Transverse presentation of the fetus at 36 weeks of gestation. Conducting labor with a transverse or oblique position of the fetus. Diagnosis of the position of the fetus

Every woman wants her pregnancy to proceed without complications and end with the birth healthy baby. But sometimes it happens that the gestation period has its own characteristics that can affect the health of the mother and child. One of these features that complicate childbirth is transverse presentation fetus.

Causes and complications

The named pathology of pregnancy occurs approximately once in 200 cases (0.5-0.7%). It happens more often with repeated pregnancies. It is determined after 32-34 weeks. Prior to this, the fetus is quite mobile and often changes its location in the uterus. And at 33-34 weeks, the baby is placed in a certain position, preparing for the upcoming birth. There are three positions that a child can take after the named period:

longitudinal (the body of the fetus is placed along the uterine cavity, facing the birth canal with the head (head position) or buttocks (gluteal position). The longitudinal arrangement is considered normal and is typical for more than 99% of pregnancies);
transverse (the baby is located across the uterus, large parts of the fetus are palpable on the right and left sides of the uterus);
oblique (the baby's body is located under acute angle to the longitudinal axis of the uterus).

There may be several reasons for the manifestation of pathological presentation (transverse or oblique). This is both polyhydramnios and oligohydramnios, multiple pregnancy, too narrow pelvis, pathologies of the structure of the uterus or some of its diseases (for example, with myoma, the nodes on the muscular tissue of the uterus prevent the child from being placed correctly). Not correct position it also happens in babies with developmental pathologies or too much body weight.

As already mentioned, transverse presentation is typical for the second and subsequent pregnancies. There is a simple explanation for this. The muscles of the anterior wall of the abdomen are stretched from the pressure of the growing uterus, become flabby and can no longer restrain the movements of the fetus. That's why it turns wrong.

In most cases, pregnancy with transverse presentation is normal. Although in a third of such cases, childbirth begins ahead of time with premature effusion amniotic fluid. If, in addition to this, there is also such a pathology as placenta previa, then severe bleeding may occur.

With a transverse presentation, complications are possible during natural childbirth. For example, prolapse of the umbilical cord or limb (arm, leg) of the fetus. This can cause infection of the amniotic fluid and inflammation of the membranes of the fetus (chorioamnionitis), provoke sepsis.

Premature discharge of amniotic fluid and prolonged "anhydrous" stay of the fetus can lead to hypoxia (lack of oxygen) or even asphyxia (suffocation).

With a transverse presentation, it is extremely rare, but there are also births with a "double torso". After the outflow of amniotic fluid and with intense contractions, the walls of the uterus press so hard on the fetus that it bends in the thoracic region. In this case, childbirth ends spontaneously. Comes out first rib cage with the neck pressed against it, then the stomach with the head pressed against it, after that - the buttocks and legs. Such childbirth occurs with great prematurity or a dead fetus.

Sometimes in a transverse presentation during childbirth, the baby turns into a normal position on its own, taking the head or gluteal position.

What is the neglected transverse position of the fetus?

Quite often, with a transverse presentation in childbirth, a complication occurs, which is called neglected transverse position fetus. Its essence is that after premature departure amniotic fluid the baby’s mobility is limited, his shoulder and arm are, as it were, “drilled” into pelvic bone blocking the movement of the head and trunk to the birth canal.

This complication can cause uterine rupture. To warn him, C-section.

How to fix lateral presentation

Once a transverse presentation, as a rule, ended fatally for both the mother and the child. Now this risk is minimized. The incorrect position of the fetus is determined during a routine examination by a gynecologist, the doctor slightly presses his fingers on the stomach and determines where the parts of the baby's body are. During the ultrasound, the incorrect position is confirmed. To fix it, pregnant women are often offered to perform simple exercises that should stimulate the child to take the correct position. However, it is worth saying that they do not help everyone.

Exercises for transverse presentation of the fetus

Special gymnastics should be done several times a day, for at least a week.

Lying on a bed or sofa, make three or four turns from side to side. On each side you need to lie for 5-7 minutes, then roll over.
Lying on your back, lift your buttocks above the level of your head. Under them, you can put a folded blanket or pillow. In this position, you need to lie down for 5-7 minutes.
Cat Pose: kneel down, rest your hands on the floor, inhale and raise your head and tailbone, bending your lower back, lower your head as you exhale and arch your back.
Get on your knees, lean on your elbows (pelvis above the head). Stay in this position for 5-7 minutes.

As is known, on later dates sleeping on your back is not very comfortable, and not desirable. After all, a sufficiently large fetus presses on the vena cava and on the internal organs. Therefore, pregnant women are advised to sleep on their side. In the transverse position of the fetus, it is advised to turn on the side where the baby's head is located. Although future mommy must determine for herself how to sleep more comfortably. If discomfort is felt, then you can change the position.

To make yourself more comfortable, you can put a rolled blanket under your stomach or back or special pillow for pregnant.

Is it possible to wear a bandage with a transverse presentation

Often in the second half of pregnancy, women are advised to wear a bandage. This helps to reduce the load on the spine, back muscles and internal organs. However, with a transverse presentation of the fetus, wearing a bandage is not recommended. After all, it fixes the position of the child in the womb, which means it does not allow him to turn around and take the correct position. If the child has turned from the transverse to the longitudinal position, the doctor may recommend wearing a bandage to fix this correct position of the crumbs.

Childbirth in the transverse position of the fetus

The position of the fetus is decisive for the tactics of childbirth. If the baby does not roll over and lies across the uterus, then natural childbirth impossible, because they may dangerous consequences threatening the life of the baby and his mother.

In such cases, the planned operation caesarean section. At the 37th week, the woman goes to the hospital and prepares for this procedure. It is performed under general or local anesthesia.

If childbirth begins prematurely, then an emergency caesarean section is performed to avoid dangerous consequences.

Especially for -Elena Semenova

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. During delivery with breech presentation, complications arise, 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. A posterior presentation is a position in which the child's back is turned 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 speak of a 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, amniotic fluid may suddenly depart, thereby provoking the onset labor activity. 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 leaves ahead of schedule. 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 the waters causes oxygen starvation The child has. Even if the baby is born alive, he will have severe physical and mental pathologies. clinical sign severe acute hypoxia is 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. This tactic remains very dangerous, because it can lead to placental abruption and organ rupture, but it is necessary when multiple pregnancy when one child has already appeared, and the second is in a 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, future mom should wear a bandage with rollers on the sides for prevention.

Speaking about the medical literature, one can recall many examples when childbirth ended in the death of the mother and her unborn child. One of the reasons for the high death rate in childbirth in the 17th-19th century was difficult births, provoked by the transverse position of the fetus. Today, such a complication of pregnancy, although it remains a danger to the life of the child and mother, but the risk of death of both participants in childbirth has significantly decreased. The incorrect position of the fetus, including the transverse one, occurs in 1 case per 200 cases of childbirth, in percentage terms it is 0.5-0.7%. It is characteristic that situations with a violation of the normal position of the fetus in the uterus occur more often in multiparous women (more often 10 times) than in women with the first birth.

Some terminology

Based on the data on the position of the fetus in the uterus, the tactics of childbirth are determined. To understand the terms, you need to understand the following concepts:

axis of the uterus - a longitudinal line that connects the cervix and the fundus of the uterus, or the length of the uterus;

the axis of the fetus is a longitudinal line that connects the head and buttocks of the baby.

The position of the fetus is the ratio of the axis of the baby to the axis of the uterus. There are two types of fetal position: correct and incorrect. The correct position is longitudinal, when the axis of the uterus and the axis of the fetus coincide, in other words, when the torso of the future mother and the torso of the child are in the same direction (for example, when a pregnant woman is standing, then the child is in an upright position). In this case, the pelvic end or head (large parts) of the child look in the direction of the entrance to the small pelvis, while the opposite part of the fetus rests on the bottom of the uterus.

The wrong position is considered to be an oblique, or transverse, position of the fetus. However, it must be remembered that for most of the gestation period, the fetus is mobile and changes its position. The stabilization of the child occurs by the 34th week, so talking about the incorrect position of the fetus before this period is not entirely appropriate.

Transverse position of the fetus

With a transverse arrangement, the fetus is located not along, but across the uterus, in other words, the axis of the fetus and the axis of the uterus are located perpendicular to each other, at an angle of 90 degrees. Since the child is in a transverse position, the presenting part is also absent, while large parts of the fetus are palpated on the sides of the uterus on the left and right, and are located above the iliac crests.

Oblique position of the fetus

The oblique position of the fetus is diagnosed when the axis of the child is at an angle of 45 degrees to the axis of the uterus. In this case, the buttocks or head are below the iliac crest. It is also possible to single out the transverse oblique position, when the axis of the fetus is located at an angle to the length of the uterus, but this angle does not reach 90 degrees, but exceeds 45 degrees.

It should also be said about the so-called precarious position fetus. In the case of intense mobility, the fetus may periodically change position, moving from oblique to transverse or vice versa.

Fetal presentation

The position of the fetus, in which its large part (either the buttocks or the head) is directed towards the entrance to the small pelvis, is called the presentation of the child. Accordingly, there are breech presentation (when the buttocks, legs are at the entrance to the pelvis) and head presentation (the head of the fetus is located at the entrance).

Factors contributing to the occurrence of malposition of the fetus

The reasons why the fetus is located across the uterus can be due to either reduced or increased motor activity of the baby, or uterine factors (the presence of obstacles in the uterus):

Myoma of the uterus.

The risk of improper location of the fetus in the uterine cavity increases if there are fibrous / myomatous nodes in it. The risk is especially high when myomatous nodes are localized in the cervix, lower uterine segment or isthmus, or if there are large nodes in size, which, although located in other places, prevent the fetus from taking the correct position. They also do not exclude the growth of neoplasms during pregnancy, which lead to deformation of the uterine cavity and forced malposition of the fetus.

Congenital malformations of the uterus.

Uterine anomalies such as a bicornuate or saddle uterus or the presence of a septum in the uterus also force the fetus to take a transverse position.

Misplacement of the placenta.

low placenta or low placenta(5 or more centimeters below the internal os), its presentation (partial or complete overlap of the placenta of the cervix of the uterus) is often the cause of the incorrect location of the fetus in the uterus.

Narrowed pelvis.

In most cases, the narrowing of the pelvis of the first and second degree is not an obstacle to the normal development, location and subsequent birth of the child. However, with more severe degrees of narrowing, and especially with asymmetric narrowing (curvature by bone exostoses, oblique pelvis), the likelihood of an oblique, transverse and mixed location of the fetus relative to the axis of the uterus increases.

Malformations of the fetus.

A certain part of the vices begins to manifest itself even when the child is in the womb. For example, with hydrocephalus (hydrocephalus, in which the head of the fetus is very large) or anencephaly (absence of the brain), an oblique / transverse arrangement fetus.

Pathology of amniotic fluid.

Excess amniotic fluid provokes excessive expansion of the uterine cavity, due to which the motor activity of the fetus increases. He ceases to feel the boundaries of the uterine cavity and begins to actively move, while occupying an oblique or transverse position. In the case of a lack of amniotic fluid, the situation is radically opposite. The tightness and lack of amniotic fluid do not allow the child to make active movements and take the necessary position.

Multiple pregnancy.

When several fetuses are present in the uterus at once, they experience tightness, as a result of which one or all babies occupy the wrong position.

Large fruit.

Significant weight and size of the fetus reduce it motor abilities, which leads to the occupation of the wrong position in the uterine cavity.

Increased tone of the uterus.

If there is a threat of termination of pregnancy, especially permanent, the uterus is in hypertonicity almost all the time, limiting the movement of the fetus.

Flabbiness of the muscles of the anterior wall of the abdomen.

This situation often occurs in women who have given birth a lot (4-5 births in history). The constant stretching of the anterior wall of the abdomen contributes to more active movements of the fetus inside the uterus (the abdominal muscles are not able to restrain the movements of the child), it begins to tumble and roll over, as a result, it is located incorrectly (obliquely or across) in the uterine cavity.

Fetal hypotrophy.

Insufficient size and weight of the child can also be the reason for its constant active movement and coups in the uterine cavity, since the child is small and there is enough space in the uterus.

Diagnosis of the transverse position of the fetus in the uterine cavity

To determine the transverse position of the child, it is necessary to perform a comprehensive examination of a pregnant woman:

Examination of the abdomen.

During the examination of the abdomen of a pregnant woman, its irregular shape is determined. The abdomen is stretched in a transverse size, in the case of a transverse position of the fetus in the uterine cavity, or obliquely stretched if the child is located obliquely to the axis of the uterus. In such cases, the uterus has the shape of a ball, while normally it should have an ovoid-elongated shape. In the course of measuring the size of the abdomen, it is found that its circumference significantly exceeds the norm, while the height of the uterine fundus does not coincide with the gestational age (less than the term).

Palpation of the abdomen.

During palpation of the anterior abdominal wall, it is not possible to determine a large part of the fetus when probing the area of the entrance to the bone ring of the small pelvis. In the area of the bottom of the uterus, the pelvic or head end is also not palpable. Large parts are palpable on the sides of middle line uterus. The position of the fetus is determined by the baby's head. If the head is located on the left, then they speak of the first position, if the head is located on the right - the second position. The fetal heartbeat is heard well in the navel, and not on the right or left, as in the correct position. There may be difficulties with establishing the position of the fetus in the presence of uterine hypertonicity and with an excess of amniotic fluid.

obstetric ultrasound.

Obstetric ultrasound allows you to determine the exact position of the fetus with a 100% guarantee, regardless of the gestational age. However, the transverse position of the fetus before the term of 20 weeks should not be a cause for panic, since the child may have time to take the necessary position before the due date.

Vaginal examination.

A vaginal examination, which is performed at the end of pregnancy and during contractions, but with the fetal bladder still intact, provides little information regarding the position of the fetus. It is only possible to determine the fact that the presenting part of the fetus is missing at the entrance to the small pelvis. When opening the uterine os up to 4 or more centimeters, as well as when water is poured out, a vaginal examination is performed with caution, since it can provoke prolapse of the umbilical cord, stem or handle of the fetus. With outflowing waters, the obstetrician can feel the ribs of the fetus, the armpit or shoulder blade, in some cases the hand or elbow is determined.

Features of the course of pregnancy and childbirth

Pregnancy in the presence of a transverse position of the fetus usually proceeds without any features. However, it is noted that in almost 30% of cases, preterm birth occurs. The most common complications of this pathology include premature rupture of amniotic fluid, which can occur both during pregnancy and provoke the onset of preterm labor, and during the birth process.

Causes of complications of childbirth in the transverse position of the fetus

In exceptionally rare cases, it is possible to independently complete labor with the transverse position of the fetus, while the child is born alive. In such situations, the baby is independently rotated into a longitudinal position and its further birth is performed by the pelvic or head end. Self-rotation is possible in case of prematurity of the fetus or its small size. In most cases, the course of childbirth is unfavorable and can be complicated by such processes:

Untimely discharge of amniotic fluid.

With the transverse position of the fetus, early or premature discharge of water is observed in almost 99% of cases. This is due to the fact that the presenting part, which is pressed against the pelvic inlet, is absent and does not separate the water into posterior and anterior.

Launched transverse position.

Such a complication occurs after an early or premature discharge of water. In such cases, due to the rapid outflow of amniotic fluid, the child's motor activity is sharply limited, and small parts may fall out of the fetus or the shoulder will be driven into the pelvis. If the loop of the umbilical cord falls out, it is clamped, which leads to impaired blood flow and death of the fetus.

Rupture of the uterus.

The neglected transverse arrangement of the fetus is accompanied by the threat of uterine rupture. After the withdrawal of the amniotic fluid, the shoulder girdle of the fetus is pushed into the small pelvis, violent contractions of the uterus occur, which provoke overstretching of the lower segment of the organ and threaten to rupture it. If the caesarean section is not performed on time, the uterus will rupture.

Choriamnionitis.

Premature discharge of amniotic fluid and a long anhydrous period of time contribute to the penetration of infection into the uterine cavity and the formation of choriamnionitis, which leads to the development of peritonitis and sepsis.

Fetal hypoxia.

A long course of childbirth paired with a long anhydrous interval provokes the occurrence of fetal hypoxia and its birth in a state of asphyxia.

Childbirth with a double body.

Against the background of intense contractions and the outflow of amniotic fluid, a close contact of the fetus with the walls of the uterus appears, as a result of which the child bends in half in the thoracic region. In such cases, childbirth ends spontaneously. First, a chest with a pressed neck appears, then a stomach with a head pressed into it, and at the end of the buttocks with legs. The appearance of a live baby in such situations is unlikely.

Management of pregnancy and childbirth

The tactics of managing pregnancy in diagnosing the transverse position of the fetus consists in carefully monitoring the condition of the pregnant woman, prescribing corrective gymnastics (only in the absence of contraindications) and limiting physical activity. Up to 32-34 weeks, the oblique or transverse position of the fetus is considered unstable, at this time there is a high probability of the child twisting into a longitudinal position.

Previously, in obstetric practice, the external rotation of the fetus was widely practiced, the purpose of which was to give the fetus a longitudinal position. Obstetric external rotation was performed at 35-36 weeks at normal condition pregnant and total absence contraindications. Today, this technique for correcting complications is ineffective and is used in exceptional cases, due to the many contraindications and complications after its implementation. During the rotation, there is a possibility of placental abruption and subsequent fetal hypoxia, and there is also a high risk of uterine rupture.

Corrective gymnastics

Special exercises can be prescribed in the absence of contraindications and evidence of the presence of an incorrect position of the fetus. Contraindications for gymnastics:

bleeding from the birth canal;

little or polyhydramnios;

uterine fibroids;

uterine hypertonicity;

severe somatic pathology in a pregnant woman;

scar on the uterus;

multiple pregnancy;

pathology of the umbilical vessels;

abnormal location of the placenta (previa or low placenta).

Gymnastics according to Dikan has proven itself excellently. A woman should perform a series of simple exercises three times a day: roll over from one side to her side and lie on her side after turning for 15 minutes (for each side). This exercise is performed three times.

A set of exercises that provokes rhythmic contractions of the muscles of the trunk and abdomen and is performed in combination with deep breathing.

Pelvic tilt.

The woman lays down on hard surface, the pelvis is raised. The position of the pelvis should be 20-30 cm higher than the head. You should be in this position for 10 minutes.

Exercise cat.

In the kneeling position, the hands rest on the floor. During inhalation, the coccyx and head rise, and the lower back bends. When exhaling, the back arches and the head drops. 10 repetitions are required.

Knee-elbow posture.

Knees and elbows rest on the floor, at the same time, the pelvis should be above the head. In this position, you must be for 20 minutes.

Half bridge.

Lie on a hard surface, and lay the buttocks on the pillows. Raise the pelvis by 40 cm, raise the legs.

Lifting the pelvis.

Lying on the floor, bend your legs at the hip and knee joints, rest your feet on the floor. On each breath, lift the pelvis and hold it in this position. On each exhalation, the pelvis lowers, the legs straighten. The exercise is repeated up to 7 times.

In most cases, corrective gymnastics must be performed within 7-10 days, during which time the fetus occupies the correct position (longitudinal). Exercise should be done three times a day.

After the fetus returns to the correct position, the woman is prescribed a bandage with longitudinal rollers. Wearing a bandage allows you to fix the result. The wearing time usually lasts until the baby's head is pressed against the entrance to the small pelvis or until the onset of labor.

Birth management

The optimal methods of delivery in the presence of a transverse position of the fetus is considered a planned caesarean section. A pregnant woman is hospitalized at week 36, undergoes a thorough examination and is prepared for surgery. The birth of a baby naturally unlikely as spontaneous rotation is very rare. Carrying out childbirth in a natural way with the subsequent rotation of the fetus on the leg (external-internal) can be only in 2 cases:

twin childbirth, provided that the second baby is located across;

the fetus is severely premature.

A planned caesarean section before the onset of labor is performed in such cases:

fetal hypoxia;

uterus with postoperative scars;

uterine tumors;

placenta previa;

prenatal outpouring of water;

true reversal.

In rare cases, at the beginning of contractions, the fetus can move from a transverse to a longitudinal position, and, accordingly, childbirth will take place naturally. In the case of an oblique position of the fetus, the woman in labor is placed on that side, the bottom of which corresponds to the large part of the child. A woman is forbidden to stand up, she must be in a horizontal position.

If a child's legs or arms fall out, under no circumstances should they be set back. Firstly, this will not bring results, and secondly, there is a high risk of injury to the child, in addition to additional infection of the uterus and delaying the time before surgical delivery.

In the case of a neglected transverse position of the fetus, an immediate caesarean section is required, regardless of the condition of the child (he is dead or alive). Some obstetricians in the case of a neglected transverse position and death of the fetus use a fruit-destroying operation. However, such surgical interventions very dangerous because they can lead to uterine rupture. If there are signs of infection (purulent discharge from the uterus, heat), caesarean section ends with hysterectomy and drainage of the abdominal cavity.

The combined external-internal rotation is performed under strict observance of the following conditions:

small size of the fetus (no more than 3600 g);

there are no strictures and tumors of the vagina, tumors of the uterus;

expanded operating room;

preserved fetal mobility;

the size of the baby's head corresponds to the size of the pelvis of the woman in labor;

consent of the woman;

a catheter that drains the bladder;

full opening of the uterine os;

live fruit.

Difficulties that are possible when performing a combined turn:

development of infectious complications in the early postpartum period;

birth injury;

fetal hypoxia, which leads to intrapartum death;

prolapse of the umbilical cord loop, after performing the turn - a quick mandatory extraction of the child by the leg;

falling out of the handle or removing it instead of the leg - putting a loop on the handle and leading it to the head of the fetus;

uterine rupture is an emergency operation;

rigidity (lack of elasticity) of the soft tissues of the birth canal - the introduction of antispasmodics, the selection of an appropriate dose of narcotic drugs, the performance of an episiotomy.

The most frequent questions on the topic

During the second ultrasound, I was diagnosed with a pregnancy of 23-24 weeks with a transverse position of the fetus. What can I do to get my child in the right position?

This short term pregnancy, so no action is required. The child occupies the final position by 34-35 weeks, and until this time he freely moves through the uterine cavity.

On last ultrasound the transverse position of the fetus was established, the period of 32 weeks. Is gymnastics required in order for the child to “lay down” longitudinally?

The expediency of performing corrective gymnastics should be discussed directly with the obstetrician leading the pregnancy. Only with the permission of the obstetrician, you can resort to performing exercises to turn the child into the correct position, since there are a number of contraindications for gymnastics.

I am pregnant with twins at 36 weeks. The first child is in breech presentation(legs), while the second lies across. Is it necessary to perform a caesarean section?

Yes, in such situations, the implementation of a planned delivery is the most optimal and safe method both for the mother herself and for her children. If the first child were in a purely gluteal position, then childbirth can be carried out naturally, followed by a combined rotation of the second child on the leg. However, in this situation, even at the birth of the first child, difficulties will naturally arise, since the birth of the legs can occur before the cervix is fully dilated, and this will make it difficult not only for the birth of the head, as the largest part of the child, but also for the pelvis.

If the axis of the fetus crosses the axis of the birth canal at some angle, incorrect positions of the fetus are created, in which the course of labor becomes dangerous for both the mother and the fetus. Incorrect positions of the fetus include transverse and oblique positions.

transverse position(situs transversus) is the position of the fetus in which its axis intersects the axis of the birth canal at a right angle or close to it (45-90 °). Oblique position (situs obliquus) is the position of the fetus in which its axis intersects the axis of the birth channel at a sharper angle (less than 45°). It is practically important that the underlying large part of the fetus is located above in the transverse position, and below the iliac crest in the oblique position.
From this it can be seen that there is no fundamental difference between the transverse and oblique position: the difference comes down only to the degree of deviation of the fetus from the length of the birth canal.

Causes of the transverse and oblique position of the fetus

The etiology of the transverse position is very diverse. The main causes contributing to this abnormal position of the fetus can be summarized as follows.

Decreased excitability of the uterus. The walls of the uterus, not having sufficient elasticity, are not able to give the fetus a longitudinal position or keep it in this position, if it has been created. A decrease in the excitability of the uterus may be the result of underdevelopment of the uterus or degenerative changes in the muscles of the uterus as a result of former births, especially if at least one of them was severe, prolonged or accompanied by a postpartum infection, as well as the result of overstretching of the uterus during pregnancy with polyhydramnios or multiple pregnancy.
Insufficiency of the abdominals, unable to adequately resist the pregnant uterus. This insufficiency occurs due to flabbiness of the abdominal wall, divergence of the rectus abdominis muscles, sagging abdomen. All these anomalies in the vast majority of cases are observed in multiparous women.
Spatial discrepancy between the cavity of the uterus and the fetus. In the presence of such a discrepancy, the fetus may either be in very free conditions if the uterine cavity is large for him, or, conversely, he may be constrained if it is small for him. Therefore, the spatial relationship between the uterine cavity and the fetus can be of two types.

The uterine cavity is too spacious for the fetus. It is caused by polyhydramnios, when in the uterus, stretched with an abundant amount of water, the fetus floats freely; stretched abdominal wall and walls of the uterus are not able to give the fetus a longitudinal position, and low tone the stretched walls of the uterus are not able to keep the fetus in a longitudinal position if he accepted it. Excessive fetal mobility in the uterus can also be caused by its prematurity, multiple pregnancy (great mobility of the second twin after the birth of the first) and fetal death, since the dead fetus no longer has the usual elasticity for a living fetus, it is easily compressed by the walls of the uterus and easily changes its position.

Excessive tightness of the uterine cavity for the fetus and its irregular shape. The fruit thus takes a forced position, in particular oblique or transverse. This is due to multiple pregnancy (with twins, one of the twins, and sometimes both, are in a transverse position); malformations of the uterus (for example, a bicornuate or saddle uterus - the transverse size of the uterus is larger than usual); the presence of tumors in the small pelvis that prevent the insertion of a large part of the fetus (head or buttocks) into its cavity; placenta previa, which prevents the head from being fixed at the entrance; discrepancy between the fetal head and the mother's pelvis (narrowed pelvis, hydrocephalus, extensor presentation of the head and other reasons that prevent the head from being established above or at the entrance to the pelvis); oligohydramnios, in which the fetus, deprived of the necessary mobility and located in a transverse or oblique position, which often occurs in the second half of pregnancy, is fixed in this position; some rare malformations and diseases of the fetus.

Recognition

Recognition of the transverse position of the fetus is quite possible on the basis of external examination alone. Difficulties occur in primiparous due to the tension of the abdominal wall, as well as in polyhydramnios. To clarify the diagnosis in similar cases Sometimes x-rays are needed. Difficulties sometimes arise in childbirth with broken waters, when frequent and strong contractions interfere with palpation of the uterus.

In the transverse position of the fetus, the abdomen has a spherical or even transverse or oblique-oval shape. With external obstetric research large parts of the fetus, the head and buttocks are found not in the upper and lower poles of the uterus, but on the side of them, while there is no presenting part above the entrance to the pelvis. The fundus of the uterus is usually lower than with the longitudinal position of the fetus at the corresponding stages of pregnancy.

If the study is carried out with whole waters, the specification of the transverse or oblique position is of some importance. The location of the underlying large part, in most cases the head, within one of the iliac regions, below the level of the crest of the innominate bone, indicates an oblique position of the fetus. If the underlying part is higher, then there is a transverse position, even if the fetus is located obliquely in the uterus. At the same time, the position of the fetus and its appearance are determined.

The heart sounds of the fetus in its transverse position in most cases are best heard in the navel. In the anterior view, the fetal heart sounds are usually heard more clearly than in the posterior view.

Vaginal examination during pregnancy and at the very beginning of childbirth, when the fetal bladder is still intact, does little to clarify the diagnosis. In this case, it is possible to find out only the degree of opening of the uterine os, the integrity of the fetal bladder, the size of the diagonal conjugate. An attempt to determine the nature of the underlying part by deeper insertion of fingers beyond the uterine os is very dangerous, since this can easily open the fetal bladder, which will greatly complicate the further course of childbirth. If, after the discharge of the waters, the oblique position does not turn into a longitudinal one, then it turns into a transverse one.

As soon as the rupture of the fetal bladder has occurred, a vaginal examination should immediately be performed with two fingers, and if necessary, with four or with the entire hand. In this case, instead of the head or buttocks above the entrance or at the entrance to the pelvis, the fetal shoulder is found, which is recognized by its characteristic roundness and by the nearby collarbones. The ribs, shoulder blades and spinous processes of the spine can be felt, as well as the handle, stem and loop of the umbilical cord that have fallen out and are in the vagina, if this complication occurs. Easily accessible for examination, the armpit of the fetus allows you to determine where the head and buttocks are facing: the head is on the side on which the armpit is closed, the buttocks are on the side where it is open.

The position of the fetus is determined by the relative position of the probed identification points. So, for example, if the scapula is facing anteriorly and downwards, the clavicle is backwards and upwards, the armpit is open in right side, closed to the left side - there is a first position, front view.

It is necessary to determine the fallen small part of the fetus located in the vagina. It is typical for the handle that the hand passes into the forearm without forming a sharp protrusion, the thumb is much shorter than the rest and is easily retracted to the side. The leg is characterized by the presence of a sharp protrusion - the heel - at the point of transition of the foot to the lower leg; the fingers are almost the same length, and the thumb differs little from the others in its mobility.

To determine which pen fell out, right or left, it is best to use the old, easy-to-remember technique - mentally “say hello” to the dropped pen; if this succeeds, then the right handle fell out. You can use another method: the dropped handle is turned with the palmar surface forward; if the thumb is pointing to the right, this is the right handle; if it is to the left, it is the left handle. In the first position, the falling out of the right handle indicates the front view, the left - to the back. In the second position, on the contrary, the falling out of the right handle indicates the rear view, the falling out of the left handle - to the front. At the same time, you should make sure that the dropped handle is not dislocated or broken (does not hang like a whip).

The life of the fetus is determined by the presence of its heart tones, by the feeling of the exploratory movement of the fetus by the hand, by the movements of the small parts that have fallen out, and when the loop of the umbilical cord has fallen out, by its pulsation.

Symptoms and signs of childbirth transverse and oblique position of the fetus

Childbirth in the transverse position can only rarely end on its own. In some cases, if there is a combination of a number of favorable conditions (comparatively small size of the fetus, its good mobility in whole waters, good condition of the uterus and abdominal wall), the oblique position, and sometimes the transverse position, spontaneously passes into the longitudinal one when labor begins. This self-rotation occurs because the uterus contracting during childbirth takes its usual shape. longitudinal fetus. At the same time, the lateral walls of the uterus, elongated in a transverse position, put pressure on both poles of the fetus, telling them the opposite direction: the buttocks - to the bottom of the uterus, the head - to the entrance to the pelvis (if the head is located slightly lower).

If self-rotation has not occurred, the course of childbirth begins to take on a pathological character, and even during the period of disclosure, serious complications can arise.

The first of these complications is usually early discharge of water. In view of the absence of an internal belt of fit in the transverse position of the fetus, there is no distinction between the anterior and posterior waters, which freely communicate with each other. In this regard, intrauterine pressure, which is not moderated by the fit belt, is concentrated on the lower pole membranes, which does not withstand this pressure and breaks.

Early rupture of the membranes, which in itself is a serious complication in childbirth, in the transverse position entails a number of other serious complications. These include: the outpouring of not only the front, but also most of the rear waters. The walls of the uterus, almost completely emptied of amniotic fluid (dry childbirth), come into direct contact with the fetus, which stimulates uterine contractions. In this case, the walls of the uterus tightly clasp the fetus; the contracting muscle of the uterus compresses the vessels laid down in it, which disrupts the uteroplacental circulation. The consequence of this is usually fetal asphyxia.

Together with the discharge of water with insufficient opening of the pharynx, in almost half of the cases, small parts of the fetus and umbilical cord loops fall out. Cord prolapse is one of the most severe complications of childbirth, since it often leads to the death of the fetus and contributes to the penetration of infection into the uterine cavity.

After the discharge of the waters due to the absence of the presenting head or buttocks, which, when longitudinal positions the fetus in such cases take on the role of the fetal bladder, the edges of the uterine os, which do not experience pressure from the inside, collapse, and the opening of the pharynx occurs very slowly in the future. The period of exile is also prolonged.

With such a long course of childbirth, a secondary weakness of the tribal forces occurs, and after the discharge of the water, a neglected transverse position occurs. A protracted course of childbirth entails endometritis in childbirth. The fetus, lying in a transverse position, under the influence of generic forces, is pressed more and more sideways to the entrance to the pelvis. In order to enter into it, the fetus must bend at an angle. Such a bend is usually made in the region of the cervical vertebrae, with the head and buttocks located on the ilium; uterine and abdominal contractions try to bring these parts closer together. The more pronounced the lateral curvature of the cervical part of the spine, the lower the fetal shoulder and. finally, it is injected into the pelvis. After this, the advancement of the fetus stops, despite the ongoing, and sometimes intensifying labor activity. This completes the transformation of the non-started transverse position into the started one. This happens especially easily when the handle falls out, which creates conditions conducive to hammering the shoulder of the fetus into the entrance.

The fetus dies from very strong and frequent contractions of the uterus, sometimes taking on a convulsive character, from the associated violation of the uteroplacental circulation, squeezing the loops of the umbilical cord. The dead fetus begins to decompose.

If the tribal forces are not exhausted and continue to develop, overstretching of the lower segment of the uterus occurs and uterine rupture occurs during childbirth.

Only in some, extremely rare cases, childbirth with a neglected transverse position can end spontaneously. This is observed with a combination of good labor activity, wide pelvis and small fruit. Almost as a rule, children are stillborn.

Such a spontaneous correction of the running transverse position is called self-twisting.

The mechanism of self-reversal can be twofold.

Its first variant is self-inversion in the proper sense of the word (evolutio foetus spontanea). It consists in the fact that the shoulder of a small, easily compressible fetus is driven into the pelvis and comes out from under the pubic arch. After that, through the pelvis are sequentially pushed past the shoulders top part strongly bent torso, buttocks and legs; after that, the second shoulder is born and, finally, the head.

The second variant of self-twisting is childbirth with a double body (condupli-catio corporis). It lies in the fact that at first a pierced shoulder is born; after that, the spine is sharply bent in the thoracic region, and the head is pressed into the chest and abdomen of the fetus. These parts of the fetus sharply pressed against each other are introduced into the pelvic cavity in the following order: first the chest and the neck pressed against it, then the stomach and the head pressed into it, and finally the buttocks with legs.

Prediction for childbirth in a transverse position, left to the natural course, is extremely difficult. The outcome entirely depends on the timely recognition of this pathology and the correctness of the measures taken. In the absence of timely and rational assistance, a woman in labor usually dies from rupture of the uterus or from sepsis. The fetus also dies, usually from asphyxia or intrauterine trauma.

Thus, in childbirth with a transverse position of the fetus, the fate of the mother and child is almost entirely in the hands of the doctor.

Prevention transverse and oblique position of the fetus

Prevention of the transverse position, which in the vast majority of cases occurs in multiparous women, lies primarily in the correct management of previous births and the postpartum period.

Of great importance is the strengthening of relaxed abdominal walls in both pregnant women and in puerperas, even after normal childbirth ( physical exercise), wearing in the second half of pregnancy and after childbirth a well-chosen bandage.

If the transverse position is recognized during pregnancy, the pregnant woman must be taken under special supervision. antenatal clinic. If the transverse position does not spontaneously turn into a longitudinal position, the pregnant woman, upon reaching 34-35 weeks of pregnancy, should be placed in maternity hospital where it remains until the onset of childbirth. There, using external techniques, she is corrected from the transverse position of the fetus to the longitudinal head (external rotation of the fetus onto the head), if there are no contraindications to this.

Conducting labor with a transverse or oblique position of the fetus

In the period of opening, attention should be focused on preventing early discharge of water. To this end, all women in labor with a transverse or oblique position of the fetus must comply with strict bed rest. With an oblique position of the fetus, the woman in labor is laid on her side, the same name as the large part located below.

So, for example, if the buttocks are in the right corner of the uterus or slightly lower, and the head is in the left iliac region or slightly higher, the woman in labor is placed on her left side. In this case, the bottom of the uterus, and with it the buttocks, due to their gravity, will approach the xiphoid process, and the head will deviate to the midline of the abdomen and will be installed above the entrance to the pelvis.

With the failure of this measure, an effective method of preventing early rupture of the fetal bladder is colpeiriz - the introduction of a rubber balloon into the vagina - a colpeirinter.

As soon as the pharynx is fully opened, without waiting for the spontaneous discharge of water, the fetal bladder is artificially ruptured and immediately, without removing the hand from the vagina, the operation of turning the fetus on the leg and removing it is performed. The rotation operation is easily performed if it is immediately preceded by an artificial rupture of the fetal bladder, performed with full opening of the pharynx, since the fetus in this case is mobile in the uterus and is in good condition.

The moment of discharge of water is the most important in the transverse position of the fetus. Therefore, as soon as the water spontaneously departed, a vaginal examination should be performed immediately. If a complete or almost complete opening of the uterine os is found, the fetus is immediately turned on the leg and removed. If the handle falls out, it should not be inserted into the uterus before turning. With incomplete disclosure of the uterine pharynx, care must be taken to preserve the remaining water in the uterus. To do this, produce metreyris and as soon as the uterine pharynx is fully opened, once again ascertaining the mobility of the fetus, they immediately begin to turn the fetus on the leg and then extract it.

The situation is much worse in those cases when the woman in labor is delivered to the maternity hospital with the existing transverse position of the fetus, which can form as early as 2 hours after the outflow of water, and sometimes even earlier. In such cases, the fetus usually dies.

Reliable signs of a neglected transverse position are the following: impaction of the shoulder of the fetus into the entrance of the pelvis, tight grasp of the fetus by the walls of the uterus and its limited mobility, even if the shoulder is not impacted into the pelvis; endometritis in childbirth, the appearance of signs of a threatening rupture of the uterus (even with apparent fetal mobility), pain in its lower segment, oblique constriction of the uterus. The presence of two or even one of these signs indicates that the existing transverse position is neglected.

When the transverse position is running, an attempt to turn the fetus on the leg inevitably leads to uterine rupture. Therefore, the rotation of the fetus in such cases is strictly contraindicated.
Since in most cases of a neglected transverse position the fetus is dead, immediately after the diagnosis is established, an embryotomy should be performed under deep general anesthesia, which is the safest operation for the woman in labor. When the shoulders are driven into the pelvis, one has to resort to decapitation of the fetus (decapitation), after which the fetus is removed from the birth canal without much difficulty. At the end of the operation, the uterine cavity must be examined with the hand inserted into it in order to establish the integrity of its walls.

A caesarean section is also performed in the presence of an infection, if the woman in labor persistently wishes to save the life of the fetus (for example, in "old" primiparas), and general state her health is good. In such cases, it is necessary to carry out a number of preventive and therapeutic measures aimed at fighting infection: introduction during surgery in abdominal cavity and into the uterine cavity of antibiotics, intramuscular injections of the latter, oral administration of sulfonamides, multiple transfusions of small doses of blood, etc.

It is necessary to resort to caesarean section in some cases even when the transverse position of the fetus is not started, when pregnancy is complicated by other processes that in themselves aggravate the course of pregnancy and childbirth (heart defects, narrow pelvis, etc.).

The position of the fetus during pregnancy

According to what scenario the birth will go, it also depends on how your child is located in the uterus relative to the entrance to the small pelvis. Therefore, before the birth, the doctor and midwife check the position of the child. With the help of the first Leopold technique, they establish the nature of the presentation of the fetus.

Ideal when the baby is in the front view before birth occiput presentation. At the same time, he rests his chin on his chest. As a rule, in this position of the fetus, childbirth proceeds without big problems and don't last too long.

In an anterior occiput presentation, the baby turns so that its back, which used to be located on the side, now runs parallel to the mother's abdominal wall, he looks back. In this position, the fetus descends deeper into the birth canal, tilting the head as low as possible towards the chest. Before passing through the vagina, it straightens its head and tilts it back slightly.

In rare cases, with head presentation, a different location of the child is observed.

It can be located, for example:

In the posterior view of the occipital presentation, when during childbirth his back is turned not to the mother's stomach, but to her spine.
In an anterior presentation with the head slightly tilted back, and the back is turned towards the mother's spine. With this position of the head, the child moves through the birth canal in a different way. Since this makes childbirth more difficult, it may take a little longer. Quite often, a perineal incision is required.
If your child is in the face or frontal presentation, childbirth cannot occur spontaneously. Such an arrangement is so unfavorable that natural childbirth lasted too long. In addition, the oxygen supply of the child is also endangered. Caesarean section is much more reliable here.

The transverse position of the fetus in the uterus is rare. If we turn to statistics, then only 0.5% of pregnant women experience a similar phenomenon, when the axis of the spine of the mother and child are not parallel to each other. In general, the transverse and oblique position of the fetus in obstetrics is considered problematic. Natural childbirth is almost impossible, as it is very risky. The baby is usually born by caesarean section. However, it is not uncommon for a woman to have a transverse position of the fetus exercise and special gymnastics helped to correct, and she gave birth on her own. One of effective methods to correct the position of the child is a set of exercises (how to perform everything correctly will be shown in the physical room of the antenatal clinic) and rest on the side where the child's head is located.

What is meant by transverse presentation of the fetus and what are its causes

The transverse position is the position of the baby when he is located in the uterus not along its axis, but at an angle. Its head and buttocks are across the exit from the uterus and pelvic organs. This position of the fetus is revealed during screening.

The condition of a pregnant woman, whose baby lies down in a transverse position, does not affect health in any way. Pregnancy can proceed absolutely calmly for the first two trimesters. But the third trimester can present a lot of not very pleasant surprises. These are bleeding, and premature birth, and even a threat to the life of both the mother and the fetus. Among other troubles, there are early discharge of amniotic fluid, prolapse of parts of the child's body, umbilical cord, damage and rupture of the organ of the uterus.

It does not matter if the transverse, oblique or unstable transverse position of the fetus, the pregnant woman must be constantly under the supervision of doctors. Inpatient treatment is unconditional in case of the slightest suspicion of bleeding.

If there is an incorrect position of the fetus during the second trimester, then there is hope that the baby will still take the correct position before the moment of birth. The baby in the mother's womb is constantly in motion. He swims in the amniotic fluid, often changing his posture. But after 33-35 weeks, the child is unlikely to be able to change its position in the mother's tummy. He has already grown enough, and he is cramped.

Doctors clearly determine the causes of the transverse position of the fetus. Firstly, this is the overdistension of the uterus as a result of previous pregnancies And a large number of amniotic fluid (at the same time, such a presentation can also lead to oligohydramnios). Secondly, early interruptions pregnancies, multiple abortions and spontaneous miscarriages may cause transverse presentation of the fetus. Thirdly, if a woman has an abnormal pathological shape of the uterus (saddle-shaped, horn-shaped, bicornuate), then there is a risk that the child will take the wrong position in the womb.

The diagnosis of fetal transverse presentation can be made by screening, palpation, or vaginal examination. Visually seeing that the fetus is not properly positioned is also possible with the naked eye. The mother's abdomen has an oval angular shape, incorrectly stretched.

An experienced gynecologist or obstetrician can easily determine the position of the fetus. First, the doctor, with the help of his hands, finds the location of the head, and then gropes for the limbs - the heels or buttocks of the baby.

Also state the incorrect position of the fetus after the departure of amniotic fluid. Dropping out separate parts body: shoulders, handles leaves no doubt that the child lies transversely.

What threatens transverse and oblique presentation

Although the pregnancy is proceeding normally, it is not permissible for the mother and the doctor under whose supervision she is to relax. preterm birth and the discharge of the waters may occur at any time. When early birth decisions must be made quickly. Most likely, a caesarean section will be scheduled. This is especially true in those cases when, during the examination, placenta previa and blocking the exit of the child from the uterus into the birth canal were noted. The wrong actions of doctors, unqualified assistance or incompetent actions can lead to serious problems. The uterus may not withstand and burst, may begin uterine bleeding which is hard to stop. In addition, life not only depends on the correctness of the decisions made. born child but also mothers.

It should be noted that natural childbirth with a transverse or oblique presentation of the fetus also takes place in medical practice. If the baby is premature or has very little weight if there is sufficient dilatation of the uterus, doctors can manually rotate the baby. However, there is no guarantee that after changing the posture, he will not take the same position again. In cases where a child's leg or handle has fallen out, it is unacceptable to set it back.

I would like to warn everyone who, out of fear of surgical delivery, decides to take risks and agree to give birth naturally, allowing them to manually turn the fetus over. This is unreasonable. It is the child who suffers first. External obstetric coup is banned in most countries due to very high risk complications.