Longitudinal presentation of the fetus. Articulation of the fetus (habitus). The position of the fetus (situs). longitudinal position. transverse position. oblique position

Speaking about the medical literature, one can recall many examples when childbirth ended in the death of the mother and her unborn child. One of the reasons high level mortality in childbirth in the 17th-19th century were difficult births, provoked by the transverse position of the fetus. Today, such a complication of pregnancy, although it remains a danger to the life of the child and mother, but the risk of death of both participants in childbirth has significantly decreased. Not correct position fetus, including transverse, occurs in 1 case per 200 cases of childbirth, in percentage terms it is 0.5-0.7%. It is characteristic that situations with a violation of the normal position of the fetus in the uterus occur more often in multiparous women (more often 10 times) than in women with the first birth.

Some terminology

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

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

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

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

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

Transverse position of the fetus

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

Oblique position of the fetus

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

It is also necessary to say about the so-called unstable position of the fetus. In the case of intense mobility, the fetus may periodically change position, moving from oblique to transverse or vice versa.

Fetal presentation

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

Factors contributing to the occurrence of malposition of the fetus

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

Myoma of the uterus.

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

Congenital malformations of the uterus.

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

Misplacement of the placenta.

low placenta or low placenta(5 or more centimeters lower from the internal pharynx), its presentation (partial or complete overlap of the uterine pharynx by the placenta) is often the cause of the fetus in the uterus being improperly located.

Narrowed pelvis.

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

Malformations of the fetus.

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

Pathology amniotic fluid.

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

Multiple pregnancy.

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

Large fruit.

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

Increased tone of the uterus.

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

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

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

Fetal hypotrophy.

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

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

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

Examination of the abdomen.

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

Palpation of the abdomen.

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

obstetric ultrasound.

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

Vaginal examination.

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

Features of the course of pregnancy and childbirth

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

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

In exceptionally rare cases, it is possible to independently complete labor with the transverse position of the fetus, while the child is born alive. In such situations, the baby is independently rotated into a longitudinal position and its further birth is performed by the pelvic or head end. Self-rotation is possible in case of prematurity of the fetus or it is not large sizes. In most cases, the course of childbirth is unfavorable and can be complicated by such processes:

Untimely discharge of amniotic fluid.

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

Launched transverse position.

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

Rupture of the uterus.

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

Choriamnionitis.

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

Fetal hypoxia.

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

Childbirth with a double body.

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

Management of pregnancy and childbirth

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

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

Corrective gymnastics

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

bleeding from the birth canal;

little or polyhydramnios;

uterine fibroids;

uterine hypertonicity;

severe somatic pathology in a pregnant woman;

scar on the uterus;

multiple pregnancy;

pathology of the umbilical vessels;

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

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

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

Pelvic tilt.

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

Exercise cat.

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

Knee-elbow posture.

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

Half bridge.

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

Lifting the pelvis.

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

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

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

Birth management

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

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

the fetus is severely premature.

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

fetal hypoxia;

uterus with postoperative scars;

uterine tumors;

placenta previa;

prenatal outpouring of water;

true reversal.

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

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

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

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

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

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

expanded operating room;

preserved fetal mobility;

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

consent of the woman;

a catheter that drains the bladder;

full opening of the uterine os;

live fruit.

Difficulties that are possible when performing a combined turn:

development of infectious complications in the early postpartum period;

birth injury;

fetal hypoxia, which leads to intrapartum death;

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

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

uterine rupture is an emergency operation;

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

The most frequent questions on the topic

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

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

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

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

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

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

Longitudinal position fetus - the most correct and optimal for the normal passage of childbirth. But many women, especially those who are pregnant with their first child, do not understand medical terminology and, naturally, such a diagnosis can panic them. Let's see what is the longitudinal position of the fetus in the womb and how does it affect the course of pregnancy and childbirth?

The position of the fetus and its meaning

As is known, at normal course During pregnancy, the position of the baby in the womb is constantly changing and has almost no functional significance. Is that sometimes it can interfere with the conduct scheduled diagnostics. But closer to the fortieth week of pregnancy, the fetus increases significantly in size and the uterus becomes small for him. As a result, it is already difficult for the child to move. He is in almost the same position, and the way the baby will be born depends on his position during this period.

So, there are two main options that are radically different from each other: the longitudinal position and the transverse position. Their small variations are also possible - mixing the axis.

In most cases, and this is the norm, longitudinal arrangement. This means that the child is located vertically in the womb, that is, the axis of the fetus - a line along the vertebra, coincides with the axis of the uterus. This is a typical position of the fetus and one of the factors for the normal passage of the upcoming birth.

In addition, during childbirth, the presentation of the fetus is also important, that is, the location of the fetus relative to the cervix with the head or pelvis. When the head is adjacent to the neck - this is cephalic presentation, and if the legs or buttocks - pelvic.

It is believed that childbirth is best when the fetus lies head down, closer to the exit from the uterus. In this case, in the absence of other contraindications, childbirth is relatively easy and natural way. That is, the head longitudinal position of the fetus is considered the most optimal.

The longitudinal pelvic position of the fetus is incorrect and even dangerous due to high risk injury.

It happens very rarely, with a probability of three percent.

With this type of fetal location natural childbirth are possible, but are more severe, and there may be complications. So, the child in the gluteal position enters the birth canal wide pelvis, which can cause bleeding and perineal rupture in the mother, as well as a violation of the integrity of the bones in the child.

Also in this case, it is important that the birth takes place as quickly as possible, any delay is fraught with serious consequences for both the mother and the child. Therefore, very often with breech presentation, experts recommend a caesarean section.

Breech presentation is not the norm. Initially, nature laid the exit of the child's head, because the bones of the skull are not connected to each other and are able to change their shape. This, in turn, greatly facilitates the passage of the baby through the birth canal. The bones of the pelvis do not have such properties, so the possibility of damage is high.

Among possible causes incorrect position of the fetus, experts distinguish: narrow pelvis, placenta previa, internal tumors female organs, flabby abdominal wall or uterine musculature, polyhydramnios.

Why does the fetus normally take a longitudinal position?

This is a question to which it is impossible to give an exact answer, since experts have not come to a consensus. But there are several assumptions. So, some scientists are inclined to believe that this is due to the relatively heavy weight head relative to body. But this theory is quite controversial. After all, on early stages pregnancy, the ratio and weight of the head compared to the body is much higher than at the end, but the fetus is not necessarily located upside down.

Other scientists believe that the position of the child in the womb is affected by a combination motor activity fetus and reactive uterine contractions. This is due to the fact that the fetus grows and begins to move more and more actively, while it affects the walls of the uterus, and in response to this kind of irritation, they begin to contract, and mainly in the transverse direction. In this case, the space in the transverse plane becomes less and less, and the fetus is simply forced to take a longitudinal position.

And the fetus is located head first due to the fact that the pelvic part is much wider than the head, and it needs more space, and the place of exit from the uterus is quite narrow.

What to do if the child lies incorrectly?

The longitudinal position of the fetus, head first, is physiologically normal, but sometimes the child is located in the womb across, obliquely, pelvis forward, etc. The position of the fetus begins to be monitored from about the thirtieth week of pregnancy, but by the thirty-sixth week it may change. Therefore, if the child is not positioned correctly, this is not a cause for concern, during this time everything can be corrected. To do this, it is enough to take special postures, which will contribute to the movement of the baby. So, for example, if the axis of the child's position is shifted to the right, then you need to lie on this side as often as possible. When the desired position has already been achieved, experts recommend fixing the result with a bandage.

Many experts believe that the cause of the incorrect position of the fetus may be insufficient physical activity mothers. Very often, pregnant women try to protect themselves from everything, sometimes crossing all boundaries. After all, moderate physical exercise in the form of swimming, hiking, charging are very useful for both future mother and for her child.

Various exercises will also be effective for changing the position of the fetus in the womb. For example, standing on all fours, swaying your hips from side to side, or moving around the house like that. It is especially useful to do this when the baby is awake.

But even if the baby has not taken the right position, modern medicine is quite capable of coping with this with minimal consequences.

The position of the fetus in the uterus becomes important only after 30 weeks. Until this time, the baby has enough space for a free change of position, and it can change several times a day - this is considered the norm.

However, the child is constantly growing, and closer to childbirth, he is already forced to remain in the same position throughout the entire time. From what exactly this position will be, it may depend on whether the birth will be natural or not, and whether any complications will arise in the process.

That is why after the third ultrasound, many women are faced with medical terms that are incomprehensible to them. Most often, they see a record in the ultrasound protocol: the longitudinal position of the fetus. Let's figure out what this means.

Possible positions of the fetus

The fetus in the uterus can be located in different ways. It is extremely rare, but still there is a transverse position, a little more often the child is located with slight deviation from the axis, and the most frequent, more than 95% of cases, is the longitudinal position of the fetus. This position is called typical.

This term refers to the position when the axis of the fetus (a line running along the spine) coincides with the axis of the uterus. To put it simply, the child is upright. This is the typical situation. However, in this case, there are several options: the longitudinal head and pelvic position of the fetus.

The situation also differs by position. So the entry in the protocol: “the position of the fetus is longitudinal, position 1” means that the child is located with its back to the left side of the uterus, if position 2, then to the right.

head position

The most common is the longitudinal position of the fetus. The head is present when the fetus is head down towards the exit from the uterus. It is considered typical. It is in this position that childbirth is easiest.

Most likely, in this case, childbirth will be natural. Unless, of course, there are no other complications. It is in this position that childbirth should take place according to the plan of nature.

breech presentation

Longitudinal position and breech presentation is much less common, no more than 3% of cases. In this scenario, a successful natural delivery is also possible, but quite often doctors prefer to resort to a caesarean section. As a rule, they also pay attention to the size of the fetus, as well as the size of the woman's pelvis.

If the situation still allows for a natural birth, you need to be prepared for the fact that they will be more difficult to pass than in the case of the head proposal.

Firstly, with a longitudinal gluteal position, the fetus enters the birth canal not with a narrow head, but with a wider pelvis, which can provoke a perineal rupture or uterine bleeding.

Secondly, in order to avoid complications, it is necessary that the birth proceed quickly. That is, a woman will have to push very hard. In such a situation, every second is precious, and delay is fraught with serious complications for both the mother and the fetus.

In addition, a child born this way should have regular visits to an orthopedist during the first year, who will closely monitor the development of the child's pelvic bones.

The bones of the child's skull were originally designed to pass through the birth canal, they are not interconnected and slightly shift under pressure, changing the shape of the skull. Pelvic bones they do not have such an ability, so passing through the birth canal can damage them or affect further development.

Why is the fetus in a longitudinal position?

Scientists and physicians have not yet fully studied this issue, and there are several theories about why in most cases the fetus still assumes a head longitudinal position. One of them says that this is due to the fact that the head has more weight.

However, this theory is unlikely to be confirmed, since early dates the size and weight of the head exceeds the size and weight of the body more significantly than at the end of pregnancy, while the fetus does not necessarily lie upside down during this period.

It is much more likely that body position is influenced by a combination of fetal motor activity and reactive uterine contraction. As the fetus develops, its movements become more active, in addition, it constantly grows and begins to touch the walls of the uterus. Those in response are reduced, and mainly in the transverse direction.

That is, there is less space in the transverse plane, which provokes the fetus to take a longitudinal position. Well, he turns his head down because the uterus is already there, and more free space is needed for the legs, because they just need to kick their mother in the tummy.

If the baby lies in the tummy incorrectly

Despite the fact that the position of the fetus begins to be fixed from the 30th week, it can change up to the 36th week of pregnancy. Therefore, if you have been told that the child is in a breech presentation, it is too early to worry.

You can try to influence the location of the fetus. To do this, sometimes it is enough just to take poses more often that provoke the child to move. So, if the fetus is slightly offset from the axis to one of the sides, you need to lie on this side, and so on.

After it was possible to get the baby to take the desired position, many experts recommend firmly fixing the stomach with a bandage, and try to remove it as little as possible. It is believed that this is what will allow you to maintain the necessary position until the onset of childbirth.

Basically, all pregnant women are trying to learn more about the features of their interesting position. Therefore, quite often during an ultrasound examination, they talk a lot about the head presentation of the child.

What and how does head presentation affect

The position of the fetus is longitudinal head indicates that the head in the uterine cavity is facing the internal pharynx. This location is the most common and desirable for natural childbirth. Because in this case the head, which is the largest part of the body, will be the first to move through the birth canal. This contributes to the rapid and uncomplicated birth of a child.

Until 28-30 weeks, the position of the child very often changes. This also applies to its presenting part. But by the end of pregnancy, the fetus is head down. In this position, most natural childbirth proceeds.

Only 3-4% are cases of breech presentation, which is a direct contraindication to natural delivery.

Occipital presentation

If the position of the fetus is longitudinal, the presenting head of the fetus may have a different placement: occipital and bending insertion of the head.

The most optimal in obstetrics and gynecology is the flexion occiput presentation. In this case, the leading point of movement along the channel is a small spring. With such a presentation in the birth process, the child's neck is bent in such a way that it is his nape that appears first. This is true for about 95% of births.

Bending insertion of the head

The remaining 5% in cephalic presentation belong to the bending insertion of the head. There are 3 degrees of such placement:

Grade 1 - the position of the fetus is longitudinal, but anterior parietal presentation, when the wire point is a large fontanel. With this placement, the possibility of self-delivery is not excluded. But there are several increased likelihood that this process may cause injury to the child or mother. Childbirth is protracted, prevention of fetal hypoxia is required.

2 degree - frontal presentation when the wired dot is the baby's forehead. It is he who is below all other parts of the head of the fetus. In this case, natural childbirth is contraindicated. In this case, only a caesarean section can complete the pregnancy (the position of the fetus (longitudinal) is abnormal).

3 extreme degree - the position of the fetus is longitudinal, but there is a presentation of the face. The head in this case will come out of the birth canal with the back of the head back. If the woman in labor has a sufficient size of the pelvis, and the size of the fetus is insignificant - independent childbirth are not excluded. Despite this, in some cases facial presentation fetus is an indication for caesarean section

Causes and diagnosis

The reasons for all kinds of non-standard postures and presentations of the fetus include the following:

• narrow pelvis;
• pathological structure of the uterus;
• myoma;
• placental presentation;
• sagging of the abdominal wall;
• heredity and others.

The position of the fetus is longitudinal head can be determined by a gynecologist after 28 weeks of pregnancy. This is facilitated by an external obstetric research. During one of them, the doctor places the open palm of his left hand over the symphysis and covers the part of the fetus that is supposed to be.

If the position of the fetus is longitudinal, the presentation is head (the photo of which can be seen above), then during palpation a dense round part is felt. She is also highly mobile and ballots in the amniotic fluid. The data obtained as a result of this examination can confirm or refute a vaginal gynecological examination.

When the position of the fetus is longitudinal, the presentation is head (the ultrasound photo confirms this), the heartbeat will be felt just below the woman's navel. Ultrasonography will help determine the position, location of the members of the body, presentation, the position of the fetus and its appearance.

How to correct presentation

If your child is located in wrong posture, you can try to adjust its placement. This is possible until birth process. An unstable or incomplete head presentation of the fetus in the uterus is subject to correction.

To do this, the mother must constantly change her position, more often take exactly the position that provokes the baby's movements. If the baby's head is not located directly towards the exit from the uterus, but is slightly displaced, it is necessary to lie more often on the side where the fetus is located.

Immediately after the fetal position is restored, longitudinal presentation will take place - it is necessary to fix it. To do this, you can use a bandage. It can only be taken in extreme cases when you need to change or bathe.

But the fetus can change its position at the very last moment. This occurs after the outpouring of amniotic fluid. Then there is more space in the uterus, and the child has a place to make a coup.

Prevention of complications

Early hospitalization is required for those women who, after the 3rd week of pregnancy, were diagnosed with the position of the fetus longitudinal, but an abnormal variant of its presentation. This is necessary so that doctors can decide in advance on the tactics of delivery.

The best option for the wrong location of the baby is a caesarean section. In some cases, natural childbirth can also be performed. But they are a risky option. The presence of any additional risks is fraught not only with complications, but also with the death of the child.

So there is no need to take any more risks. In this case, this is not allowed. It is better to agree to a caesarean section and be firmly convinced that the baby will be alive and unharmed after birth. Do not be afraid of this operation, because it will help your child appear on this world completely healthy and unharmed.

Be vigilant and prudent. Good luck with your birth and healthy babies!

The location of the fetus in the uterus largely determines how the birth will take place. On an ultrasound scan in the third trimester, the doctor examines the position of the baby, making one or another conclusion. But medical terms how, for example, the longitudinal position of the fetus or transverse, may be incomprehensible to many expectant mothers, especially those who are in interesting position for the first time, which in turn causes certain anxieties and feelings.

Longitudinal position

In this position, the longitudinal axes of the baby (the line of the back of the head, spine, tailbone) and the uterus coincide. The longitudinal position of the fetus is the norm, which means that childbirth is possible naturally. The best option is the occiput presentation, when the baby's head is slightly lowered forward, and the chin is pressed to the chest. With the longitudinal position of the fetus, the largest part is born first - the head, which means that the rest of the body will literally slip through the birth canal without complications.

Another type of longitudinal position of the fetus is. With this arrangement of the fetus, childbirth is significantly complicated, since the child in the uterus is legs forward, which can cause some difficulties in the birth of the head. In turn, breech presentation with a longitudinal position of the fetus can be gluteal and foot. The first option is the most favorable, since the probability of a leg falling out is practically excluded, which means that the risk of injury is much lower. It is worth noting that with breech presentation, childbirth can also take place naturally. The question of the appointment of a caesarean is decided taking into account the size of the fetus and the pelvis of the mother, the type of presentation, the sex of the child, the age of the woman and the characteristics of the course of pregnancy.

Oblique and transverse position

In an oblique position, the longitudinal axes of the fetus and uterus intersect under acute angle, with a transverse - under a straight line. Similar arrangements of the baby in the uterus are almost always an absolute indicator for a caesarean section. Earlier in medical practice, such a technique as “turning by the leg” was used, which was performed by the doctor already in the process of childbirth. Today, due to the high traumatism of the mother and baby, this practice has been abandoned.

So, in the period from 32 to 36 weeks, the child should take the head longitudinal position. It is worth noting that the wrong position of the baby is quite a rarity. So, for example, the transverse or oblique position occurs in only 2-3% of women. Change the wrong position to a longitudinal head fetus can independently at any time, so understand exactly how the baby is located in this moment, only constant supervision at the doctor will help or assist. Despite the fact that on later dates due to the large size, it is already difficult for the baby to roll over, the position of the fetus may change immediately before the birth itself, so you should not panic.

There are also a number of exercises that will help the child get into the right position. So, for example, it is recommended to lie on each side for 10 minutes, changing position 3-4 times. Repeat the exercise several times a day before meals. The knee-elbow pose and exercises in the pool also contribute to the result.

After the baby has turned head down, many doctors recommend wearing a special one that will fix the correct position. Most often, pregnant women wrong presentation 2 weeks before delivery, the fetus is placed in a hospital, where, under the supervision of specialists, a delivery plan is drawn up.