Unstable position of the fetus. What does the longitudinal position of the fetus mean

Obstetric definitions are not always clear to pregnant women. After receiving the results of the ultrasound or exchange card, women are perplexed, trying to decipher the conclusion. The longitudinal position of the fetus is considered natural and occurs in more than 95% of all pregnancies.

Childbirth largely depends on how the fetus lies in the uterus. Thanks to this information, doctors can predict in advance whether the baby will be born. naturally or using caesarean section.

Two axes are taken as the basis for determining the location. The first is mentally drawn along the line of the child's spine, from the top of the head to the coccyx. The second strictly vertically divides the uterus into two equal parts. If the position of the fetus is longitudinal, it is understood that these axes are parallel.

Concepts in obstetrics that describe the placement of a child:

position - longitudinal, transverse, oblique;
view - front, back;
position - first, second;
presentation - head, pelvic.

View means the relationship of the child's back to the walls of the uterus, position - to the left (I position) or right (II position) side. If the child's back is facing back wall uterus, talk about the rear view, and vice versa. The head presentation is divided into occipital, anterior head, facial and frontal, pelvic - into the gluteal, foot and mixed.

What does the longitudinal position of the fetus mean? In obstetrics, the term defines the physiologically correct placement of the baby in the womb. It is located vertically, the line of the spine coincides with the axis of the uterus. This is one of the conditions for the possibility of natural childbirth and their normal course.

The ideal position is considered to be longitudinal, and the presentation of the fetus is head occipital, anterior view. That is, the face is pressed to the chest, the child "looks" at the mother's spine, and with his back rests against the front wall of the uterus. The first of the birth canal appears a small fontanel.

Unlike the longitudinal position of the child, the transverse and oblique are considered to be a deviation from the norm. Delivery in both cases is carried out by caesarean section. In a transverse position, the main axes form a cross, are perpendicular, in an oblique position - under acute angle. The child stretches the uterus across.

breech presentation

In addition to the transverse and oblique position, the longitudinal position does not always mean the correct physiological placement. The child can be vertical, parallel to the axis of the uterus, but not head down, but buttocks or legs. Then they talk about the longitudinal pelvic presentation of the fetus. According to statistics, 3-5% of pregnancies occur with this diagnosis.

Choice of mode of delivery breech presentation depends:

from the sex of the child;
mother's age;
the size of the woman's pelvis;
fetal weight;
subspecies of presentation.

Childbirth in this case is considered pathological due to high risk complications. But the longitudinal position of the fetus with a breech presentation is not a mandatory indication for a caesarean section. Doctors take other factors into account when making a decision.

If the presentation of the fetus is pelvic longitudinal, then natural childbirth carried out under the constant supervision of medical staff. The legs and buttocks are the first to emerge from the birth canal, and there are often difficulties with advancing the head. high risk intrauterine hypoxia, possible infringement and premature extension of the head, throwing back of the arms, aspiration of amniotic fluid.

If the position of the fetus is longitudinal, and the presentation is breech, the second frequent complication natural childbirth is high level maternal and child trauma. A woman may start heavy bleeding when passing a head that has not undergone a configuration, that is, “did not develop”. A newborn must be examined by an orthopedic traumatologist to exclude bone damage.

Pelvic longitudinal presentation fetus during pregnancy implies attempts to change it to the head. Appointed special gymnastics, if necessary, an external preventive turn is performed. If you cannot change internal arrangement, then the woman is hospitalized to determine the risk group and choose suitable way delivery.

Unstable position of the fetus

Until the age of 30 weeks, the child has the right to stay in any comfortable posture and change it repeatedly. The ratio of the size of the uterus and the fetus allows him to freely tumble, swim inside. Therefore, diagnosing an unstable situation at this time is not entirely correct.

As the child grows, it becomes crowded, free space decreases. By 32-36, less often by 38 weeks, he takes a stable position in which he will be born. If by this time the longitudinal is not determined, but the unstable position of the fetus remains, then we can talk about pathology.

In this case, the line along the back is deviated to the side relative to the vertical axis of the uterus. The situation is dangerous because the child does not want to turn longitudinally. He will either remain in an oblique position or settle across the uterus. Both options involve a caesarean section.

Reasons for the unstable position:

polyhydramnios - the uterus is overstretched, the child is not crowded, there is no need to become in a classic position;
narrow pelvis women - an anatomical feature of the body or the ratio of the size of the fetus and pelvis;
- low presentation children's place in almost 50% of cases wrong position"guilty" fixing the placenta;
second and subsequent pregnancies - in multiparous women, the likelihood that the child will not physiologically accommodate is higher.

At unsuccessful attempts to achieve a longitudinal position, it is important to carry out a caesarean section before the start labor activity. Otherwise, there is a risk of prolapse of the umbilical cord or limbs during contractions, premature discharge amniotic fluid. The percentage of mortality in natural childbirth with an incorrect position of the fetus is 9 times higher than in longitudinal head.

The inner mood of a woman is important. It is necessary to talk with the child, to convince, to ask him to roll over, affectionate words explain the importance of proper placement in the womb. After the fetus takes a physiological position, it is imperative to consolidate success by wearing a bandage. This will prevent the reverse change of position.

Diagnostics and position correction

Self-understand that the fetus in longitudinal position, difficult. Some movements roughly indicate the placement of the baby in the abdomen. The most active strikes are made with legs, long smooth area- this is the back, strongly protruding soft area - the buttocks. This is the "belly map" method, which is used after analyzing observations of the movements of the baby in the womb.

The doctor is able to reliably determine the placement of the fetus. For this, listening, probing and ultrasound are used. A stethoscope allows you to hear which side your baby's heart is beating. In the supine position, the abdomen is palpated and compared with the definitions correct form uterus. The exact placement of the baby in the womb can be seen literally with an ultrasound.

Correction is necessary if fetal malposition is confirmed. Emphasis on the performance of some exercises by a woman. Swimming is effective, being in the knee-elbow position for 10 minutes daily.

Rolls. Rolling from side to side helps to correct breech presentation. A pregnant woman should make 5-6 approaches daily for 10-15 minutes. You need to change the sides slowly, carefully.

A similar tactic is used to change the position or type of placement of the child. You need to lie or sleep on the side where the fetus and its head are located. This will provoke an instinctive desire to move in the child.

Lifting the pelvis. Starting position: lying on your back, pillows are placed under the lower back, the pelvis is 25-30 cm above the level of the head. In this position, you need to stand for up to 15 minutes, perform 2-3 sets a day.

Kitty. Starting position: on all fours. Alternately bend and arch your back. While inhaling, raise your head and bend, while exhaling, lower your head and round your back. Repeat 10-15 times every day.

Existing sets of exercises allow you to achieve a longitudinal arrangement of the fetus. But, when performing them, it is necessary to take into account contraindications. Severe gestosis, placenta previa, the threat of miscarriage, scars on the uterus mean that you should not be zealous with physical activity.

Longitudinal position together with head presentation is an argument in favor of successful natural childbirth. But if the fetus in the womb did not want to be placed physiologically, then you should not panic. modern medicine allows a healthy baby to be born even in most cases.

It depends on the woman whether the birth will proceed naturally or the future mother will be sent for a caesarean section in order to avoid possible complications.

The position of the fetus may be different. So, for example, they distinguish oblique, transverse, longitudinal presentation of the child. In the first case, it is located obliquely, but with the onset of childbirth it is able to take the right position. The transverse position of the fetus means that the baby is across the uterus. In this case, the expectant mother is sent for a caesarean section. Previously, when such operations were rare and could greatly harm a woman, they tried to deploy the fetus, which could lead to backfire for the baby. Today, with the high development of medicine, the availability of high-quality medicines and materials for suturing, a caesarean section does not pose any danger to either the mother or the baby. The longitudinal position of the fetus means that the axis of the baby's body coincides with the axis of the woman's uterus. Some moms get scared when they read such a doctor's report, which does sound a little threatening, but in fact these words indicate that everything is going fine. It is this position of the child that contributes to the successful course of childbirth. Therefore, you should not be afraid, but rejoice.

Correct position of the fetus

We have already figured out that the longitudinal presentation of the child is ideal. At the same time, he should be head down and be turned with the back of his head towards the mother's tummy. Firstly, in this position, he feels more comfortable. Secondly, during childbirth, his chin is in contact with chest, which provides:

uniform and gentle pressure on the cervix, which stimulates its expansion and production of the necessary this moment hormones in a woman's body
turning the baby's head, allowing him to place its widest area at the most spacious point of the mother's pelvis
the necessary angle of inclination of the baby's head, providing a faster and more convenient passage of the crumbs through the birth canal

Thus, the longitudinal head position of the fetus allows mother and baby to meet faster and go this way with the least loss. It is this position of the child that is observed in most women in labor.

However, in about one in ten cases, the baby may have the above location, but at the same time be with the back of the head to the mother's spine. That is, this is also the head position of the fetus, but less advantageous than when the back of the head of the baby is facing the woman's stomach. The baby is usually also born naturally, but this position can cause some problems, for example:

premature discharge of water
prolonged and delayed labor
back pain in future mother
the beginning of attempts until the cervix is fully dilated

During childbirth, reaching pelvic floor, the baby may turn around, which will require additional time. And in some cases, the reversal does not occur, and then the doctors have to help him, using, for example, forceps.

This position of the child is called posterior and may be due to:

anatomical features of the structure of the pelvis of a woman
the lifestyle of the expectant mother or professional factors

If you have sedentary work, this increases the possibility that the baby will take a back position. After all, when you are in a similar position, your pelvis is tilted back. Accordingly, the baby's head also deviates back. But if you move a lot and spend most of the time on your feet, then the pelvis is tilted forward, and the baby has every chance to take the right position.

However, if the baby is in the back position, you can try to turn it around. To do this, you need to tilt the pelvis forward, not backward. For example:

sitting, pay attention to ensure that your knees are not higher than the level of the hips
sitting on a surface that does not provide the desired posture, put a pillow under you, raising the pelvis
exercise with a fitball, bending over it
stand on all fours (this position ensures that the back of the baby's head turns to the mother's tummy): you can just stand like this for 10 minutes or do some simple exercises, or you can wash the floors, setting aside the mop

Malposition

Incorrect positions of the child include pelvic, transverse and oblique presentation. In the transverse position, they are always prescribed, and in the other two cases, much depends on various factors, but most often a woman is also referred for surgery.

There is also such a thing asunstable fetal position. This means that the child “cannot decide”: at first he takes a longitudinal position, and then suddenly finds himself in a transverse or oblique position. Then the situation can change again. This happens with increased mobility of the baby.

What can cause wrong fetal position ? Various factors can influence this:

increased baby mobility
reduced mobility of the child
developmental pathology of the uterus
pathology of fetal development
phenomena that prevent the insertion of the head (for example, a narrow pelvis, fibroids in the lower part of the uterus)

If your baby has taken the wrong position, then you can "persuade" him to turn around. For this, it is necessary to perform special exercises(which ones - it is better to consult a doctor, because each case is individual). When the baby turns as it should, you can insure against further changes in posture and wear it all the time, taking it off only in those cases when you really can’t do without it. However, it is also better to talk to your doctor about the need for a bandage.

The position of the fetus during pregnancy is determined by ultrasound from an early date, and by palpation from about the end of the second trimester. What role does the location of the child in the uterus play, and what is the norm and what is the pathology?

The most favorable position of the fetus is the longitudinal presentation of the head - this is how it is more convenient for the child to go out into the world, and it is this arrangement that reduces the risk of injury to the child and his mother. However, even in such a physiological, and the most common position, the child is not the entire pregnancy. Until the third trimester, babies are very mobile. This is due to their still small size. Children are especially mobile if their mother has polyhydramnios, as a result of which the uterus is overstretched. In the second trimester, in the conclusion of the ultrasound, they often write "unstable position of the fetus." But this is not a pathology at all, and such a diagnosis, in principle, does not have to be indicated in the conclusion of the examination at such times.

What the unstable position of the fetus means can only be thought about if this problem arose in the third trimester of pregnancy, after 30-32 weeks. For example, when the baby lies head to the cervix, but his back is not exactly along the spine of the uterus, not perfectly longitudinal, that is, but slightly tilted. This position of the fetus at 32 weeks may threaten the fact that the child will finally settle "obliquely" or across the uterus, which will make natural childbirth impossible. In this case, gynecologists recommend, for the purpose of prevention, to do special exercises to help the baby properly position in the uterus, as well as wear a bandage. And it is very effective, even if the position of the fetus at 30 weeks is not head. There is still more than one week to fix everything. The simplest thing is to do the exercises lying down. Lie on one side for 10 minutes, then turn and lie on the other side for 10 minutes and repeat 2-3 times. A contraindication to exercise is placental abruption, a scar on the uterus, decompensated heart defects in the fetus, and others.

The reasons for the adoption by the child of the pelvic, transverse or oblique position in the uterus are numerous and varied. In most cases, it is impossible to determine what exactly caused the wrong position. It is known that more often obstetric pathology occurs in women with anatomical pathologies of the uterus, in women who give birth not for the first time, with an excess amniotic fluid, low placenta previa, clinically narrow pelvis, or relatively narrow pelvis and large baby.

While the fetus is still quite small, it can move quite freely in the uterus in different sides. The closer the due date, the less free space remains a child. On short term pregnancy, the doctor can diagnose the patient with an "unstable position" - this means that the fetus is still actively moving. On early dates this is considered the norm. The child usually occupies the final position by the 33–34th week of pregnancy (and during the second and next pregnancies, even on the 38th).

Presentation indicates how the baby is located in the uterus - upside down or legs. In addition to presentation, there is also the term "fetal position". In obstetrics, the correct position of the child is determined by the ratio of its axis to the axis of the uterus. The axis of the fetus conditionally runs along the spine, connecting its coccyx and the back of the head. The axis of the uterus divides it into equal halves. Relative to the axis, the child can be located in a longitudinal position, oblique or transverse.

The most dangerous is the transverse position. Natural childbirth in this case is prohibited, since this position of the fetus is dangerous with severe injuries to the newborn. In an oblique position, in order to avoid risks, as a rule, a cesarean is also prescribed. However, often the child changes position from oblique to normal longitudinal already during childbirth.

Question 2. What is the presentation of the fetus?

In addition to being located along or across the axis of the uterus, the fetus can lie upside down or upside down. In this regard, there are two main types of presentation:

head (head down);
pelvic (upside down or buttocks).

The position of the baby upside down is considered the norm, which happens in most cases. Depending on which part of the head is located at the entrance to the small pelvis, it is also divided into occipital, parietal, frontal and facial. At occipital head the baby is bent, and therefore this position is called flexion, and the rest - extensor.

Flexion cephalic presentation- the most optimal and natural position of the child, in which childbirth can easily take place in a natural way, since at first the head, the most voluminous part of the body, will go along the birth canal. This will allow the rest of the pieces to come out faster and easier.

Breech presentation is much less common. There are three options for breech presentation:

foot (legs of the child are located in front);
gluteal (the buttocks of the child are located in front);
mixed (legs and buttocks of the child are located in front).

Foot presentation can be complete (the fetus is located with both feet down), incomplete (one leg) or knee (he sits on his knees, as it were). More favorable is the breech presentation.

Question 3. What is a low presentation?

In addition to the listed forms of presentation, there is also the so-called low presentation. It refers to the too early lowering of the child's head into the pelvic region of the woman. This usually happens 3-4 weeks before delivery, but it can happen earlier. A deviation from the norm is the lowering of the head before the 22nd week of pregnancy. The result of such a presentation may be premature delivery.

If you have been given a similar diagnosis, it is important to take care of yourself, limit physical exercise, including leisure, and all sorts of stresses, lie more, and also use a supporting bandage. low presentation may also result in hospitalization future mother hospital under observation.

Question 4. What are the causes of incorrect presentation?

It is very difficult, sometimes even impossible, to determine the specific cause of a particular position of the fetus in the uterus. Doctors identify a number of reasons due to which the presentation may become incorrect:

high fetal activity;
oligohydramnios or polyhydramnios;
overstretching (hypotension) of the walls of the uterus - due to repeated pregnancy or multiple pregnancy;
uterine scars;
very narrow pelvis of a pregnant woman;
anomalies of the uterus (saddle uterus, bicornuate, etc.);
tumors, uterine fibroids;
short umbilical cord;
entwining the child with the umbilical cord;
small fruit weight.

Question 5. Why is incorrect presentation dangerous?

Presentation - very important indicator for a doctor. The method of delivery that will be prescribed in order to avoid complications depends on this. Malposition is dangerous birth trauma and other problems both for a woman (ruptures of the external genital organs, hematomas are possible) and for her child (hypoxia, asphyxia, hematomas may occur), up to the death of the fetus in the most severe cases.

In addition, the birth itself can be more difficult, weakness of labor activity is possible.

Question 6. How to determine the type of presentation?

It is impossible to independently determine the location of the child in the uterus. This can only be done by a doctor.

As a rule, the definition of presentation is included in the planned examinations of a pregnant woman from about the 28th week (when the position of the baby can still be changed). It is carried out using the following methods:

external determination of the location of the fetus by an obstetrician using palpation (palpation) through the wall of the abdomen;
vaginal examination;

Question 7. How is childbirth with the wrong presentation?

It is very important to determine the position of the child: it is one of the main indicators for choosing the method of delivery. So, the most favorable for natural childbirth is the head occipital (flexion) presentation.

However, head presentation is not always an indicator for natural delivery. Such a presentation can become dangerous if it is extensor (frontal, parietal or facial). Often, this position is established immediately before childbirth, and then an emergency caesarean section can be performed to avoid possible injuries to the woman and child. In some situations, a caesarean section is mandatory. So, with frontal and facial presentation there is big risk injure the baby's neck, as it is very strongly curved. The most dangerous is facial presentation. In this position, the neck is in a very unfavorable condition and can be injured.

Breech presentation is even more difficult and carries with it the risk of complications for both the fetus and the mother. The complexity of this situation lies in the fact that the first part of the child's body is born less voluminous, and further births are more difficult.

However, breech presentation does not always mean that you will have to do a caesarean section. For example, in the gluteal position, a woman can try to give birth herself. Choice in this case always individual. It all depends on a number of reasons: the size of the fetus (with a breech presentation, a child over 3.5 kg is considered large, and with a head one - more than 4 kg), the size of the mother's pelvis, the gender of the baby (for boys, natural birth in breech presentation is dangerous with genital injuries) and currents of previous births.

In addition, natural childbirth with a breech presentation often leads to ruptures and damage to the mother's genitals. Therefore, it is better to immediately reduce such risks to a minimum.

Question 8. What can be the presentation of twins?

At multiple pregnancy babies can be in the mother's belly in different position, and it depends on how much easier or more problematic the birth will be.

Several scenarios are possible:

cephalic presentation of both children. In this case, often, in the absence of other indications, natural childbirth is allowed;
the child, which is closer to the exit from the uterus, is located in the head presentation, and the second - in the pelvic. In this situation, childbirth can also take place naturally without problems;
the first baby is in pelvic position, the second - in the head. During childbirth, they can catch on their heads, so perhaps the doctor will prescribe delivery by caesarean section;
if one of the children is in a transverse presentation, as a rule, a caesarean section is prescribed.

Question 9. Is it possible to make the fetus turn to its normal position?

The baby can roll over in the mother's stomach for a long time, therefore, if the gynecologist diagnosed an incorrect presentation, the baby can be tried to be forced to turn on its own. This is facilitated, for example, swimming in the pool. You can also do the following exercises at home:

twice a day for 10-15 minutes to become in the knee-elbow position;
roll over yourself: lie on one side, lie down for about 10 minutes, and then quickly turn around on the other side, and repeat 4 times.

Such exercises should not be done if there is a threat premature birth if there are scars on the uterus, placenta previa, preeclampsia and any complications of pregnancy.

If studies have shown that the fetus has turned over, a special bandage can be worn to fix its position. It is important to remember that only a doctor can prescribe a bandage, you cannot choose and wear it yourself.

Question 10. Can the doctor turn the fetus over himself?

In the past, doctors tried to turn the child over with their hands, but today they have stopped doing this due to low efficiency, and most importantly, complications. Manual rotation is dangerous for violations of the condition of the fetus, as well as premature detachment placenta, and hence premature birth.

If your doctor has diagnosed you with a presentation other than head presentation, do not panic. Firstly, the child can change his position for a long time. But most importantly, the risks of complications are minimized if the presentation is diagnosed on time, so do not forget to visit the gynecologist regularly during pregnancy and undergo all necessary examinations. In this case, you should not be afraid of a caesarean section either: this is the only way you will get a guarantee that the birth will take place without injuries, and you, and most importantly, your baby will remain healthy.

The position of the fetus is the stable location of the unborn child in the body of the uterus, in which the child will be born. This position is characterized by the ratio of the axis of the uterus to the axis of the fetus. It is worth noting that the axis of the fetus is considered to be an imaginary line running along the back, from the back of the child's head to his tailbone.

What does it mean - the position of the fetus is unstable?

The unstable position of the fetus is called the location of the child, at a gestational age of more than 30-32 weeks, head down, that is, the head lies near the cervix, and its back is not clearly longitudinal, but slightly tilted. In the early stages, such a concept as the unstable position of the fetus is not there is talk, after all, for periods up to 30 weeks, the child is surrounded by enough space to change his position often. Especially often the position is changed by babies whose mothers have polyhydramnios, resulting in a distended uterus.

Often, the unstable position of the fetus is determined by ultrasound examination. In many cases, the specialist in the conclusion of the ultrasound, which was carried out in the second trimester of pregnancy, introduces information about the unstable position of the baby, which leads expectant mothers to anxiety state. However, such a situation at such times is not a pathology, this phenomenon may not be mentioned at all.

What needs to be done?

It is worth emphasizing that such a position for periods of more than 32 weeks is dangerous because the child will not roll over, or will take a position across the uterus, in such cases, childbirth will occur using a caesarean section. In order to favorably influence this situation, experts recommend that pregnant women perform special exercises that help change the position of the baby in the head presentation position. Such exercises should be performed lying down. First, lie down on one side for 10 minutes, and then slowly roll over to the other side. This exercise should be done 2-3 times.

It is contraindicated to perform the exercise for women who have a scar on the uterus, placental abruption, as well as in the presence of decompensated heart disease in the unborn child. If the child has taken the desired position, then the woman needs to wear a bandage to avoid changing the position. The reasons that provoked the child to take the pelvic, oblique or transverse presentation, are very diverse. Basically, the reason why the fetus changed position cannot be found out.

However, most often the unstable position of the fetus is observed in women with:

anatomical features of the uterus;
clinically narrow pelvis;
a large amount of amniotic fluid;
narrow pelvis compared to the size of the baby;
low placenta previa;
in women who have already given birth.

If the fetus does not take the desired position before childbirth, then childbirth occurs with the help of a caesarean section, since there is a very high risk that the umbilical cord or parts of the fetal body will fall out of the uterus, early discharge of water, as well as other situations that can cause death fetus and/or mother.

Video: How to independently determine the position of the fetus in the uterus?