Head presentation of the fetus. The correct position of the fetus is longitudinal

Finding out the position of the fetus in the uterine cavity is of exceptional importance for the management of pregnancy and childbirth. In the study of pregnant women and women in labor, the articulation, position, position, type, presentation of the fetus are determined.

Articulation of the fetus (habitus) - the ratio of its limbs to the head and torso. With a typical normal articulation, the body is bent, the head is tilted to the chest, the legs are bent at the hip and knee joints and pressed to the stomach, the arms are crossed on the chest. With a normal flexion type of articulation, the fetus has the shape of an ovoid, the length of which during a full-term pregnancy is on average 25–26 cm. Fetal movements lead to a short-term change in the position of the limbs, but do not violate the characteristic articulation. Violation of the typical articulation (extension of the head, etc.) occurs in 1-2% of childbirth and complicates their course.

Fetal position (situs) - the ratio of the longitudinal axis of the fetus to the longitudinal axis (long) of the uterus.

Longitudinal position of the fetus.

There are the following provisions:

- longitudinal (situs longitudinalis) - the longitudinal axis of the fetus and the longitudinal axis of the uterus coincide, the axis of the fetus is a line passing from the back of the head to the buttocks;

Transverse position of the fetus.

- transverse (situstransverse) - the longitudinal axis of the fetus crosses the longitudinal axis of the uterus at a right angle; - oblique (situsobliquus) - the longitudinal axis of the fetus forms an acute angle with the longitudinal axis of the uterus.

Longitudinal position of the fetus is normal, it occurs in 99.5% of all births. The transverse and oblique positions are pathological, and 0.5% of births are also found. In the transverse and oblique positions, insurmountable obstacles arise for the birth of the fetus.

When palpating the abdomen, they use the so-called external methods of obstetric research (Leopold tricks). Leopold (1891) introduced palpation of the abdomen into the system and proposed typical palpation techniques that received universal recognition.

The first reception of an external obstetric examination (see fig.). Its purpose is determine the height of the fundus of the uterus and the part of the fetus located in its fundus.

Research methodology . The palmar surfaces of both hands are placed on the uterus in such a way that they tightly cover its bottom with adjacent areas of the corners of the uterus, and the fingers are facing each other with nail phalanges. Most often, at the end of pregnancy (in 96% of cases), the buttocks are determined in the bottom of the uterus. Usually it is not difficult to distinguish them from the head by less pronounced roundness and sphericity, lower density and less smooth surface (see below).

Drawing: The first reception of external obstetric research.

The first external obstetric examination makes it possible to judge the gestational age ( according to the height of the fundus of the uterus), O fetal position(if one of its large parts is in the bottom of the uterus, then there is a longitudinal position) and about presentation (if the buttocks are in the bottom of the uterus, then the presenting part is the head).

The second reception of external obstetric examination (see fig.). Its purpose is determine the position of the fetus, which is judged by the location of the back and small parts of the fetus(arms, legs).

Research methodology . Hands are lowered from the bottom of the uterus to its right and left sides to the level of the navel and below. Gently pressing the palms and fingers of both hands on the side walls of the uterus, determine which way the back and small parts of the fetus are facing. The backrest is recognized by its wide and curved surface. When pressing on a large part located in the bottom of the uterus, towards the womb, the body of the fetus bends, as a result of which the back becomes more accessible for research. Small parts of the fetus are determined on the opposite side in the form of small, mobile tubercles. At multiparous women due to the flabbiness of the abdominal wall and the muscles of the uterus, small parts of the fetus are more easily palpated. Sometimes their movement is visible to the eye.

The second external reception of obstetric research also allows you to determine the condition of the round uterine ligaments, their soreness, thickness, tension, symmetry of the right and left ligaments, their location in relation to the uterus. In this case, if the ligaments converge upwards, the placenta is located on the back wall of the uterus, if they diverge or run parallel to each other, the placenta is located on the anterior wall of the uterus.

Drawing: The second reception of external obstetric research.

Next, the reaction of various parts of the uterus (its right and left half, body and lower segment) to physical irritation is determined: gently pressing on the uterus with the fingers of both hands, they monitor the strength of the contractions of the muscles of the uterus caused by this technique and its soreness. These data, which make it possible to judge the functional state of the uterine muscle, play a special role during childbirth.

palpable detectable fluctuation in the uterus with a large abdomen indicates polyhydramnios.

By the direction in which the back of the fetus is facing, its position is recognized : backrest left - first position, backrest right - second position.

If during this study it was possible to feel the movement of small parts of the fetus, we can assume that the fetus is alive.

The third reception of external obstetric research (see fig.). Its purpose is determine the nature of the presenting part and its relation to the small pelvis.

Drawing: The third reception of external obstetric research.

Research methodology . One, usually right, hand covers the presenting part, after which they carefully move this hand to the right and left. This approach allows you to determine nature of the presenting part(head or buttocks) relation of the presenting part to the entrance to the small pelvis(if it is mobile, then it is located above the entrance to the pelvis, if it is motionless, then at the entrance to the pelvis or in the deeper parts of the small pelvis).

The fourth reception of external obstetric research (rice.). Its purpose is determine the presenting part(head or buttocks) location of the presenting part(above the entrance to the small pelvis, at the entrance or deeper, where exactly), what is the position of the presenting head(in bent or unbent).

Drawing: The fourth reception of external obstetric research.

Research methodology . The researcher becomes facing the legs of a pregnant woman or a woman in labor and puts her hands flat on both sides of the lower part of the uterus. With the fingers of both hands facing the entrance to the pelvis, he carefully and slowly penetrates between the presenting part and the lateral sections of the entrance to the pelvis and palpates the accessible areas of the presenting part.

In the event that the presenting part is movable above the entrance to the pelvis, the fingers of both hands can be almost entirely brought under it, especially in women who have given birth to many women. It also determines the presence or absence of symptom of balloting, characteristic of the head. To do this, the brushes of both examining hands are tightly pressed with the palmar surfaces to the lateral sections of the head; then, with the right hand, a push is made in the region of the right half of the head. In this case, the head is repelled to the left and transmits a push to the opposite - left hand (simple ballot). After that, quickly returning to its original position, the head sometimes gives a push to the right hand. (double ballot).

With head presentation one should strive to get an idea of the size of the head and the density of the bones of the skull, the location of the occiput, forehead and chin, as well as their relationship to each other (the nature of the presentation).

With the help of the fourth reception, it is possible to determine the presence or absence of an angle between the back of the head and the back of the fetus(the higher the chin with the head fixed at the entrance, the more pronounced the flexion and the more smoothed the angle between the back of the head and the back, and vice versa, the lower the chin is, the more the head is extended), position and type of fetus- according to where the back of the head, forehead, chin are facing. For example, the back of the head is turned to the left and anteriorly - the first position, front view; the chin is turned to the left and forward - the second position, rear view, etc. In cephalic presentation, it is also necessary to determine in which pelvic cavity the head is located with its large segment.

45. Listening to the fetal heartbeat during pregnancy and childbirth.

The exciting months of bearing a little one are almost behind, and the woman is preparing for the main event - a meeting with her baby.

The birth of a baby is the result of painstaking work not only of a woman, but also of a child, so he is also preparing for his birth. At short waiting times, the baby is still small, so it can move inside the uterus, freely changing its position. Therefore, they do not talk about presentation at this time. The situation changes in the third trimester, when the size of the baby imposes restrictions on freedom of movement. It is at this time that the baby turns its head down.

Head presentation of the fetus

During the examination at the appointment with a gynecologist after the 30th week, a woman often hears about the head presentation of the fetus. This wording is not always clear, and the expectant mother does not know if she should be worried when she hears it. What does the head presentation of the baby mean and is there any reason for concern in this position? Speaking about the position of the crumbs, the doctor evaluates the ratio of the axis of the uterus to the line of the child. The latter refers to the line from the back of the head to the coccyx, passing along the back. Thus, head presentation involves the longitudinal position of the baby, while his head is located on the eve of the small pelvis. This position of the crumbs is physiological and occurs in 95-97% of women. The remaining percentage includes mothers whose little ones are located with their buttocks towards the “exit” or even lie across. In this case, the delivery process will be pathological. How to determine the head presentation of the child during pregnancy?

Diagnosis of the presentation of the baby

Determining the position of the baby is an important point during the observation of a pregnant woman, as its results can affect the course of labor. Although the expectant mother should remember that information about the breech or transverse presentation received before the 34th week is not a cause for alarm, since her little one can roll over more than once. A woman can find out about the position of a peanut in several ways.

During a visit to the gynecologist. The doctor examines the woman by external examination and establishes the position of the crumbs. The results of the study by palpation are in most cases correct, although there are errors.
Ultrasound diagnostics. During such an examination, the doctor can easily find out how the little one is located in the mother's womb. The method is highly informative and more reliable compared to the previous method, and it is also completely safe for both participants in the procedure.

Many women are interested in the question, can they independently determine the head presentation of the fetus during pregnancy? This is not easy to do, but you can try using the techniques used by obstetricians-gynecologists:

Place your palms on your upper abdomen. The buttocks will be soft to the touch and motionless, the head will be more dense and balloting. In the longitudinal position, the head and buttocks will be determined in the left and right parts of the abdomen.
With your right hand, grab the lower abdomen between your fingers (forefinger and thumb). If the head is down, you will feel for it.

If the expectant mother has doubts or concerns about the baby, it is better to trust the specialists and conduct additional medical examinations.

Head presentation: positions and types

The head presentation of the crumbs can have several "variations". There are the following types of head presentation:

The occipital is the most natural from the position of the physiology of childbirth and therefore the optimal position. In the process of moving along the birth canal, the neck is bent, the chin is pressed to the chest, and the baby goes with the back of the head forward. In this case, the likelihood of injury to both mother and baby is minimal.
Anterior head (parietal) position - the head of the crumbs is tilted forward, but not as much as possible. The wire point in the process of birth is a large fontanel. With this position of the child, both natural and operative delivery is possible. Mandatory monitoring of the condition of the baby and the prevention of his hypoxia, as there is a protracted course of childbirth in the majority of cases. Natural birth is often accompanied by trauma.
The frontal position is an infrequent phenomenon, but quite dangerous. In this case, the neck is extended, the baby goes through the birth canal forehead forward. Delivery in a natural way with this position of the crumbs is impossible, surgery is performed - a caesarean section.
Facial position. This is the presentation of the head longitudinal, in which there is a strong deviation of the head back. In this case, the leading point is the chin. The baby moves backward with the back of the head. The prognosis of delivery, as well as the technique of its implementation, depend on many factors, not least of which are the size of the pelvis and baby, the activity of labor. Both natural birth and caesarean section are possible. The decision is made in each case individually.

In addition, the "position" of the baby is also important - the location of the back of the crumbs relative to the uterine walls. According to this criterion, with head presentation, positions are distinguished:

1 position - the most common option, in which the back of the crumbs is facing the left uterine wall. This position is considered physiological and safe.
2 position - the back of the baby is turned to the right wall of the uterus.

When the back of the crumbs is turned to the anterior or posterior wall of the uterus, they speak of an anterior or posterior head presentation, respectively.

Low cephalic presentation

For the natural and prosperous course of pregnancy and subsequent delivery, not only the location of the crumbs relative to the axis of the uterus is important, but also how close the child is to the “exit”. With the approach of the moment of the birth of the baby (approximately at the 38th week), it descends. But the fact that the presentation is head, and the baby is low, a woman can also find out in the period from the 20th to the 36th week. In this case, there may be a threat of premature delivery. If the doctor said that the baby is low, do not immediately panic. Compliance with all recommendations will help to bring the pregnancy to the due date.

The best helper for a woman is a prenatal bandage, which will relieve the load and “support” the expectant mother.
Avoid physical activity.
Don't run.
Try to get more rest.

The course of childbirth in most cases is normal and has a successful outcome - the appearance of a new person.

Causes of incorrect presentation

Unfortunately, the baby is not always located the way nature "intended" it. The reasons can be very diverse:

The woman has an anatomically narrow pelvis.
There are anomalies in the structure of the uterus.
Polyhydramnios - as a result, the activity of the child can be increased.
Low water - the mobility of the crumbs decreases.
Myoma of the uterus.
Reduced uterine tone, as a result of which the ability of the organ to contract is reduced.
Placenta previa.
External factors - incorrect position of the body during sleep, clothing that brings discomfort.
Heredity.

In the presence of the above factors, the likelihood that the child will not be located in the head presentation increases significantly.

Exercises to correct the position of the baby

If the pregnancy has “stepped over” the 34th week, and the baby’s head is not in the lower part of the uterus, the doctor may recommend helping the baby to take a physiological position. If the baby is large, the doctor will pay attention to this factor after the 30th week. How to turn the baby into head presentation? A number of exercises will help the crumbs to position themselves correctly:

A woman needs to lie on her side on any hard surface - the floor, the couch, the sofa. Spend 10 minutes in this position. Roll over to the other side and wait another 10 minutes. Repeat the exercise 3-4 times. During the day, it is desirable to make 2-3 approaches.
Take a knee-elbow position and stand in this position for 15-20 minutes. Repeat 2-3 times a day.
Swimming is a great way to keep a woman in shape. In addition, classes have another "bonus" - this sport is able to stimulate the turn of the little one with his head down.
Lie on your back, after placing a pillow under the buttocks, and raise your legs (the limbs are bent at the knees). The pelvis should be 30-40 cm above shoulder level. Buttocks, knees and shoulders form a straight line. Very often, after one approach, the baby takes the correct position. If not, the exercise is performed 1-2 times a day.
Lie on your side, bend your knees and pull them slightly towards the body. Wait 5 minutes, take a smooth deep breath and roll over to the other side for another 5 minutes through your back. If the baby is located with his buttocks towards the “exit”, the starting position is the side towards which the back of the little one is facing. If the position is transverse, you should start from the side towards which the head is facing. Further straightens the upper leg (with breech presentation) and the lower (with an oblique position). Lie down. Bend your leg again. Grab your knee (upper) with your hands and describe a semicircle inward with it, touching the wall of the abdomen. Release your leg and relax. Repeat the exercise 5-6 times.

It is worth remembering that all exercises are performed at a calm pace and only after consultation and approval from the doctor.

Other types of presentation

If, despite all efforts, the pelvic presentation of the child is preserved, and not the head presentation of the child, or there is a transverse arrangement, the doctor decides on the delivery technique:

Breech (pelvic) presentation. In this case, both natural childbirth and caesarean section are possible. Among the determining factors are the size of the pelvis of the woman in labor and the weight of the baby. More often than not, surgery is preferred.
Transverse (oblique) arrangement. In this position, the baby is delivered by surgical intervention. Natural births are excluded.

If it is not entirely clear to the expectant mother how, according to the idea of \u200b\u200bnature, the baby should be located, the doctor can show the woman options for head presentation in the photo. Thus, the pregnant woman will have a clearer and more accurate understanding of the physiology of the birth process, many worries and doubts will go away.

Even in the case of head presentation, there are cases when natural birth is impossible or poses a danger to the mother and baby. Do not despair if your baby turned around in a way that would be better in terms of physiology. The doctor may decide on an operative intervention - a caesarean section. The operation will allow your baby to be born healthy, and this is the most important thing for every mother!

The presentation of the fetus determines the method and method of delivery. To make an accurate diagnosis, it is necessary to conduct an ultrasound. An experienced doctor can determine the presentation of the fetus as early as the twenty-second week. But before the onset of labor, this situation may change. The final intrauterine position of the fetus is established at the thirty-sixth week.

The most correct and optimal is considered longitudinal. It is the most common, and with it the baby's head lies down in the direction of exit from the uterus. In such a presentation, with qualified medical care, childbirth will be successful and with the least pain.

Childbirth with longitudinal head presentation in most cases takes place naturally. Except in cases where the fetus is too large (more than 3600 g) or the size of the pelvis of the expectant mother does not allow the baby's head to pass. Such situations may be an indication for a caesarean section.

When determining what cephalic presentation of the fetus means, it is important not to confuse this concept with the position of the fetus. The longitudinal position of the fetus in head presentation can have two positions:

1 position head presentation - the back of the baby lies to the left uterine wall;
2 position head presentation - the back of the fetus is facing the right uterine wall.

There are also types of positions: front, in which the back is turned forward, and rear view of the head presentation - in which the back is turned backward.

Low cephalic presentation of the fetus

You can determine the low location of the fetus from the twentieth to thirty-sixth week. Then, as the lowering of the fetus during the normal course of pregnancy occurs at the thirty-eighth week. This diagnosis should not lead to panic. This situation can provoke premature birth, but if you follow all the doctor's recommendations, then the birth will take place safely and on time.

If a pregnant woman is diagnosed with a low head presentation of the fetus, it is recommended to wear a special prenatal, limit physical activity, do not run and rest more often.

In the normal course of childbirth with a longitudinal head presentation of the fetus, the birth canal is the first to pass through the head, and then the entire body slips out. Women who are at risk of giving birth with pathologies are recommended hospitalization, where they will be under the supervision of specialists.

From determining what position the fetus occupies (longitudinal or transverse), it depends on how the pregnancy will proceed in the future and how the doctor will conduct the birth. Longitudinal is the norm. It occurs in most cases with a normal pregnancy. Other positions are deviations from the norm and are obtained due to any deviations in the physiology of the mother.

The position of the fetus is longitudinal when the imaginary axis of the body of the unborn child, passing from the back of the head to the coccyx along the spine, is located longitudinally to the imaginary axis of the future mother's uterus. The axis of the uterus is a line running along its entire length from top to bottom. If these axes intersect and form an angle of ninety degrees, then this position is considered transverse. In the case where the angle is other than ninety degrees, the position is called oblique.

In order to make it more clear what the longitudinal position of the fetus looks like, the photos are placed below. If in the first two trimesters of pregnancy the unborn child has not taken a longitudinal position, then there is no reason for concern yet. It occupies its final position in recent months, and until then it can repeatedly change it due to the fact that its size allows you to calmly swim and roll over. In recent months, it will be in the same position, since its growth will no longer allow you to calmly move around inside mom.

Doctors, as a rule, determine at a glance which position of the fetus (longitudinal or transverse) and which presentation. It is quite difficult for inexperienced future mothers to do this, so it is better to trust the results. But you can still try. The first way to determine is to take a stethoscope and listen to where the heart of the unborn baby is beating. But this way is too subjective. The second is to lie on your back and see where two elevations appeared, which should be the head and buttocks of the baby. Then you need to alternately lightly press on these elevations. If the elevation is the head, then it should disappear, and then return to its place. If the baby's ass is under the elevation, then it will not go anywhere.

Of course, all mothers want them to have the correct position of the fetus - longitudinal. To be 100% sure, it is important to remember that there is nothing more accurate than the result of an ultrasound examination, and an independent determination of the position of the child inside may be unreliable.

To give birth to a healthy child, a woman is observed by an obstetrician-gynecologist and undergoes various studies. Determining the position of the child in the uterus allows you to choose the tactics of delivery.

Physiological childbirth is possible with the longitudinal position of the fetus. In all other cases, there are indications for a caesarean section.

Until the third trimester of pregnancy, it is pointless to talk about position and presentation because of its instability: the baby moves freely in the uterus due to its small size.

From 34–35 weeks of gestation, the fetus occupies a relatively stable position, which in more than 85% of cases remains unchanged until the onset of labor.

From this point on, you can choose a hypothetical tactic for conducting the birth process. Tactics may vary depending on the mobility of the child and other indications.

The position is the ratio of the axes of the fetus and uterus. There are 3 types:

Longitudinal, in which 2 axes coincide. Large parts are located at the exit from the pelvis and at the bottom of the uterus.
Transverse, in which the axes are at right angles. Large parts are determined on the sides of the uterus.
Oblique, in which the axes form an acute angle. Large parts are located in the upper and lower opposite sections of the uterus.

The major parts of the baby include:

head;
buttocks.

Causes

Many are interested in why the fetus occupies a longitudinal position of head presentation. It is not known for certain why this occurs. There are a number of hypotheses.

One of the first concerns the greater weight of the head compared to the buttocks. However, it does not find practical confirmation. It is known that in the early stages of gestation, the weight of the fetal head is also greater, but its location is not necessarily vertical with the head down. This casts doubt on the hypothesis.

Another hypothesis concerns the reactive contractile activity of the uterus and the motor activity of the fetus. With growth, its movements become more active, and it touches the walls of the uterus, which, in response to an irritating factor, respond with contractions. There are more contractions in the transverse direction, due to which there is little space for the fetus.

In order to take the most comfortable position, the child becomes upright. It is believed that the lower limbs need more space, so they are located at the bottom of the uterus.

Position is affected by:

condition of the uterus
its contractility;
volumes of the maternal pelvis;
fruit size.

Kinds

There are 2 types of longitudinal presentations:

head,
pelvic.

Presentation is the ratio of a large part of the fetus to the exit from the pelvis, and the presenting part is the one that first passes through the birth canal.

Head presentation of the fetus

In cephalic presentation, the baby is positioned vertically with the head down. If the parameters of the head of the child and the pelvis of the mother correspond, childbirth proceeds without complications.

The presenting part is determined from the second trimester of pregnancy, when the fetus is in a relatively immobile position by ultrasound and manual examination.

There are 4 types in head presentation:

Flexion:
- Occipital.

The most common option in which the birth process proceeds physiologically. On palpation, the occipital part of the head is determined. The chin is pressed against the chest of the child.

Extension:
- Anterior head - 1 degree of extension of the head.

Childbirth in a natural way is possible. In this case, the child's chin is separated from the chest, and a large fontanel becomes a wire point. Childbirth is protracted.

Frontal - 2nd degree.

Surgery is preferred. On examination, the frontal bone is determined.

Facial - 3 degree.

Childbirth is carried out by caesarean section, since in advanced cases, death in the fetus is possible. On examination, parts of the face are determined, and the chin is the wire point.

Among the causes of incorrect presentation, the most important are:

narrow pelvis;
entanglement of the umbilical cord around the neck;
disturbed labor activity;
decreased tone of the uterus.

breech presentation

In breech presentation, the baby is positioned vertically with the head up. During physiological childbirth, the pelvis and legs of the child are born first.

There are 3 types of breech presentation:

Gluteal.

The child "squats", while the legs are pressed to the body. On examination, the gluteal groove is determined.

Mixed berry.

The legs are bent at the knees and are determined when viewed at the level of the buttocks.

Foot.

The presenting part is the legs of the fetus.

In breech presentation, a caesarean section is preferable to avoid a number of complications.

Among the reasons are:

abnormal structure of the uterus;
oligohydramnios or polyhydramnios;
decreased tone of the uterus.

Fetal positions in multiple pregnancies

Multiple pregnancy with two or more fetuses most often becomes an indication for a caesarean section. However, under certain conditions, physiological childbirth is possible.

If the fetuses occupy a longitudinal position and have a head presentation, it is possible to carry out the birth in a physiological way.

It is also possible to give birth on your own when the first child has a cephalic presentation, and the second has a pelvic presentation.

With multiple pregnancies, location situations are possible when the first child is in the breech presentation, and the second in the head. During childbirth, there may be a clutch of the heads, so operative delivery is necessary.

If one of the fetuses is transverse, surgery is necessary.

With multiple pregnancy triplets, their position can be any, but delivery must be carried out operatively.

Position correction

In the case when the wrong position of the child is diagnosed after 30 weeks of gestation, simple exercises can be used, which in some cases help him roll over.

What exercises can be used should be asked from the attending physician, as they may differ depending on the position of the child.

After adjustment, you can use a bandage to consolidate the effect.

Conclusion

The longitudinal position is occupied by the fetus, ready for normal delivery by physiological means through the natural birth canal in the absence of contraindications.

If the child is not positioned correctly, exercise therapy often helps in this case. Exercises are prescribed by a doctor. Self-medication is prohibited.

Remember that in order for the birth to be successful, it is necessary to attend a antenatal clinic and follow all the instructions of an obstetrician-gynecologist.