Pelvic location of the fetus. Signs of breech presentation. Features of children born in breech presentation

In no case do I urge to do without supervision during pregnancy qualified specialist. But sometimes it just isn't.

I live in a small town, we have only four G. in our LCD. And for the long practice of a pregnant woman, I was convinced that they are real, 100% G. I don’t know, maybe they lack knowledge, qualifications ... But most likely they lack humanity, conscience and desire to do their job, to serve people.

Hoping, believing and trusting such doctors is much worse than relying on your intuition.

For the third ultrasound, and even more so for prenatal ultrasound, we are not only not sent, but in fact they are forbidden to do it, arguing with the words “You have nothing to do?”, “First deal with your sores”, etc. and so on.

My good friend carried her first child very responsibly. She really wanted, like everyone else, that everything was perfect. It was so in the card, because the doctor also regularly accepted gifts. The exciting and long-awaited day of childbirth has come. The couple was preparing for a partnership. And suddenly in prenatal it turns out that the child is in the breech presentation and, due to a number of circumstances, EP is impossible.

Thank God everything ended well. But the doctor did not even warn the woman about the problems associated with presentation. Not a word was said about a possible COP.

If you want to understand the position of the baby in the tummy. You may find this article useful.

Mapping the tummy helps parents to independently determine the position of their baby - during the last month or the last two months of pregnancy

So. Belly Mapping, or mapping the tummy, consists of three steps necessary to determine the position of the child (or, as they say in medicine, “the position of the fetus”) in recent months pregnancy.

Parents can use Belly Mapping just for their own enjoyment. Midwives and doulas will benefit from this knowledge in a rear view situation. occiput presentation.

Most women in the ninth month of pregnancy can, without an ultrasound examination, determine where the face of their baby is directed in head presentation: to the right, to the left, forward or backward. Some, however, find it difficult to map the tummy without outside help.

A strong tone, polyhydramnios, a placenta along the anterior wall of the uterus or a plump tummy can muffle the kicks and jolts by which the baby's body parts are determined.

Mothers often know more about their child's condition than they think. If the woman has not yet studied the habits of the baby, advise her to observe them for a day or two. She will notice more movements of the child in the reclining position, breathing slowly and deeply.

Step 1: Draw a pie. Draw a diagram of the abdomen in the form of a circle divided into 4 parts.

how to correctly determine the position of the fetus?

Draw a circle and divide it into four parts - as if the cake was divided into four large pieces. Imagine that this is a map of your tummy. At the top is the bottom of the uterus (at the end of pregnancy, at 7 or 8 months). Below - the pubic bone. Your right side is on the left side of the map, and your left side is on right side. It's like you're looking in a mirror.

Put marks on the paper where you feel kicks - strong and weak. Show where the big bulge sometimes appears. If you can, draw a heart where the doctor, nurse, or midwife listened to the baby's heartbeat. If one side of your tummy is significantly firmer than the other when you are lying on your back, then draw a line on that side.

If you mentally divide the uterus into four parts, it will be easier to determine the position of the baby's body parts.

Each of the four sectors gives clues!

The woman draws where she feels the bulge and hard side of the uterus.

With words or pictures, the mother or doula notes what is felt in each quadrant:

The strongest shocks;

Weaker shocks or movements;

Firm back;

Large bulge, usually at the top - in the middle or side;

If you know where the baby's head is, draw a circle there and

If you remember where the heartbeat was heard during the last examination, draw a heart there.

If you're not sure about something, don't draw. Mark only what you are sure of.

Step 2: visualize the position of the child

incorrect and correct position of the fetus

drawing: from Gail Tully's The Belly Mapping Workbook

Take a rag doll or a teddy bear.

Set the legs of the toy in the same position as the legs of the baby on the "map", and so on. The legs and arms of the toy should bend.

To make it easier to draw a map, remember the three pairs of opposites in the child's body:

head and butt

Belly and back

Legs and handles

These opposites are on different sides of our "pie".

The butt is always opposite to the head, it is at the top if the head is at the bottom. Also, if the head is down, the baby's legs are on top, and the arms can be felt in the lower half (the legs push more powerfully than the arms). In addition, the legs and arms are on the opposite side of the backrest. The baby's knees are bent, but when the legs are extended, the feet may stick out. The baby's body can take a triangular shape when stretching the legs. The bulge where the feet protrude appears to be rounded. But rest assured, the baby only has one head!

The expectant mother sometimes feels parts of the baby's body as large and small bulges.

The more you practice, the easier it is to determine the position of the child!

how to determine the position of the fetus yourself?

drawing: from Gail Tully's The Belly Mapping Workbook

If the child is in head presentation, then the mother holds the doll upside down, and the doll's head is located at pubic bone mother.

The woman turns the doll so that her legs are in the same sector of the abdomen where she feels the strongest shocks. The baby's feet are on the side of the tummy, so the back of the doll needs to be turned in the opposite direction.

If the baby's butt sticks out in a large bulge (often in the upper abdomen), place the doll's butt in the same sector.

This bulge can be a bit confusing: are both bulges legs, or is one of them the head? If the child is upside down, then this cannot be. If the baby is in a breech presentation, then legs cannot grow from the head (but they can from the hips).

The knees of the child bend, and because of this, the pushes often change their place. When viewed from the rear, the knees may be closest to the surface of the abdomen, sometimes felt near the mother's navel.

Opposite the kicking legs is a solid place - the back of the baby. This is the sector where the heartbeat is best heard when visiting a doctor.

If the child is in full posterior occipital presentation, then no part of the abdomen seems particularly hard and full. The knees, feet and arms can move on both sides of the mother's abdomen. If the handles are felt at the front, just above pubic bone, which means that the child is facing forward.

Pens often feel like slight wiggling or champagne bubbles - if at all. In a cephalic presentation baby, such movements between the pubic bone and the navel (not pushes into the pubic bone!) Definitely belong to the arms. But with a breech presentation, the movements in the lower abdomen can be "stomping" legs. Other sensations in this area may be due to overcrowded Bladder, "grinding" the forehead of the child facing forward, the movement of the pubic bone or, if the sensations are in depth, the maturation of the cervix.

Now imagine how the baby's legs and arms move. They will always be on the side of the tummy and often near the mouth. If the handles are felt in the front, the child is in the posterior occipital presentation - i.e. face forward.

Step 3: Position Name

how to determine the position of the fetus?

drawing: from Gail Tully's The Belly Mapping Workbook

Using the same names for baby positions gives us the opportunity to study and discuss childbirth together. Three questions, asked in this order, determine the name of the position in which the baby is:

1. To which side of the mother is the baby's back turned?

2. What part of the baby's body enters the pelvis first?

3. To which side of the mother's body, back or front, is this part of the child's body turned?

It is in this order that the one-word answer tells us:

1. Mother's side

2. Part of the baby's body

3. Anterior or posterior side of the mother's body

The first answer could, for example, be: "left" or "right" (Left or Right, L or R)

A child in LOA—left anterior occiput—is in one of the ideal starting positions.

Then the second question: what part of the baby's body enters the pelvis first?

The second answer tells us which of the parts of the baby's body that have importance in the process of childbirth, the first goes to the exit. The most common answer is the back of the head ("O" - from Latin occiput). The occipital bone is located at the back of the skull. Another landmark is the sacrum (Latin sacrum), bones triangular shape at the base of the spine. The letter "S" is used to indicate breech presentation (booty down), even if the legs are in front of the sacrum. The letter "M" (from the Latin mentum - "chin") stands for facial presentation, and "Fr" (lat. frontum - "forehead") - frontal presentation, they are rare and quite risky.

Third question: which side of the mother's body is this part facing?

The third and last letter refers to the front, back side of the mother's body or her thigh. The corresponding expressions are used:

Anterior view ("A" - anterior), if this is the front side of the mother's body

Posterior view ("P" - posterior), if this is the back side of the mother's body

Or the lateral position ("T" - transverse), if it is the side or thigh of the mother. If the answers to the first and third questions are the same, then only the third is used.

how to determine the position of the fetus?

Fetal position rose, transverse position shown at bottom right.

Image: from Gail Tully's The Belly Mapping Workbook

how to independently determine the position of the fetus? Left occipital presentation (Left Occiput Transverse)

Left occipital presentation (LOT) is one of the best starting positions in childbirth.

Transcription: the child is in the left lateral occipital presentation

1.) is located with its back to the left side of the mother,

2.) upside down, and

3.) facing the mother's thigh, and the thrusts of the legs are felt in the upper right part of the mother's abdomen.

We call this position LOT.

(When we say "transverse position of the fetus", the child is located across the uterus). When the back is pointing straight forward, we will say OA (Occiput Anterior) instead of AOA, right?

The legs can move in an arc in their sector of the circle. Butt also can move a little. The position of the baby affects the course birth process.

Anterior view: three initial positions in childbirth

how to determine the position of the fetus?

The three positions in anterior occipital presentation, LOT (Left Occiput Transverse), LOA (Left Occiput Anterior) and OA (Occiput Anterior) are ideal for initiating labor.

Both LOA and OA require fewer turns from the child than LOT and can be the start of more quick delivery, but they are less common than LOT. Usually midwives or doctors do not address special attention on the position of the head, so a baby in the LOT position is often referred to as LOA or simply OA.

The four initial positions often transition (or remain) into pure OP (posterior occiput presentation) in active period childbirth. Right occipital presentation (ROT), right occiput posterior (ROP), and left occiput posterior (LOP) progress to pure OP in more than long time childbirth. The child in the LOP position has to turn a shorter distance to move into the LOT position. The incidence of posterior view at the onset of labor has been little studied, and almost all studies have ignored all other options except pure OP.

Four "rear" positions

position of the fetus in the womb

Drawing from Gail Tully's The Belly Mapping Workbook

When labor begins, the high ROT baby tends to move into the ROA position past the sacral promontory at the base of the spine and then rotates into the LOT position to enter the pelvis.

pelvic floor or perineum.

If the baby is in the ROT position, he will usually move into OP (in rare cases, ROA) in the middle part of the pelvis, and on further advancement will be born in ROA or OA.

Some of these babies turn quite easily, especially in mothers with a round pelvis, in good vertical position, with strong contractions, as well as those who have already given birth safely before.

Obstetrics textbooks say that about 15-30% of babies are born in posterior cephalic presentation. Jean Sutton in his book "Optimal Fetal Position" writes that 50% of children tend to rear view in the initial period of childbirth, when the mother only goes to the hospital. According to my observations, 75% of babies are located with their hands forward before the onset of labor, i.e. backs closer to the mother's back than to her stomach. Strong preparatory contractions lead to the fact that a third of them turn into the LOT position before the cervix begins to dilate.

Differences between textbook information, Jean Sutton's observations, and my own show that some of the babies who were in the posterior at the beginning of labor turn before they arrive at the hospital, and then a fraction of them turn before the average doctor notices their position. In other words, this is not a big problem. Just a third of the kids unfold more noticeably than others.

Only 5-7% of children are born in a clear posterior occiput presentation, the rest turn during childbirth. At least 12% of all caesarean sections are performed when the baby is stuck in the OP position due to large diameter heads compared to the head in position OA. Babies in the ROT, ROP, and OP positions are more likely to turn during labor and be born backward facing (OA).

Thanks to the fact that DONA co-founder Penny Simkin has previously dealt with physical therapy, our doula trainings and annual conferences hosted by DONA include useful exercises for babies whose heads are located in the mother's pelvis is not as ideal as we would like. Two key books, "Optimal Fetal Position" and "Handbook of the Birth Process", describe non-surgical methods of birth using movement and gravity.

Mapping the tummy is an enjoyable activity that strengthens family ties. Fears associated with posterior cephalic presentation should be greatly reduced by talking calmly and confidently about the many options available to the mother. Simple demonstrations of some of the exercises learned in doula training, such as the Abdominal Lift, Lunge and Open Knee Chest, will reassure parents that the baby can indeed turn over.

Toddlers in the "three front positions" easily rotate into the final position of the front view of the occipital presentation.

If the child is progressing well in the posterior occipital presentation, then, as a rule, everything is fine. An exception is when a woman has a narrower pelvis, usually triangular or male type. If, given the current position of the fetal head, the head is too large to pass through the pelvis, rapidly progressing labor ends unexpectedly. After a normal first stage of labor, there is a long pause when the baby stops moving. In such cases, it is often C-section. If a child in posterior occiput presentation can rise back up a little and try again, then there is hope for natural childbirth.

In the first half of pregnancy, the fetus constantly moves in the uterus and changes its position, but usually by 30-32 weeks it turns head down and is installed in this position. But sometimes the baby becomes down with legs or ass - this is the breech presentation of the fetus. Natural childbirth in such a situation is possible, although it is more complicated and requires the use of special benefits. In breech presentation, 3-5% of all babies are born.

Currently, the following types of such presentations are distinguished, this is necessary to resolve the issue of the method of delivery:

Breech presentation:

Purely gluteal- the buttocks are presented to the entrance to the small pelvis, the legs are straightened at the knee joints and extended along the body, the feet are located near the face. This is the most favorable type for independent childbirth. It occurs in 60 - 70% of cases.
Mixed breech presentation- the fetus is located in the uterus, as if squatting, that is, the buttocks and legs of the fetus are turned into the small pelvis. The frequency of occurrence is 20 - 25%. In the process of childbirth, it can turn into a purely breech presentation.

Leg presentations are formed most often during childbirth (occur in 10 - 15% of all breech presentations):

Complete- both legs of the fetus are presented to the entrance to the small pelvis.
incomplete- one leg of the fetus is presented, and the other is extended along the body.
knee- the knees of the fetus are facing the entrance.

Reasons for development

Currently, a large number of causes and factors provoking the formation of a breech presentation of the fetus have been put forward. They can be divided into groups:

Maternal factors:

- the narrowing of the entrance to the small pelvis does not allow the baby to establish itself correctly, and he turns to the bottom, with his narrower part - the buttocks;
Anomalies in the development of the uterus(, saddle uterus, the presence of an internal septum in the uterus);
Tumors of the uterus(especially myomatous nodes in the lower segment of the uterus);
Tumors of the pelvis, violation of the shape of the pelvis due to fractures;
Postoperative scar on the uterus;
Change in multiparous.

fruit factors:

prematurity- how less term pregnancy, the more common breech presentation. This is associated with the immaturity of the vestibular apparatus, in connection with this, the fetus cannot take the correct position in the uterus and settle down with its head down;
multiple pregnancy- when two or more fetuses are in the uterus, due to lack of free space and limited mobility, they are often not located correctly;
- due to developmental delays, the rate of maturation of the fetal nervous system and its vestibular apparatus also slow down. Also, with a normal amount amniotic fluid and the small size of the fetus, its excessive mobility occurs, which makes it difficult to install in the correct position.
- anencephaly (a decrease in the size of the fetal head due to the complete or partial absence of the cerebral hemispheres and skull bones) and hydrocephalus (an increase in the volume of the head due to excessive accumulation of cerebrospinal fluid). Incorrect dimensions of the fetal head do not allow it to be correctly inserted into the entrance to the small pelvis.
Increased activity of neurosecretory cells of the nuclei of the hypothalamus(section of the medulla oblongata, responsible for many functions of the body, including spatial arrangement).

Placental factors:

- a condition in which the placenta partially or completely covers the uterine os, because of this, the head cannot take the correct position.
Location of the placenta in the fundus or corners of the uterus changes the internal space of the uterus, and the fetus cannot be established in the head presentation.
- by the end of pregnancy, the amount of amniotic fluid is less than 500 ml, which makes it difficult for all movements and movements of the fetus.
- an excessive amount amniotic fluid(more than 1500 ml) does not allow the fetal head to gain a foothold in the entrance to the small pelvis, and it constantly changes its position.

Diagnostics

Palpation of the abdomen during a general examination of a pregnant woman. Distinguish cephalic presentation from the pelvic can be with palpation (palpation) of the abdomen of a pregnant woman using the classic obstetric techniques of Leopold. At the same time, soft, irregularly shaped buttocks of the fetus are determined above the entrance to the small pelvis, and a rounded dense head is located in the bottom of the uterus or in one of its corners. The heartbeat is better heard at the level of the navel on the right or left, depending on the position (where the back of the fetus is turned).
At vaginal examination also palpable through the vaults of the vagina ass of the fetus.
is the most exact way determine the position of the fetus. During the study, many more parameters are determined that are necessary for choosing a method of delivery (this is gender, estimated weight, position of the fetal head (bent or unbent), entanglement of the umbilical cord, location of the placenta, its degree of maturity, the nature and amount of amniotic fluid). And on the basis of all the data obtained, choose the method of delivery.

Ways to change the breech presentation to the head

Information The presentation is finally formed by 35 - 36 weeks of pregnancy, that is, from the moment of diagnosis, there is still time to try to help the baby roll over.

A number of exercises have been developed that change the tone of the muscles of the anterior abdominal wall and uterus, affect the vestibular apparatus of the fetus, stimulating its overturn. Here are the simplest ones:

Lying on a hard surface, you need to alternately turn over 3-4 times on the right and left sides, and lie on each of them for 10 minutes. Repeat the exercise 3 times a day.
In the supine position with legs bent at the knees, raise the pelvis and hold for 2-3 seconds in this position and lower. Do at a calm pace, not forgetting to breathe, 5 - 6 times. If it is difficult to perform the exercise, then you can put pillows under the ass so that the pelvis is located above the head, and lie down like this for 5 to 10 minutes. Also do it 3 times a day.

When performing these exercises, the rotation of the baby on the head can occur during the first week.

External prophylactic rotation, proposed by Arkhangelsky B.A., should be carried out only in a hospital, is currently rarely used, as it can lead to many complications.
Communicate more with your baby, ask him to roll over. Mentally imagine that the baby is already in head presentation.

Birth in breech presentation

In a planned manner, a caesarean section is performed if, in addition to breech presentation, there is also additional indications to operation:

Anatomically narrow pelvis;
Estimated fetal weight less than 2000 g or more than 3600 g (with a breech presentation, such a fetus is considered large);
Scar on the uterus;
Varicose veins of the vulva and vagina;
Extension position of the fetal head
Foot presentation of the fetus;
Posterior view of the breech presentation of the fetus;
Mixed breech presentation in nulliparous;
Placenta or umbilical cord previa
The age of the primipara is over 30 years;
Prolonged infertility in history;
Chronic fetal hypoxia;
Immature cervix in full-term pregnancy.

The frequency of caesarean section in breech presentation of the fetus is currently 80 - 85%.

Although breech birth is considered pathological, there are a number of conditions under which natural childbirth ends successfully. Let's list them:

Good condition of mother and fetus;
The average size of the fetus with sufficient capacity of the pelvis of the pregnant woman;
Bent fetal head;
The readiness of the mother's body for childbirth, a mature cervix;
Pure breech presentation.

However, such genera require heightened attention on the part of the doctor and midwife, and constant monitoring of the fetal heartbeat and contractile activity of the uterus. The mechanism of childbirth is significantly different from childbirth in head presentation, because the buttocks and legs of the fetus are born first, and the largest part, the head, comes last, and it does not have time to take the optimal shape and stretch the birth canal. When the whole body was born and only the head remained, it presses the umbilical cord against the walls of the pelvis and the blood supply to the fetus is sharply reduced. To prevent serious damage to the child's brain, it is necessary to pull out the head for 5, maximum 10 minutes. During childbirth, the following complications may occur:

premature(before the beginning labor activity) or early (up to 5 - 6 cm) outflow of amniotic fluid;
Cord prolapse or fetal legs when ruptured amniotic sac and outflow of amniotic fluid. In such a situation, an emergency operation is indicated;
Anomalies of labor activity: primary and secondary weakness, weakness of attempts;
Acute fetal hypoxia- cessation of oxygen supply due to pressing of the umbilical cord by the fetal head;
Premature occurs due to a sharp decrease in the volume of the uterus after the birth of the legs of the fetus.
Deep ruptures of the cervix and the mother's vagina.

Additionally Regardless of the method of delivery, all babies born in breech presentation are under special control neonatologist (micropediatrician) for early detection of possible consequences of hypoxia in childbirth. Although of course after surgery, such complications are much less.

breech presentation fetus

At the beginning of your pregnancy, while future child still very small, it moves freely inside the uterus, changing its position. Over time, as the fetus grows, it becomes tighter and tighter. However, until about 30 weeks of gestation, his position should not be a cause for concern.

By this time, the child, as a rule, turns head down. This position is called head presentation. This classic version, the most convenient for childbirth. It is in the head presentation that up to 90% of children are born.

However, it happens that the child takes the opposite position. Thus, the buttocks are the presenting part, and this position is called the gluteal, or breech presentation fetus. At breech presentation of the fetus In this case, natural childbirth is also possible, although more difficult.

Presentation is determined during an ultrasound examination and during a manual examination by a gynecologist by palpation of the abdomen. If after 30 weeks your baby has taken a transverse or pelvic position, you will be advised to do some exercises to help the baby roll over. You should not be afraid of this situation, since many children take a classic pose after 32-34 weeks, or even on the eve of childbirth. The proposed course of exercises will allow you to contribute to this process.

A set of exercises for breech presentation of the fetus

1. "Indian bridge". You need to lie on the floor, raise your legs and put a few pillows under the pelvis so that the pelvis becomes 30-40 centimeters higher than the shoulders. In this case, the shoulders, pelvis and knees should form a straight line. Thanks to this exercise, some children turn into the correct position the first time. If the child is still stubborn, repeat the lesson 2-3 times a day. However, never do this on a full stomach. There is another version of this exercise. You can sit your husband opposite and put your legs on his shoulders so that your popliteal fossae are on his shoulders.

Besides classic way there are also methods of cauterizing certain points on the outside of the little toe on the leg, as well as acupressure inner surface feet. But this requires highly qualified specialists.

2. With transverse and (or) breech presentation of the fetus three more exercises:

Introductory: Feet shoulder-width apart, hands down. For a count of times, raise your arms to the sides with your palms down, stand on your toes and at the same time arch your back, taking a deep breath. For two - exhale and start position. Repeat 4 times.

Basic: Lie on the side to which the back of the fetus is facing when breech presentation, or opposite to that to which the head is facing in the transverse. Bend your knees and hips and lie still for 5 minutes. Then take a deep breath, turn over your back to the other side and lie still for 5 minutes again. Then straighten the leg that you have on top - with the pelvic, or the one on which you lie, with transverse position fetus. The second leg must remain bent. Take a deep breath and again bend the straightened leg at the knee and hip joints, grab your knee with your hands and take it towards the back in breech presentation or towards the buttocks in transverse presentation. At the same time, the torso will lean forward, and the bent leg will describe a semicircle inward, touching the front wall of the abdomen. Take a deep breath, relax, straighten and lower your leg. Then take a deep breath again and repeat the exercise again. This exercise should be done 5-6 times.

Final: Lying on your back. Bend your legs at the knee and hip joints, rest your feet shoulder-width apart on the floor, stretch your arms along the body. On the count of times - inhale and lift the pelvis, resting on the feet and shoulders. For two - lower the pelvis and exhale. Then straighten your legs, tighten the muscles of the buttocks, draw in the stomach and perineum while inhaling. Relax - exhale. Repeat 7 times.

If during the next ultrasound it is found that you have achieved your goal and the baby has turned from the pelvic to the normal position, you can forget the introductory and basic exercises, and perform the final one until childbirth occurs.

If during classes you feel movement in your stomach or something similar to noise, then most likely you have "persuaded" the child to take the correct position. A long walk will help him fix himself in this position. But to make sure of luck, you need to do an ultrasound.

Childbirth with breech presentation of the fetus The following location of the fetus in the uterus is considered normal: the head is located below, located above the bosom, and during childbirth the first passes through the mother's birth canal. But this is not always the case. In 3-4% of all women, the fetus is located in the uterus on the contrary, in the so-called breech presentation. In breech presentation, the buttocks of the fetus (gluteal), legs ( foot presentation) or buttocks together with legs (mixed breech presentation).

Childbirth in this case can proceed quite normally, but situations often arise that are unfavorable for the mother and child.

Why does breech presentation occur?

Possible causes of breech presentation of the fetus:

- increased fetal mobility with polyhydramnios, premature pregnancy(the amount of water is greater than with a full-term pregnancy), multiple pregnancy,

- narrow pelvis, placenta previa (location on the way of the fetus moving along the birth canal), fetal abnormalities (large disproportionate dimensions of the fetal head)

- oligohydramnios, anomalies in the development of the uterus. This limits the mobility of the fetus in the uterus.

- Decreased uterine tone. The ability of the uterus to correct the position of the fetus in response to irritation of its walls decreases.

What types of breech presentation of the fetus are there?

There are the following types of pelvic presentation of the fetus:

gluteal (buttocks are located above the womb, legs are extended along the body)

foot (legs of the fetus are presented)

mixed (buttocks facing the mother's pelvis along with legs bent at the hip and knee joints).

Leg presentations are formed during childbirth. Breech presentations make up 30-33% of all breech presentations. Very rarely, in 0.3%, there is a knee presentation, a kind of foot presentation, in which the bent knees of the fetus face the mother's pelvis.

How to recognize the breech presentation of the fetus?

With external obstetric research during examination of a pregnant woman above the entrance to the pelvis, a large, irregularly shaped and softish consistency presenting part is probed. There is also a high standing of the uterine fundus compared with the same gestational age with cephalic presentation. This is due to the position of the pelvic end of the fetus above the entrance to the mother's pelvis until the end of pregnancy and the onset of labor. In the bottom of the uterus, on the contrary, a dense, rounded fetal head is determined. Fetal heartbeat is best heard in pregnant women in breech presentation above the navel.

You can clarify the diagnosis with a vaginal examination. At the same time, softish tissues of the presenting buttocks and legs of the fetus are probed. Since all pregnant women repeatedly undergo an ultrasound examination during pregnancy, diagnosis is not difficult.

How does pregnancy proceed with a breech presentation of the fetus?

Pregnancy with a breech presentation proceeds in the same way as with a head presentation. Starting from the 32nd week of pregnancy, with a diagnosis of breech presentation, a certain set of exercises is recommended to correct it. The pregnant woman, lying on the bed, turns alternately on the right and left side and lies on each for 10 minutes. And so 3-4 times. Classes are held 3 times a day. Often, the fetal rotation on the head occurs during the first 7 days, if there are no aggravating circumstances (oligohydramnios or polyhydramnios, irregular shape of the uterus). The meaning of these exercises is to stimulate the nerve receptors, increase the excitability and motor function of the uterus. If by 37-38 weeks the stubborn baby has not changed its position, childbirth is carried out in a breech presentation. 2 weeks before the expected date of delivery, hospitalization is offered in a hospital, where the issue of the method of delivery is decided.

How to give birth with a breech presentation of the fetus?

In the maternity hospital, to decide on the method of delivery (caesarean section or birth through the natural birth canal), the following points are evaluated:

age of the woman (the first childbirth after 30 years is referred to as aggravating moments)

how past pregnancies went, whether there were births and how they ended. An important point is the presence in the past of independent childbirth.

how was it real pregnancy, is there swelling, increased arterial pressure, impaired renal function

estimated fetal weight (estimated baby weight over 3500 g inclines to a decision in favor of caesarean section)

fetal condition (signs chronic hypoxia, lack of oxygen, which can be aggravated against the background of prolonged labor)

the size of the mother's pelvis (there is a tendency to develop a clinically narrow pelvis during childbirth). It is possible to use X-ray pelviometry (assessment of the size of the bone pelvis using X-rays)

the condition of the cervix, its readiness for childbirth (the mature cervix is soft, shortened to 1.5-2 cm, located in the center of the small pelvis, skips the tip of the finger)

type of pelvic presentation. The most unfavorable is considered - foot presentation ( frequent complications in the form of prolapse of the fetal leg, loop of the umbilical cord

the position of the fetal head (with excessive extension, according to ultrasound, operative delivery is also recommended). This can lead to injuries to the brain, cervical spine.

If there are complications during pregnancy, a narrow pelvis, a fetus weighing more than 3500 g, the age of a primiparous woman is more than 30 years, a decision is made to deliver a pregnant woman with a breech presentation of the fetus by caesarean section. The frequency of caesarean section with breech presentation of the fetus is more than 80% on average.

Assistance in childbirth with breech presentation of the fetus

After the operation, a scar remains on the uterus, so if the condition of the mother and fetus is good, the cervix is mature and the baby is supposed to be small, childbirth is carried out under close supervision independently.

In the first stage of labor (contractions and dilatation of the cervix), a woman must observe bed rest to avoid complications (premature discharge of water, prolapse of the fetal leg or umbilical cord loops).

If, after all, a decision is made to deliver childbirth through the birth canal, obstetric care is provided in the form of benefits in the second stage of childbirth. Main principle- maintain the articulation of the fetus (the legs are extended along the body and pressed to the chest by the arms of the fetus). First, the baby is born to the navel, then to bottom edge the angle of the shoulder blades, then the handles and the shoulder girdle, and then the head. As soon as the baby was born before the navel, his head presses the umbilical cord with the development of a lack of oxygen. Before full birth the child should take no more than 5-10 minutes, otherwise the consequences of oxygen starvation can be very unfavorable. A perineal incision is also made to speed up the birth of the head and make it less traumatic. They also use a dropper with reducing agents (), antispasmodics (no-shpa).

Condition of children born in breech presentation with independent childbirth, requires increased attention. Frequent signs of hypoxia suffered during childbirth adversely affect the child's nervous system (consultation of a neurologist). Often such a pathology as a dislocation of the hip joint. A neonatologist must be present at the birth pediatrician) to provide resuscitation, if necessary. With these precautions, children born in this way are no different from other children.

Video. breech presentation at 20 weeks

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

Varieties of breech presentations

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

Factors affecting breech presentation

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

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

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

Diagnosis of breech presentation

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

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

coup attempt

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

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

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

Choice of method of delivery

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

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

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

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

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

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

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

Discussion

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

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

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

Position and presentation of the fetus. Breech presentation is not an absolute indication for caesarean section. Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. Another ultrasound showed that the baby was in a breech presentation.

Discussion

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

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

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

Discussion

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

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

Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. pelvic presentation. Girls, has anyone had a baby roll over after 36 weeks? Pregnancy, childbirth and breech presentation of the fetus. How to fix?

Discussion

And how was the pelvic defined? On ultrasound or probed through the stomach? During my first pregnancy, they told me "pelvic", and the ultrasound showed - head.

It is now believed that the boy in breech presentation is a 100% indication for a caesarean section in order to avoid male problems in the future. If the girl - the doctor decides on the situation. But do the exercises as much as possible, you should always hope for the best outcome.

Pregnancy and childbirth: conception, tests, ultrasound, toxicosis, childbirth, caesarean section, giving. What good is an independent birth in the pelvis? There are many risks, especially for the fetus :(, the ratio of risks of cesarean and independent birth in the pelvic is not balanced.

Discussion

You know, I have a girl sitting next to me. She is a midwife by training. Then she got even higher, already artistic, now a designer. But immediately after college, I managed to work for 1-2 years in a maternity hospital, somewhere on the periphery. So we once discussed this problem with her, she said that never for them, the pelvic was not a problem (let me remind you that in the most ordinary maternity hospital, on the periphery about 10 years ago ...) And neither the mother nor the child had any problems with the pelvic ... I tend to believe her. Now it is much more customary to play it safe ...

I read this Chernukha. He's not quite right. According to serious international studies, the percentage of risk is the same, but the complications are different in nature. I'll look for the link right now.

In general, there are many prerequisites for breech presentation (including heredity, and if it hadn’t turned over, then I would definitely have done a caesarean - in our family Malposition fetus. The most common of the "non-standard" ...

Breech presentation, cesarean at the discretion of the doctor on duty, was Saturday, in the maternity hospital - natural childbirth is welcome, I have a second birth (first 14 years Pregnancy: ultrasound, position of the fetus in the uterus, breech presentation. Childbirth - independent, caesarean section.

Discussion

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

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

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

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

09/14/2000 17:58:27, LenaO

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

Discussion

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

08/03/2000 10:27:46, Xenia

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

Breech presentation of the fetus - the placement of the child along the uterine cavity, while the legs and buttocks are directed to the small pelvis. Some women do various exercises with the breech presentation of the fetus, but such activities are not recommended without the advice of the attending physician.

At about 20 weeks, the baby in the womb turns over, that is, it assumes a head-down position, its back is turned to the left. This placement of the fetus is correct, called head presentation. In this position, all children are born, with the exception of 10%.

Etiology

Exist various reasons formation of pelvic presentation of the fetus. hinder correct position fetus in the uterus can such factors:

the presence of fibroids in the lower part of the uterus;
irregular shape of the pelvis (especially if the pelvis is narrow);
the presence of neoplasms of the internal organs of the pelvis;
diseases: cephalocele, and others;
low position and .

Too high muscle tone the lower part of the uterus and low in the upper segment. In this situation, the head turns away from the pelvis and turns to the top of the uterus. Such a contraction of the muscles of the uterus, especially in the third trimester, occurs due to an improperly developed organ. This can happen due to its inflammation, frequent curettage, a large number of births, difficult births.

A negative effect on the tone of the muscles of the uterus has a scar formed after a cesarean. There is another reason that affects this situation - a large activity of the fetus, which can begin with:

large volume of amniotic fluid;
delay physical development;
prematurity.

Low mobility occurs under such conditions:

change in the shape of the organ during the development of anomalies;
a small amount of amniotic fluid;
entanglement of the fetus with the umbilical cord, any part of the body can suffer;
too short umbilical cord.

Scientists have made some observations, during which the following fact was established: if a woman was born in a breech presentation, then during the period of gestation the fetus will take the same position. This suggests that one of the reasons genetic predisposition. Today, scientists have not yet fully studied this issue.

If a subsequent pregnancy in a woman proceeds against the background of the same negative factors as the previous one, then the risk of recurrence of the pathology is very high.

In some cases, it can be difficult to establish the cause of this position of the baby, in addition, the factors can be combined.

But still, the main causes of breech presentation are called:

narrow pelvis of a woman in labor, having an irregular shape;
pathological changes organ, for example, a formed scar, developmental pathology, inflammation;
the presence of neoplasms;
diseases in which failures occur in the autonomic nervous system;
frequent curettage, numerous and complex childbirth;
absence or excess of amniotic fluid, delayed physical development of the fetus, oxygen starvation.

Despite this, the child still tries to take the most comfortable position for himself, in addition, the instinct of self-preservation "prompts" him to the chosen position.

Classification

Breech presentation in obstetrics is divided into gluteal and foot:

Gluteal. Only the gluteal, that is, incomplete - this means that only the baby's buttocks are directed towards the pelvis, the legs will be extended along the body. This position - pelvic longitudinal presentation of the fetus, is observed in seventy percent of cases.
Mixed gluteal. It means that not only the buttocks are deployed to the entrance to the pelvis, but also the legs, which are bent at the knees and pelvis. This position of the fetus occurs in twenty-three percent of women in labor.

Foot (observed in ten percent of pregnant women) are divided into the following subspecies:

complete, when both legs are turned to the pelvis;
incomplete - only one leg;
knee - the baby's knees are directed to the pelvis (such a presentation occurs in 0.3 percent of cases).

The classification is carried out on the basis of the features that caused the biomechanism of the onset of labor.

If the fetus has a breech presentation, the pelvis of the woman in labor is not narrow, then the woman can give birth on her own, without complications. When the presentation of the fetus is foot or mixed, it is necessary to resort to a caesarean section, because in this case the prognosis for the health and life of the child is unfavorable.

Foot presentation is the most unfavorable, because serious complications can appear.

Symptoms

Breech presentation in comparison with the head presentation is more dangerous, because it can happen:

spontaneous abortion;
will occur, that is, there will be a malfunction in the work of the kidneys, blood vessels and brain of a pregnant woman;

The above conditions can affect the development of the nervous, endocrine and other systems of the baby. Breech presentation, which is diagnosed at 32 weeks of pregnancy, begins to slow down the development of the medulla oblongata. As a result, pericellular and perivascular edema occurs, one of the layers of the adrenal glands is depleted, and the protective reactions of the fetus are reduced.

With breech presentation, the fetus develops defects:

hearts;
central nervous system;
gastrointestinal tract;
musculoskeletal system.

If there are violations of the placenta in terms of blood flow, then the fetus appears:

oxygen starvation;
cardiopalmus;
reduced motor activity.

When labor begins with a breech presentation of the fetus, the intensity of the labor process often decreases in a woman. With mixed breech or foot presentation, more complex changes appear.

Diagnostics

If the pregnancy proceeds normally, without complications, then by the twenty-fourth week the fetus turns head down. However, in a period of three months, the situation may change repeatedly. At this time, multidirectional contractions of the uterus, that is, its individual sections, occur. Such contractions maintain proper blood flow in the uterus and placenta. The change in the posture of the fetus can take place several times a day. The baby takes its final position by the thirty-fifth week. If this is a breech presentation, then it is necessary to prepare for labor with such a pathology.

Based on the foregoing, we can conclude that the diagnosis of "breech presentation of the fetus" at the thirty-fifth week will be correct. If it is placed at earlier stages of pregnancy, then the conclusion of the doctor is erroneous. To diagnose breech presentation, two types of research are used:

external obstetric examination;
vaginal examination.

With breech presentation, the bottom of the uterus is high above the pubis, and this is not typical for certain period pregnancy.

During an external examination, the doctor determines the large, round, hard and moving part - this is the baby's head. With breech presentation during a vaginal examination, the doctor palpates the soft volumetric part, the inguinal fold, coccyx and sacrum are clearly felt on it. The doctor should not determine the sex of the baby during palpation, because the genitals can be damaged.

If the presentation is foot or mixed-buttock, then you can feel the feet. They can be distinguished from the child's hand by the fact that the calcaneal tubercle and short fingers, which are located on the same line, are easily determined.

Foot presentations are the easiest to recognize. Most often there are problems with the definition of the gluteal, which can be confused with the facial or frontal.

To correctly determine the presentation, it is necessary to conduct an ultrasound examination. As additional diagnostics are used:

echography;
dopplerography;
cardiotocogram;
computer cardiointervalography.

Ultrasound will help to make the correct diagnosis. Sonography will determine the presentation of the fetus and its variety. For this, it is better to use three-dimensional echography.

Treatment

A pregnant woman with a breech presentation of the fetus is determined in a hospital. Basically, this happens as early as the thirty-ninth week. The hospital staff will necessary examinations and choose the mode of delivery. The choice of method is only individually because it depends on many factors:

the number of previous pregnancies and births;
the age of the woman in labor;
gestational age;
readiness of the body for childbirth;
the size of a woman's pelvis and much more.

It cannot be said unequivocally that a caesarean section is necessary with a breech presentation of the baby. But if it is combined with complicating reasons, then only surgery is prescribed.

A caesarean section will be scheduled if:

a woman over thirty years old, and this is the first birth;
the patient suffers from nephropathy;
extragenital pathology;
violation of fat metabolism;
narrow pelvis;
large fruit, more than four kilograms;
violation of blood flow;
Rhesus incompatibility of the blood of the fetus and the pregnant woman;
breech presentation and foot presentation.

Natural childbirth is possible with a diagnosed breech presentation, if there are no health complications in the mother and unborn child. The baby should be full-term, medium-sized.

It is necessary that with breech presentation the mechanism of childbirth be spontaneous. In the first period of labor, the pregnant woman should not get out of bed and lie only on her side when the fetal spine is determined - this will help reduce the risk of complications. The fetal heartbeat and uterine contraction during this period must be strictly controlled. In the second period, medical personnel provide benefits. The baby is born within five to ten minutes. If necessary, a perineal incision is made.

The birth of a baby in a natural way, if a foot presentation is diagnosed, is possible only in women who have given birth earlier, with a full-term pregnancy, a small fetus. In addition, a written refusal of the woman in labor from a caesarean is required.

After the birth of babies with a breech presentation, they need special attention. oxygen starvation, which newborns have suffered, can give complications to nervous system. But if the doctors provided qualified assistance, the further development of such children will not differ from others.

Possible Complications

A child who was born in a breech presentation often suffers from complications:

intracranial injury;
spinal pathology;
hip disorder.

If the baby's neck was wrapped around the umbilical cord or the baby swallowed amniotic fluid, resuscitation is necessary. Immediately after the birth of such children, they should be examined by a neurologist.

As for the woman in labor, after delivery, the woman has such complications:

rupture or forced incision of the perineum;
rupture of the cervix;
vaginal rupture;
pelvic bone injuries.

How to avoid possible complications, the attending physician will prompt.

Prevention

Preventive measures that contribute to normal delivery are as follows:

it is necessary to identify the reasons why the pelvic position of the fetus may occur;
adhere to the physiological course of pregnancy;
drug prevention and timely identification of causes threatening miscarriage;
warning of a large fetus;
gymnastics with pelvic presentation of the fetus;
inform the woman in advance about the caesarean section;
proper preparation women to upcoming birth;
professionally performed childbirth;
special attention to the baby after childbirth.

All preventive actions are aimed at correcting disorders that occur during pregnancy and childbirth, both in the mother and in the child.