetus is transverse. But it is important to know that this operation is very traumatic and fraught with high risk complications (, fetal death).

As you can see, the management of childbirth with such a pathology naturally very dangerous and endangers the life of the child and the mother. Currently, the principles of gentle obstetrics are actively developing, in which such techniques as a combined rotation are not justified.

Features of operative delivery

Given all the difficulties and dangers of natural childbirth, it is not surprising that the transverse position of the child in the womb is an absolute indication for a caesarean section.

The most important condition for a successful outcome is to perform the operation in a planned manner, when there are no complications.

Operation steps:

Dissection of all layers of the abdominal wall in layers;
Making an incision in the uterus;
The most responsible and difficult stage is the extraction of the fetus.

The doctor's hand grabs the fetal leg and it is transferred to pelvic position, after which the fetus is removed completely by the pelvic end. At the same time, the assistant helps the surgeon by guiding the baby's body from the outside.

Sometimes it is difficult to extract the child, as a result of which it is necessary to increase the incision on the uterus, and this, in turn, is dangerous by damage to the vascular bundles.

Removal of the placenta, curettage of the uterine cavity;
Restoration of the integrity of the uterine wall, examination of all organs in abdominal cavity;
Stitching of the abdominal wall.

case from practice
On one of the shifts, a woman with labor was admitted to the maternity hospital at 40 weeks. According to the woman in labor, her water broke 8 hours ago, and the contractions have been going on for 2 hours. At the same time, the woman constantly complained about foreign body in the perineum.

On examination, it was revealed that the position of the fetus is transverse, and the baby's hand was visible from the open cervix. At the same time, the fetal heart rate was rapid, reaching 180-200 per minute. As it turned out, the woman was not examined anywhere during pregnancy and was not registered, and therefore did not know about the incorrect position of the child.

Given the current situation, it was decided to perform an emergency caesarean section. However, during the operation there were difficulties in extracting the fetus. Thus it was necessary to increase the incision on the uterus.

Fearing to damage the vascular bundle, the surgeon increased the access not in the transverse direction, but somewhat upwards, in the form of a “smile”. This helped avoid damage. uterine arteries and safely retrieve the baby. The baby was born weak, 5-6 points on Apgar. But by the time of discharge, his condition did not pose any threat.

The predominance of operational tactics in the transverse position of the fetus is fully justified by the principles of gentle obstetrics. This approach contributes not only to the reduction of maternal and child mortality, but also to the absence of adverse complications during delivery.

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

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

Kinds

There are two types of pathology:

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

Causes

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

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

Diagnostics

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

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

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

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

dangers

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

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

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

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

Features of childbirth

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

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

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

Prevention

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

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

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

Doctors advise to perform this complex 3 times a day:

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

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

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

Pregnancy and childbirth is a natural process that occurs in a woman's body. From the moment of conception to the birth of a child, the body of the expectant mother is subject to special laws and needs. New life develops and female body 9 months serves as a habitat for the fetus, supplying it with all the resources for normal growth.

During this mysterious period, it is very important that future mom stay healthy as the body needs to focus on maintaining the new life within itself. Otherwise, complications may occur that affect the health of both the mother and the child. One of these complications is transverse presentation fetus.

What is a transverse presentation of the fetus?

The most favorable and natural position of the baby in the uterus at the time of delivery is head down towards the birth canal. And at normal course pregnancy, this position is established by itself. The bodies of mother and child are preparing for the difficult process of childbirth. The woman's hips expand, and the baby turns head down into the resulting hollow, facing the mother's back. This position is called head presentation and is considered the most favorable for the safe course of childbirth.

But in some cases, the child is located in the uterus incorrectly and is risky for birth. One of these locations is the transverse presentation of the fetus. This means that the axes of the spines of the mother and child are perpendicular to each other, that is, the child lies across the stomach, and not along.

You should not frighten yourself in advance and look closely at the outlines of the abdomen - only 0.5% of pregnant women are diagnosed with transverse presentation of the fetus. And almost always medicine is able to help mom and baby.

Diagnostics

Inside the fetal bladder, the child feels safe - it is warm there, a knock is heard mother's heart comes the sound of her voice. And the wonderful aquatic environment, the amniotic fluid, supports small body in the state of zero-gravity". The child turns, spins and somersaults. This period of mobility lasts until 34-35 weeks, while the body of the fetus is still small, and there is an active process of formation of internal organs in it.

Therefore, until the end of the seventh month of pregnancy, you are unlikely to hear from the doctor a categorical diagnosis of the abnormality of the fetus. But at 8-9 months, the baby is actively gaining weight, his position becomes stable, and the gynecologist during this period can already objectively judge the location of the child in the uterus.

Sometimes a woman may herself suspect that something was wrong. The transverse oval shape of the abdomen is a sign of the incorrect position of the fetus. But since visits to the obstetrician-gynecologist become more frequent from the seventh month, the doctor closely studies and examines the expectant mother.

The following methods are used to determine the position of the fetus:

visual inspection. If the baby is large, its location in the womb is obvious and visible to the naked eye.
Palpation (examination by touch). The doctor puts his hand on the baby's head, and the other on his pelvis or heels. It also listens to the heartbeat - in the transverse position, the baby's heart rate is heard only in the woman's navel. Vaginal examination is usually not performed.
Ultrasound examination (ultrasound). This is the final stage of diagnosis, giving a complete confirmation (or refutation) of the preliminary diagnosis.

Causes

The factors and causes of the incorrect position of the child inside the uterus are diverse - from features prenatal development fetus to the consequences of mother's diseases and pathologies of the child.

Do not neglect visits to the doctor, even if you are not pregnant for the first time and consider yourself experienced mom and a woman in labor . The transverse position of the fetus in women giving birth is more common than in women giving birth for the first time.

Too much or too little amniotic fluid

Factors affecting the volume amniotic fluid, have not been fully explored. This is the sacrament of the body of a pregnant woman. The amniotic fluid is generated by the inner epithelium of the amniotic sac, and at the end of pregnancy, its composition is updated every three hours.

With polyhydramnios (the volume of amniotic fluid is 1.5-2 liters or more), it is more difficult for a child to “lie down” head down, since the internal space of the uterus is extensive. Conversely, with a small amount of amniotic fluid (less than 600 ml), the movements of the fetus inside the uterus are so difficult that the child is squeezed by its walls.

Decreased tone of the walls of the uterus and weakness of the abdominal muscles

Most often, weak muscular walls of the uterus are found in women who give birth again. The natural location of the uterus is vertical, inverted pear-shaped. Ideally, the smooth muscles of the reproductive organ are elastic enough to stretch with the growth of the fetus and elastic to maintain its vertical position. And since we are all exposed to gravity, without proper support, the uterine muscle and abdominal wall of the child is located as it suits him, and not as he should.

Misplacement of the placenta

In medical terminology, the incorrect location of the placenta is called "previa" and means the attachment of a "baby place" in the cervical region. The placenta completely or completely occupies the place that the baby's head should take by the end of pregnancy. Placenta previa is a categorical indication for caesarean section (CS) because natural childbirth impossible.

Normal location of the placenta and its presentation in the lower segment of the uterus

Neoplasms in the uterine cavity

Of course, for the well-being of the child, a calm and safe course of pregnancy, it is recommended to carefully monitor the health of the mother. Indeed, in the presence of adenomas, fibrous tumors and polyps in the lower segment of the uterus, the risk of transverse presentation of the fetus increases significantly. Regular visits to a gynecologist and strict adherence to medical recommendations throughout pregnancy are recommended.

Features of the structure of the uterus

Quite rare pathologies are the saddle and bicornuate uterus - only 0.1% of pregnant women can hear a similar diagnosis. It means that the shape of the uterus is not a regular elongated pear-shaped shape, but saddle-shaped (with a deflection in the bottom) or bicornuate (divided in two by a septum in the upper section). And it is clear that it is difficult for a child developing in such conditions to assume the position necessary for an easy exit from the mother's body.

Options for the structure of the uterus in the photo

bicornuate uterus The structure of the uterus is normal

Fetal pathologies

Since cephalic presentation of the fetus is necessary for successful birth process, then pathologies in the development of the child, such as hydrocephalus (cerebral edema) or anencephaly (underdeveloped cerebral hemispheres), can prevent the fetus from taking the desired position inside the uterus.

What threatens the transverse presentation of the fetus?

Pregnancy with a transverse presentation can proceed absolutely normally, although women who have given birth know that it is “normal” in recent weeks implies pain in the lower back and hips, heaviness, shortness of breath and constant fatigue. The most risky moment comes during childbirth due to the inconvenient position of the child relative to the “exit” from the uterine cavity.

The uterus has pear-shaped with a narrow part pointing down. And it is logical that with the transverse position of the fetus, an increased load falls on the side walls of this organ. Therefore, when diagnosing given state, the pregnant woman should be under the constant supervision of doctors in the hospital.

Risks and complications:

Early discharge of amniotic fluid and premature birth;
Rupture of the uterus and uterine bleeding;
Hypoxia (oxygen starvation) of the fetus with a long anhydrous state during childbirth;
Launched transverse position and prolapse of parts of the child's body from the uterine cavity (limbs, shoulder or umbilical cord);
Death of a child or mother.

With the responsible approach of the expectant mother to her condition and the implementation of the doctor's recommendations, the transverse presentation of the fetus is just a difficulty, but not a stop factor for the happy birth of a child.

The most common and justified solution for transverse presentation is caesarean section. Especially if a number of activities (exercises, external rotation) did not produce results, or due to pathological causes(placenta previa, uterine neoplasms or pathologies) natural childbirth is not possible.

But at small size and the weight of the fetus, it is still possible to resolve the burden in a natural way, albeit risky. In any case, the gynecologist will give recommendations regarding childbirth individually for each woman.

Transverse presentation of twins

Pregnancy is a test for a woman and a child, especially the bearing of twins. Two babies can occupy a variety of positions relative to each other and the axis of the uterine cavity. The optimal positions are cephalic presentations of both fetuses or the head position of one child and the pelvic (booty down) position of the other.

The transverse presentation of one or two twins is extremely rare (1% of the total number of multiple pregnancies) and is a strong argument in favor of surgical intervention during childbirth.

In the event that one child has a vertical position and is born first, then for the second baby lying across the uterus, a turn on the leg may be applicable. But this is a risky and complicated procedure, which is practically not performed in our time. As a rule, an emergency caesarean section is performed.

Gymnastics for flipping the fetus

Some simple exercises help the fetus change its position. But you can do this gymnastics only after consulting a doctor and making sure that there are no contraindications: complete or partial placenta previa, the threat of miscarriage.

It is better to do gymnastic exercises on an empty stomach or a few hours after eating. Relax your body and calm your nerves.

In the supine position, spend 7-10 minutes, take a deep and calm breath, turn to the other side. Perform 3-4 visits during the day. It is better to lie on the elastic surface of the sofa or couch, and not on a soft bed.
Place one pillow under the lower back, several under the legs so that they are 20-30 cm above the head. Lie in this position for 10-15 minutes 2-3 times a day.
A useful stand in the knee-elbow position, which also needs to be done 2-3 times a day for 15-20 minutes.

Sleeping position - on the side, to which the head of the child is facing. Very efficient swimming. During water procedures muscles that do not work "on land" are included. The general tone of the body rises, blood flow to the internal organs and the fetus is stimulated to take the correct vertical position.

A set of exercises according to I.I. Grishchenko and A.E. Shuleshova

Lie on the side opposite the fetal head, bend your legs at the hip and knee joints. Hold in this position for about 5 minutes, turn to the other side.
Lying on your side, alternately straighten your legs. Lying on the right side - left, on the left - right.
Assuming a sitting position, grasp the bent knee opposite the side to which the baby's head rests. Gently lean forward, making a semicircle with your knee and touching the front wall of the abdomen. Inhale deeply and calmly, straighten your leg and relax.

When the child takes the desired position, it is advisable to put on and wear a special prenatal bandage during the day.

External rotation of the fetus

This manipulation consists in forced pressure on the pregnant woman's abdomen in order to turn the child into the desired position. This is an extreme procedure, often painful for the mother and dangerous for the child, because the hands of even the most experienced obstetrician cannot “see” through skin and uterine wall. The fetus is turned over only by a doctor in a hospital, since this procedure is fraught with complications - uterine rupture, placental abruption, and premature birth.

To date, external rotations of the fetus are practically not used, and in a number of European countries strictly prohibited.

The main thing in the diagnosis of lateral presentation of the fetus is to remain calm, rely on common sense and advice from a gynecologist. Listen to fewer "horror stories" from highly experienced friends, do not engage in self-diagnosis and self-treatment. Although the transverse position of the fetus is considered rare, any obstetrician knows exactly what to do in each specific case. And the task of a pregnant woman is to patiently and accurately follow the advice of a doctor and think only about the good. Happy meeting with your baby!

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

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

Diagnosis of the transverse position of the fetus

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

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

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

Tactics of conducting labor in the transverse position of the fetus

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

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

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

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

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

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

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

What is called transverse presentation of the fetus?

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

Types of presentation during pregnancy:

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

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

Diagnosis of the transverse position

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

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

Causes of incorrect positioning of the child in the uterus

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

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

The course of pregnancy

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

Possible Complications

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

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

Tactics of conducting childbirth

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

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

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

Corrective gymnastics

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

List of corrective exercises:

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

List of exercises according to Grishchenko and Shuleshova:

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

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