Facial presentation of the fetus of the child: consequences, causes. Questions Type of head in case of incorrect presentation

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 legs 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 condition of the fetus, 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.

The location of the fetus in the uterus is determined by its presentation and position. From these characteristics will depend on how exactly the baby will be born: by the method of uncomplicated independent childbirth - or by caesarean section.

What is the presentation of the fetus - types of presentation of the child in the uterus

The condition under consideration is the position in which the baby is in the last weeks of gestation - or immediately before childbirth.

Often, an obstetrician-gynecologist can determine the presentation - or the position of the fetus - after the 32nd week of pregnancy. The thing is that at this stage of development, the fetus increases in size, and there is not enough space in the uterus for it to roll over freely.

Video: Position, presentation, position and view of the position of the fetus

Depending on which part of the body is located closer to the pelvis, there are two types of presentations:

1. Breech presentation

The infant is positioned longitudinally in the uterus with its legs/buttocks facing the pelvic outlet.

There are several types:

Foot (extensor). The fetus rests with one or both legs against the entrance to the small pelvis.
Gluteal (flexion). The baby's feet are practically on the same level with the head, and the legs themselves are extended along the body.
Mixed.

Options for breech presentation of the fetus - leg extensor, gluteal flexion, mixed

2. Head presentation

The fetus is in a longitudinal position, its head is turned towards the entrance to the woman's small pelvis.

There are several options for the considered type of fetal presentation:

Occipital. During labor, due to the deformation of the cervix, the back of the head appears first, which is turned forward.
Anterior head (anteroparietal). The main emphasis at the exit is on a large fontanel. This makes childbirth more protracted, and also increases the risk of injury to the baby.
Execution. The wire point at the time of labor activity is the forehead of the child. In this case, natural childbirth is impossible - surgical intervention should be performed.
Facial. Often, with such a presentation, doctors prepare a woman in labor for, although natural delivery is also possible. The child comes out of the small pelvis with the back of the head, and the chin serves as the leading point.

Head presentation of the fetus is diagnosed in 96-97% of cases

Types of position of the child in the uterus

When determining the placement of the fetus in the uterus, use two basic concepts:

Axis (length) of the uterus- a straight line, conditionally passing through the bottom and cervix.
fetal axis- a transverse line that stretches along the back from the back of the head to the coccyx.

When determining the position of the fetus, the direction of its axis in relation to the length is taken into account.

In the event that the axes of the baby and uterus coincide, there is a place to be longitudinal position of the fetus. In simple terms, if the expectant mother is standing, the fetus will also be vertical. The head should ideally be aimed towards the exit from the small pelvis, and the pelvis towards the uterine fundus.

The position of the fetus is considered incorrect if it:

transverse. The infant's head and pelvic bone are palpated in the lateral sections of the uterus. Diagnostic measures confirm that the axis of the uterus and fetus are at an angle of 90 degrees with respect to each other.
oblique. The angle between the uterine axis and the fetal axis is 45 degrees. In some cases, this value may increase.

Causes of the incorrect position of the child in the uterus and pathological presentation

There may be several reasons for the pathological phenomena under consideration, but all of them are conditionally divided into 2 large groups:

1. Those caused by errors in the structure of the uterus

2. Pathological phenomena that provoke an increase or decrease in the motor activity of the fetus:

Errors in the development of the fetus. Absence of the brain, dropsy of the brain can lead to the fact that the baby takes an oblique position in the womb.
The presence of several fetuses in the uterus. This phenomenon significantly limits the mobility of babies.
Hypertension of the uterus. Such a pathological condition can be triggered by curettage of the uterus, inflammation of the cervix / body of the uterus, abortion. In addition, frequent overwork, stress, neurosis, etc. can lead to an increase in the tone of the uterus.
Much or little water. In the first case, the uterus increases in parameters, which creates conditions for active movements for the baby. If the amniotic fluid is below normal, the child is simply not able to take the correct position.
The weight of the fetus is very large (from 4 kg and above) or very small. In the latter case, the child is able to freely and regularly change position in the uterine cavity.
Weakness of the abdominal muscles. This is especially true for women who have a history of 4 births or more. Muscles lose their elasticity and are not able to restrain the movements of the fetus.

According to the observations, gynecologists-obstetricians note a hereditary factor in the pathological presentation or incorrect placement of the child in the uterus.

Why is the wrong position of the child in the uterus dangerous?

With a non-standard fetal position in the uterine cavity, a favorable independent resolution of childbirth is extremely unlikely.

Often, labor activity is accompanied by the following negative phenomena:

Premature release of amniotic fluid. Due to the lack of pressure on the entrance to the small pelvis.
Inflammatory processes in the walls of the fetal bladder, as well as infection of the amniotic fluid. With the penetration of harmful microorganisms into the uterine cavity, peritonitis and sepsis may develop.
Acute fetal oxygen deficiency.
Violation of the integrity of the uterus. Earlier discharge of amniotic fluid can be the result of a strong indentation of the shoulder girdle into the entrance to the small pelvis. Against the background of active contractions of the uterus, its lower section is stretched, and can break.
Prolapse of small parts of the child's body with the rapid discharge of amniotic fluid. When the umbilical cord is clamped, serious circulatory failures occur, and childbirth, as a rule, is fatal for the baby.
Injury to a child during childbirth.

With a strong contraction of the uterus and the transverse position of the fetus, it is possible to bend it in half. In this case, the sternum comes out first, then the stomach with the head pressed against it. The lower limbs come out last. Such a development of events often ends in the death of the baby.

Signs and symptoms of malpresentation or position of the fetus in the uterus - can you notice it yourself?

Self-determination of the position of the fetus inside the uterus is a difficult task, and not always effective. Better for similar purposes contact an appropriate specialist and/or undergo an ultrasound examination.

Obstetrician-gynecologists, as a preliminary diagnosis, feel the belly of the future woman in labor.

If in the upper part it is soft and inactive, and a dense, rounded and movable part is felt below, this indicates a longitudinal presentation of the fetus.
If palpation of the upper and lower sections of the uterus confirms the emptiness of the uterine fundus, and the head and buttocks of the baby are palpated in its lateral sections, the position of the fetus is transverse.
With an oblique location of the baby in the uterine cavity, its head (dense part) will be localized in the iliac zone.

Diagnosis of the position of the fetus in the uterus

Diagnostic measures to determine the posture of the fetus are complex. They consist of several procedures, which carried out not earlier than on the 34th week of gestation:

External inspection. In the normal course of pregnancy, the uterus should have an oval-elongated shape. If the fetus is placed incorrectly, the abdomen will visually appear obliquely stretched (oblique position of the child) or transversely stretched (transverse position of the baby). If the baby’s position is incorrect, the uterus is spherical, not oval, and the bottom of the uterus is not high enough.
Internal inspection. It is informative only after the discharge of water and the opening of the uterine os by several centimeters. It is necessary to conduct vaginal examinations in such cases very carefully - with the transverse placement of the fetus in the uterine cavity, the handle, leg or umbilical loop may fall out. If the fetus is turned with its buttocks towards the entrance to the small pelvis, the obstetrician, upon examination, will be able to examine the coccyx, sacrum, and also the baby's feet.
Palpation of the abdomen. The details of this procedure were described in the previous section. At this stage, the doctor also determines the fetal heartbeat. With a longitudinal arrangement, it is palpable in the right / left part of the uterus.
Ultrasonography. Determines the pose of the fetus with 100 percent accuracy.

Features of childbirth with incorrect presentation and position of the fetus in the uterus

Independent childbirth with an incorrect fetal position is possible with a combined external-internal rotation.

The obstetric situation should be uncomplicated, which includes the following conditions:

The uterus should open completely.
The woman in labor agrees to such a procedure.
A catheter is inserted into the bladder.
The fruit is not too large in size and can be expanded.
Pregnancy is singleton.
There are no pathologies on the part of the future mother and baby.

Surgical delivery with oblique / transverse placement of the fetus before the onset of contractions is carried out under the following pathological conditions:

Early discharge of amniotic fluid.
Overlapping a child.
placenta previa.
Oxygen starvation of the fetus.

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

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.
Prematurity.
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.
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.
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.

In natural childbirth, the fetus enters the birth canal on its face rather than the top of its head, thereby increasing the risk of birth injury. The child is born with a deformity of the head.

Causes and consequences of facial presentation of the fetus
Perhaps the most common causes of facial presentation of the fetus obstetricians consider repeated entanglement of the umbilical cord around the child's neck, or the presence of tumors on it. Such consequences of presentation as tumors and deformation pass over time and do not pose a danger to the baby. The swelling disappears by the time of discharge from the maternity hospital, and the deformed head recovers a little longer.

Tactics of conducting childbirth
In most cases, a woman can give birth to a child on her own with a facial presentation. However, it is important to find an experienced obstetrician who has already taken such births. Since the baby walks with his head thrown back, this is fraught with hypoxia. As a rule, such childbirth, in addition to a positive experience, requires promptness. In addition, the birth itself always takes longer than the birth with a child in the traditional position. From a woman here requires maximum patience. Excessive effort and ignoring the doctor's instructions always leads to tears and sprains of the perineum.

Therefore, doctors resort to a perineal incision or episiotomy, which helps. Another feature of childbirth is the expectant position of doctors. They deliberately do not correct the position of the child, as this can harm, and do not use forceps. A cesarean section operation with a facial presentation of the fetus is performed in the presence of either complications or concomitant indications, for example, such as a narrow pelvis, fetal hypoxia, and others. A caesarean section is also performed if there is a risk of the head falling out of the uterus before the onset of labor, and also when it is thrown back too much (frontal presentation).

Diagnostics
Facial presentation of the fetus is usually diagnosed at the last ultrasound. In addition, an experienced gynecologist is able to install it when viewed manually. Once a pregnant woman is diagnosed with this, she should be as careful as possible. It is important not to provoke the so-called prolapse of the head and not to increase the swelling of the face in the baby.

Usually, natural childbirth with a facial presentation of the fetus is quite successful. In the process of passing through the birth canal, the baby turns its head. The consequences of the facial presentation of the fetus pass quickly enough. The deformed head takes on a normal shape, swelling subsides. Perhaps the most negative consequence is a hemorrhage in the chest, in which the child cannot take the breast. The baby first needs to recover and at this time it is worth feeding him with expressed milk.

The child occupies the position in the uterine cavity, on which the process of childbirth and the presence of pathologies depend in the future.

Many people confuse the presentation of the fetus with the position. But there is a significant difference between these two definitions. The position of the fetus is determined in relation to the location of the child relative to the axis along the uterus, and the presentation depends on how the child is turned towards the exit from the uterus (cervical pharynx).

Presentation, like the position of the fetus, can change throughout pregnancy, but starting from the 33rd week, the child almost always remains in a certain presentation. This is due to its size, because it is getting harder to spin, there is less and less space every day. And already from 34 weeks the fetus is gradually preparing for birth. The expectant mother begins to feel preliminary (training) contractions, and the baby gradually descends. At the last ultrasound, the presentation of the fetus is determined, in which it will be born.

Consider the types of presentation of the fetus.

Head presentation of the fetus

This is the most common position for giving birth. According to statistics, almost 95% of women give birth to babies head first. The child in head presentation is in a longitudinal position.

This presentation, in turn, is further divided, depending on the level of extension of the head:

occipital;
anterior head;
frontal;
facial.

Occipital cephalic presentation of the fetus is the norm, in which all women give birth on their own, without additional intervention.

Anterior presentation is worse because the head enters the pelvis in the largest size, such childbirth is much more difficult. But there were cases when the child adapted and changed the position of the head during childbirth, facilitating his way into the world. Such a presentation may be an indication for a caesarean section, but this issue is very individual. Each case is considered separately, taking into account other aspects.

Frontal presentation is very rare, it is the average degree of extension of the head. With this position of the fetus, natural childbirth is impossible, only with surgical intervention.

Facial presentation - maximum extension of the head. Technically, such childbirth can take place in a natural way, but with injuries for both the child and the mother, which determines in most cases the tendency to caesarean section.

For a better perception of information, we suggest looking at a photo of the head presentation of a child with varying degrees of extension of the head.

Breech presentation of the fetus

The second name for this type of presentation is gluteal. In this case, the baby is turned with its buttocks towards the exit from the uterus. That is, the butt and legs enter the small pelvis first. A baby is born either with the buttocks or legs forward, so the breech presentation is divided:

pure breech presentation (position a in the picture);
mixed (position b);
foot (position c).

Such presentation during childbirth is not very common (only about 5%). In most cases, when determining the breech presentation, gynecologists give recommendations or perform manipulations themselves to turn the child over.

Childbirth in breech presentation is considered pathological, as it is accompanied by complications. Such childbirth is quite possible to produce in a natural process, but in some cases they decide on a caesarean section.

It all depends on many characteristics of pregnancy:

The size of the pelvis of the woman in labor.
Child's weight.
Gender of the child (in boys, the genitals may be damaged during childbirth).
What kind of breech presentation (breech, mixed or foot).
At what age is the woman.
What are the births, the history of previous births.

Transverse or oblique presentation of the fetus

Transverse and oblique presentation of the fetus is an indication for caesarean section. Naturally, it is impossible to give birth to a child in such a presentation.

Previously, during childbirth, turns were used for the limbs of the child, but in our time it is prohibited, because this procedure can cause irreparable harm to both the child and the mother. The only case when these manipulations can be applied is only at the birth of twins. When the first child is born, and the second has taken the wrong position in the transverse or oblique presentation.

Low fetal presentation

Such a presentation is considered the norm immediately before childbirth, when the child gradually descends, it is also noticeable externally - the stomach drops.

But when a woman finds out about this in the second trimester of pregnancy, you can’t call it good news, but you shouldn’t panic either.

Depending on the general condition of the woman, on the tone of the uterus, the size of the cervix, they can diagnose a threatened miscarriage and prescribe:

ambulatory treatment;
put the expectant mother in the hospital for preservation;
install a pessary;
sew on the neck.

Healthy food;
take medications, vitamins prescribed by a doctor;
spend enough time outdoors;
do not play sports, remove all physical activity;
Enough to drink during the day and not get drunk before bedtime.

Fetal Turning Exercises

Malpresentation of the fetus is not always an irreversible problem. There are a lot of exercises that provoke and help the child roll over into the correct presentation. It is not worth starting exercises on your own, without the knowledge of a doctor, because there are a certain number of contraindications:

Myomas.
Placental presentation.
Previous births by caesarean section.
Many different diseases of the systems and organs of the mother.

The incorrect presentation of the child can be changed with the help of exercises of 50% of women. There are cases when a child changes its presentation almost a couple of days before birth. In this situation, it is worth regularly visiting a gynecologist who will conduct an examination and tell you how to give birth. Even if you have been prescribed a caesarean section, do not be upset, because your child needs a healthy and happy mother who is looking forward to his arrival!

How to independently determine the presentation of the fetus? You will find this information in the video.