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Facial presentation of the fetus of the child: consequences, causes. Facial presentation of the fetus - causes, diagnosis and consequences Problems in a child with posterior occipital presentation

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

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

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

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

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

The corresponding size is called vertical, is 9.5 cm in a full-term fetus and is equal to the size with the most favorable occipital presentation for childbirth, however, the bones of the facial skull do not configure to the shape of the birth canal as well as the bones of the cranial vault in the occipital presentation. The frequency of occurrence of facial presentation is 1: 500 births.

Causes of facial presentation of the fetus of the child

  1. Fetal malformations (occur in 15% of newborns with facial presentation). The most common major malformations of the central nervous system (CNS) are anencephaly and meningomyelocele. Various tumors of the cervical region can also contribute to extension and the formation of facial presentation.
  2. Prematurity.
  3. Moderate discrepancy between the size of the fetal head and the size of the pelvis. It is possible that in some cases with anterior presentation, with a comparative disproportion between the fetal head and the size of the pelvis, the head can be fully extended, and a facial presentation will form.
  4. Excessive tone in the extensor muscles of the neck. It has been suggested that this condition may be a prerequisite for the formation of facial presentation. This theory has been used to explain the causes of primary facial presentation, which was formed before the onset of labor. The formation of facial presentation during childbirth is called secondary facial presentation.
  5. High parity. In most cases of facial presentation, no obvious reason has been found for its development, other than high parity.

Diagnostics of the facial presentation of the fetus of the child

The wire point in facial presentation is located between the chin and the superciliary arches. Usually during vaginal examination it is possible to palpate the eyes, nose, mouth and chin. Significant swelling of the soft tissues of the face often develops, which makes it difficult to recognize anatomical structures. The differences are usually obvious, but the mouth can be mistaken for the anus and vice versa. In such a situation, it is necessary to insert a finger into the hole in order to palpate another marker - the edges of the gums.

Quite rarely, the diagnosis can be made before the onset of labor. However, malpresentation of the fetus during examination of the pregnant abdomen can be suspected if the fetus is easily palpated and its back is located strictly anteriorly. In the case of a normal flexion position of the fetal head, palpation of the back and head can determine a small depression corresponding to the cervical spine. With facial presentation, this depression is pronounced significantly. The diagnosis is confirmed by ultrasound.

The location of the chin in face presentation is a determining factor in making a diagnosis. The following types of facial presentation are distinguished: anterochin, posterior chin and transverse chin and, accordingly, the first or second position.

In most cases, anterior-chin appearance occurs.

Tactics of conducting with facial presentation of the fetus of the child

In rare cases, facial presentation is diagnosed before the onset of labor, and therefore a thorough examination using ultrasound should be carried out to exclude fetal malformations. If facial presentation is detected during pregnancy, the patient should only be observed, because. in some cases, the fetus spontaneously returns to its normal position - occipital presentation. However, if the facial presentation persists and the fetus has no malformations, then delivery should be carried out by caesarean section, which is the safest for the fetus.

In the case of diagnosing facial presentation during childbirth, fetal malformations should be excluded and pelvimetry should be performed to determine the size of the fetus and identify pelvic narrowing or deformities. Only after the study of the pelvis and its measurements should the type and features of the facial presentation be fully assessed. Depending on the estimated fetal weight, type, position of the presenting part, clinical assessment of the size of the pelvis and the nature of labor, it is necessary to develop a plan for the management of labor. The following clinical tactics are possible.

“When the chin is turned in the direction of the pubis at the bottom of the pubic bone, the woman in labor should be laid on her back and obstetrical forceps should be prepared ... and only when the chin is removed from under the pubis, it is necessary to pull the head along the arc of a circle upwards, resulting in the forehead and back of the head will be brought out and shown in the crotch"

If, in the anterior chin view, which corresponds to the vertical size (equal to the small oblique size in occipital presentation), the fetus is not large and its size clinically corresponds to the size of the pelvis, it can be assumed that the birth will take place through the natural birth canal. In most cases, the fetus in a transchin face presentation will unfold into a clinically more favorable anterochin view.

50 years ago, when mortality and morbidity after caesarean section were high, attempts were made to turn the head from facial to occipital presentation. This procedure was performed with full or almost complete dilatation of the cervix under deep anesthesia in combination with drugs that relax the uterine muscles. In a previous edition of this manual, Chasser Moir (1964) described his technique as follows:

“When a (lateral-chin) view was detected at the beginning of labor, in five cases I managed to correct the presentation of the fetus and transfer it to the occipital position by a simple intrauterine manipulation, which consisted of “hooking” the occiput with the fingers while simultaneously squeezing up the chin and superciliary region with the thumb, after which the delivery always proceeded normally.

In our time, we would not recommend such a manipulation, except perhaps a very careful attempt, which will be successful only with a small size of the fetus and a relatively large size of the pelvis. This manipulation should be carried out only if it is certain that it can be carried out easily and atraumatically.

It is necessary to carry out tractions very carefully. Even in the case when the face cuts, the bones of the skull can be located in the plane of the entrance to the small pelvis. The guiding position in this case sounds like this: "head is higher than you think." If forceps are to be used, the fetal head should not be palpated above the pubic arch, and the sacral cavity should be filled with the fetal head. Both classic forceps and Killand forceps can be used. In face presentation, the chin is the main reference point instead of the occiput. If Killand forceps are used, the grooves on the handles should be directed towards the chin. When using forceps of both varieties, the spoons are directed in the same way as in the anterior view of the occipital presentation - along the chin-occipital diameter of the head. The curve of the spoons of classical forceps resembles the curve of the birth canal of the pelvis, the chin is at the base of the spoons, and the face is directly below the level of the handles. When using Killand's tongs, the upper segment of the spoons is located at the level of the superciliary arches, and the face of the fetus is above the level of the decussation of the arms.

Once the forceps are in position, the handles are lowered slightly to give the head maximum extension so that it is in the smallest position. At the height of the contraction, traction is carried out slightly downward, the patient is asked to push until the chin is under the pubic symphysis. When using classic forceps at this point, the handles are gradually raised to a level of 45 ° so that the occiput is born. When using Killand's forceps, the curvature of which is less, the handles should be raised only to a horizontal level, after which the head is bent and born.

With the posterior chin type of facial presentation, which does not unfold into the anterochin during childbirth. In the past, in such situations, Kylland's forceps were applied and a rotation was performed from the posterior-chin and transversal-chin view to the anterior-chin view. However, in modern obstetrics, such a manipulation is considered high-risk and the patient is delivered by caesarean section.

While the fetus is still very small, it can move quite freely in the uterus in different directions. The closer the due date, the less free space remains for the child. At a short gestational age, the doctor can diagnose the patient with an "unstable position" - this means that the fetus is still actively moving. In the early stages, this is considered the norm. The child usually occupies the final position by the 33-34th week of pregnancy (and in the second and subsequent 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. With the occipital, the baby's head is bent, and therefore this position is called flexion, and the rest - extensor.

Flexion cephalic presentation is the most optimal and natural position of the child, in which childbirth can proceed naturally without hindrance, since the head, the most voluminous part of the body, will go through the birth canal first. 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 diagnosed with such a diagnosis, it is important to take care of yourself, limit physical activities, including outdoor activities, and all kinds of stress, lie more, and also use a support bandage. A low presentation can also cause the expectant mother to be hospitalized in a 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 (hypotonicity) 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 is a very important indicator for a doctor. The method of delivery that will be prescribed in order to avoid complications depends on this. Incorrect presentation is dangerous for birth injuries and other problems for both 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 a big risk of injuring the baby's neck, since it is very strongly curved. The most dangerous is the 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. The choice in this case is 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?

With multiple pregnancies, babies can be in the mother's stomach in a different position, and it depends on how much easier or more difficult 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 the 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 practiced if there is a threat of 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 fetal condition, as well as premature detachment of the 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 the 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.

Incomprehensible terms of doctors often frighten pregnant women, because not every of them has a medical education or read additional literature related to pregnancy. On ultrasound, many have to hear the diagnosis of "cephalic presentation of the fetus." What does he mean? Is it a pathology or a normal condition that does not threaten the mother and child? Without knowing the exact information, do not panic and worry. It is better to check with the doctor for details or to find answers to your questions on your own.

What does cephalic presentation of the fetus mean?

This position of the baby in the uterus is the most common and most desirable for natural childbirth. By head presentation is meant the location of the baby's head at the entrance to the small pelvis.

In 95-97% of cases, the baby is head down in the uterus. The remaining 3-5% are in the breech presentation of the fetus, in which childbirth is considered pathological.

Experts distinguish several options for the longitudinal head position of the fetus. The tactics of childbirth and the prevention of complications during delivery depend on them.

Head presentation options

Obstetricians and gynecologists distinguish several different options for the head presentation of the baby:

  • occipital
  • facial
  • frontal
  • anterior head

The best option in gynecology and obstetrics is considered occiput presentation . The neck of the baby, passing through the birth canal during delivery, is bent. The back of the baby's head appears first at birth. About 90-95% of births proceed in this way. Occipital presentation allows the mother to give birth without breaks, and the child to be born without injury.

What does head mean presentation of the fetus of the facial type ? This variety is characterized by maximum extension of the head. The baby comes out of the birth canal backwards with the back of the head. In most cases, with such a presentation, the child is born due to a caesarean section. However, independent childbirth is not excluded.

frontal presentation is very rare. The forehead of the fetus serves as a conductive point through the birth canal. With this variant of presentation, a caesarean section is necessary. Natural childbirth is excluded.

Front head variant also called anterior. During the period of exile, a large fontanel serves as a wire point. With an anterior presentation, a child can be born both naturally and due to a caesarean section, but with independent childbirth, there is a high probability of injury to the baby. A mandatory measure during delivery is the prevention of fetal hypoxia.

The location of the fetus is also characterized by position. 1 item head presentation of the fetus means that the back of the crumbs is facing the left uterine wall. It occurs quite frequently. The position of the child, in which his back is facing the right uterine wall, is called by obstetricians and gynecologists 2 position head presentation of the fetus.

The back of the child is not always facing the left or right uterine wall. Usually it is turned back or forward. In this regard, distinguish the type of position. In the front view, the back is turned forward, and in the back view, it is backward.

All incorrect presentation and position of the fetus can be caused by the following reasons:

  • narrow pelvis
  • abnormal structure of the uterus
  • uterine fibroids
  • polyhydramnios
  • placenta previa
  • heredity

Low cephalic presentation of the fetus

Pregnant women learn about the low location of the fetus, as a rule, at 20-36 weeks of pregnancy. Fetal descent should occur around 38 weeks. Having heard such a diagnosis, do not panic. Of course, due to the low presentation of the fetal head, premature birth can begin, so doctors should carefully monitor the course of pregnancy, and expectant mothers should follow all the doctor's instructions and take any actions with extreme caution.

In most cases, childbirth goes well. There are no negative consequences for the baby and his mother.

With a low head presentation of the fetus, experts recommend:

  • use a special prenatal bandage
  • not to run
  • give up physical activity
  • rest more often

Diagnosis of head presentation of the fetus

At about 28 weeks, the obstetrician-gynecologist, upon examination, can tell about the presentation of the fetus. To determine its type, methods of external obstetric examination are used. With cephalic presentation, the head is palpated above the entrance to the small pelvis.

Ultrasound is needed to make an accurate diagnosis. The doctor can even determine the head presentation at 22 weeks. However, before the birth, the situation may change several times. As a rule, the fetus changes its position several times before 32 weeks, since there is enough space in the uterus for its movements.

The presentation of the fetus (pelvic or head) can be determined by the woman herself. To do this, lie on your back, bending your knees and placing one hand on your lower abdomen. If, with slight pressure, the head of the child is felt, then the presentation will be head. Establishing a variant of the head presentation is much more difficult. Here, a woman on her own will not be able to determine anything. Only ultrasound can show an accurate diagnosis.

Features of childbirth with various types of head presentation of the fetus

Childbirth is considered correct and favorable if it occurs with an anterior view of the occipital head longitudinal presentation of the fetus. The head of the child, leaving the small pelvis, bends. The chin is pressed against the chest. When passing through the birth canal, the small fontanel plays the role of the leading wire point. The head, moving forward, turns inside. The face is turned to the sacrum, and the back of the head - to the pubic joint. The head, showing itself to the light, unbends. Further, the shoulders unfold inside, and the head outside. Now the baby's face is turned to the hip of his mother. Following the head and shoulders, the rest of the body emerges easily.

During childbirth in the posterior view of the occipital head presentation of the longitudinal position, some difficulties arise. The head inside turns to face the pubic joint. The back of the head is turned towards the sacrum. The advancement of the head is delayed. There may be weakness of labor activity, which is dangerous with complications. Doctors in such a situation conduct stimulation. Obstetric forceps are superimposed with the development of asphyxia.

With facial presentation, a woman can give birth under the following conditions:

  • normal size of the pelvis
  • small fruit
  • active labor activity
  • the baby's chin is facing forward (anterior type of facial presentation)

During childbirth, a wait-and-see position is taken. The condition of the woman in labor and the dynamics of labor activity are under control. With the help of phonocardiography and cardiotocography, the fetal heartbeat is monitored. If, with a face presentation, the child's chin is turned backwards, then a caesarean section is performed.

Independent childbirth is very rare in frontal cephalic presentation of the fetus. They are fraught with various complications: ruptures of the perineum and uterus, the formation of vaginal-vesical fistulas, and fetal death. Before inserting the head, if this type of presentation is suspected, the obstetrician-gynecologist can turn the fetus. If it is impossible to make a turn, then the child can be born only as a result of a caesarean section.

With anterior head presentation, the tactics of childbirth is expectant. If the health of the fetus or mother is threatened by some kind of danger, then a caesarean section is performed.

Prevention of birth complications in cephalic presentation

Women who are diagnosed with cephalic presentation of the fetus at week 30, and its pathological variant is determined, should be hospitalized in advance in the maternity hospital to select the appropriate tactics for childbirth. With an incorrect presentation for the child and mother, the most favorable caesarean section is the most favorable.

In conclusion, it is worth noting that the head presentation of the fetus, which indicates the location of the child in the uterus with the head towards the entrance to the small pelvis, is considered the most favorable option for delivery. However, not all of its types are safe for the mother and fetus. With facial, frontal and anterocephalic presentation, there is a possibility of injury, death of the fetus. Doctors may prescribe a caesarean section. Do not be afraid of her, because thanks to her, the baby can be born alive and unharmed.

The position of the fetus is the ratio of its axis (which passes through the head and buttocks) to the longitudinal axis of the uterus. The position of the fetus can be longitudinal (when the axes of the fetus and uterus coincide), transverse (when the axis of the fetus is perpendicular to the axis of the uterus), and oblique (middle between the longitudinal and transverse).

The presentation of the fetus is determined depending on that part of it, which is located in the area of ​​\u200b\u200bthe internal pharynx of the cervix, that is, at the place where the uterus passes into the cervix (presenting part). The presenting part can be the head or the pelvic end of the fetus; in the transverse position, the presenting part is not determined.

head presentation

Head presentation is determined in approximately 95-97% of cases. The most optimal is the occipital presentation, when the head of the fetus is bent (the chin is pressed to the chest), and at the birth of the baby, the back of the head goes forward. The leading point (the one that first goes through the birth canal) is a small fontanelle located at the junction of the parietal and occipital bones. If the nape of the fetus is turned anteriorly, and the face is backwards, this is the anterior view of the occipital predilection (more than 90% of births occur in this position), if vice versa, then the posterior. In the occiput posterior presentation, childbirth is more difficult, during childbirth the baby can turn around, but childbirth is usually longer.

With cephalic presentation, the pelvic end of the fetus may deviate to the right or left, depending on which way the back of the fetus is facing.

Also, extensor types of head presentation are distinguished, when the head is unbent to one degree or another. With a slight extension, when the leading point is a large fontanelle (it is located at the junction of the frontal and parietal bones), they speak of an anterior presentation. Childbirth through the natural birth canal is possible, but they take longer and are more difficult than with occipital presentation, since the head is inserted into the small pelvis in a large size.

Therefore, cephalic presentation is a relative indication for a caesarean section. The next degree of extension is frontal presentation (it is rare, in 0.04-0.05% of cases). With the normal size of the fetus, childbirth through the birth canal is impossible, and surgical delivery is required. And finally, the maximum extension of the head is the facial presentation, when the fetal face is born first (it occurs in 0.25% of births). Childbirth through the natural birth canal is possible (in this case, the birth tumor is located in the lower half of the face, in the area of ​​​​the lips and chin), but they are quite traumatic for the mother and fetus, so the issue is often resolved in favor of a caesarean section.

Diagnosis of extensor presentation is carried out during vaginal examination during childbirth.

Breech presentation of the fetus

Breech presentation occurs in 3-5% of cases and is divided into foot presentation, when the legs of the fetus are presented, and gluteal, when the baby is squatting, as it were, and his buttocks are presented. more favorable.

Childbirth in a breech presentation is considered pathological due to the large number of complications in the mother and fetus, since the first to be born is a less voluminous pelvic end and difficulties arise when removing the head. With a foot presentation, the doctor delays the birth of the child with his hand until he squats down to prevent the legs from falling out, after such a benefit, the buttocks are born first.

Breech presentation is not an absolute indication for caesarean section. The question of the method of delivery is decided depending on the following factors:

  • the size of the fetus (with a breech presentation, a large fetus is considered to be more than 3500 grams, while during normal childbirth - more than 4000 grams);
  • the size of the mother's pelvis;
  • type of breech presentation (foot or gluteal);
  • gender of the fetus (for a girl, childbirth in a breech presentation is associated with a lower risk than for a boy, since the boy may have damage to the genitals);
  • woman's age;
  • course and outcome of previous pregnancies and childbirth.

Transverse and oblique position of the fetus

The transverse and oblique positions of the fetus are an absolute indication for caesarean section, childbirth through the natural birth canal is impossible. The presenting part is not defined. Such positions are determined in 0.2-0.4% of cases. The previously used turns by the leg during childbirth are now not used due to the great trauma for the mother and baby. Occasionally, a similar rotation can be used for twins, when, after the birth of the first fetus, the second took a transverse position.

The transverse position may be due to tumors in the uterus (for example,), which prevent them from taking a normal position, in multiparous women due to overstretching of the uterus, with a large fetus, with a short umbilical cord or wrapping it around the neck.

In the absence of reasons preventing the fetus from turning on the head, you can perform the same exercises as with breech presentation. In an oblique position, you need to lie more on the side where the back is predominantly facing.

The position of the fetus in twins

With twins, vaginal delivery is possible if both fetuses are in the head presentation, or if the first (which is closer to the exit from the uterus and will be born first) is in the head presentation, and the second in the pelvic. If, on the contrary, the first is in the breech presentation, and the second in the head, the situation is unfavorable, since after the birth of the pelvic end of the first fetus, the babies can catch on their heads.

When determining the transverse position of one of the fetuses, the issue is resolved in favor of a caesarean section.

Even with a favorable arrangement of the fetuses, the question of the method of delivery for twins is decided not only on the basis of the position, but also depending on many other factors.

Elena Kudryavtseva