Breech presentation and malposition of the fetus. The course of pregnancy and childbirth. Head presentation of the fetus

Delivery largely depends on the position of the fetus in the uterus. With the correct location of the child, the risk of injury and rupture is practically eliminated, and the passage of the fetus through the birth canal itself is quick and easy. Sometimes doctors are forced to resort to a caesarean section to remove the child, there is simply no other way to avoid injury. Caesarean section is used in a number of cases, one of which is malpresentation of the fetus - a position in which the position of the child in childbirth can cause complications.

As the term increases, the child grows and becomes less mobile in the woman's stomach, and from there he occupies a certain position in which he is until the very birth. The fetus with any one part of the body approaches the birth canal, for example, with the buttocks, head, knees, feet, shoulder or arms, and moves along the birth canal in this position. In the last stages, the obstetrician-gynecologist takes control of the position of the fetus in the uterus, fixes the approximate weight and size, and thanks to these data, predicts the upcoming delivery.

Why is the fetus in the wrong position

The location of the fetus in the womb depends on a number of reasons, according to many experts, in most cases, the deviation is provoked by too active movements of the child, as well as reflex activity of the muscles of the uterus. Unfortunately, these two decisive factors do not depend on the actions and desires of the expectant mother, and therefore cannot be controlled. There are other reasons due to which the fetus may not be located correctly in the uterus just before childbirth:

polyhydramnios or oligohydramnios;
abnormal deviations in the shape of the uterine cavity;
the constitution of the expectant mother is too narrow a pelvis;
very low position of the placenta (placenta previa);
short umbilical cord;
tumors, scars, fibroids, fibromas in the uterine cavity;
, or vice versa - reduced tone;
diagnosis of myometrial dystrophy;
bicornuate or saddle uterus.

What complications are caused by incorrect presentation?

According to statistics, every fifth woman, with a presentation of the fetus, bears and gives birth to a child without complications. Problems usually arise only under the influence of factors due to which the fetus has taken the wrong position in the uterus. Often, with a breech presentation, there is a threat of miscarriage, preeclampsia, polyhydramnios, oligohydramnios, fetal hypotrophy and cord entanglement.

Types of fetal presentation

The location of the pelvic end closer to the bottom of the mother's pelvic floor is called breech presentation. In medicine, it is customary to distinguish several types of breech presentation:

gluteal (the head of the child is located at the top of the uterus, and the legs are straightened along the body so that the feet are closer to his face);
foot (one of the legs, or both limbs of the fetus are located at the lower edge of the woman's small pelvis);
mixed (with the gluteal-leg position of the child, his lower limbs and buttocks lie closer to the small pelvis).

The breech type of the child's presentation is one of the most frequent, almost 35% of pregnancies with such a complication is characterized by the fact that the fetus, just before the birth, takes a position with straightened legs at the knees, but bent at the hip joint. The breech or breech presentation is quite dangerous, as this position increases the risk of serious injury to both the woman and the child. In a woman in the process of such childbirth, the tissues of the uterus and vagina can be severely affected.

Foot presentation is divided into three types: full, incomplete and knee. This placement of the child is usually provoked by too active labor activity. When the fetus occupies a full foot position in the womb, its legs are extended at the knee and hip joints and are located closer to the woman's pelvis. When fixing an incomplete leg presentation on ultrasound, one leg of the child is completely bent at the hip joint, and the second is unbent at the knee and hip joints. Knee presentation of the fetus is a very rare phenomenon, characterized by legs bent at the knee joint, which are facing the small pelvis.

If the baby's head before birth is closer to the pelvic floor, this indicates a head presentation - a safe and correct position of the fetus in the womb. In this position, it will be easy for the baby to pass through the birth canal, in addition, this process will not cause severe pain for the woman. Childbirth in this position passes without consequences and the young mother quickly restores her strength. If the baby is turned to the birth canal with its occipital part, then the delivery will be as favorable as possible. Head presentation also has several varieties that affect the birth process in different ways. For example, in the occipital presentation, the back of the child's head passes first through the birth, and in the anterior head presentation, the child's head begins to move along the birth canal with that part of it where the diameter is largest. In this case, a natural delivery is performed, but there are concerns about the possible risk of injury to both the child and his mother. Therefore, in order to prevent undesirable consequences, the expectant mother is recommended to agree to a caesarean section.

The movement of the child's forehead through the birth canal is called frontal presentation - quite dangerous for many reasons. As a rule, the child's neck is not in a comfortable position for childbirth - it is strongly extended, due to which the head area becomes larger. With this arrangement, natural childbirth is impossible and doctors recommend a caesarean section. The fetus very often takes a frontal presentation during delivery.

The most dangerous obstetrician-gynecologists consider the facial presentation of the child before childbirth. In this position, the baby passes through the birth canal with the back of the head, risking injuring or even breaking the cervical vertebrae. Cesarean section for such an arrangement of the baby in the womb remains the only safe way to be born.

What are the types of position of the fetus in the uterus

What position the child occupies in the uterus, gynecologists determine with the help of a conditional line drawn from the back of the baby's head to his coccyx through the back, correlating it with the axis of the uterus. In total, there are three types of position of the child: oblique, longitudinal and transverse. The longitudinal position is fixed if the axis of the uterus coincides with the axis of the fetus, which has taken a pelvic or head position. The oblique position of the child is distinguished by the intersection of these lines at an acute angle. With the transverse position of the fetus, the axis of the uterus and the axis of the child form a right angle.

There is also such a thing as the type of position that the fetus takes before childbirth. The gynecologist, in order to determine the position of the baby in the mother's abdomen, determines to which wall of the uterus his back is turned. When the fetus is turned with its back to the anterior uterine wall, the anterior view of the position is fixed, if to the opposite, the posterior view. For example, an ultrasound gynecologist can determine that the fetus in the womb is located in the occipital presentation, anterior position and longitudinal position. Consequently, the child is located in the uterus along its axis, the back of the head is directed to the small pelvis, and the back is turned to the anterior uterine wall.

As you know, the position of the child in the uterus, throughout the entire period, can change many times, especially if the fetus is quite active. In this case, even with an oblique presentation, there is a chance that the child during childbirth will remain as active and take the desired position. However, doctors in any case recommend that the expectant mother not take risks and give birth to a baby using a caesarean section. Natural delivery is completely excluded in the transverse position of the fetus - since the largest parts of the child's body are located above the edges of the iliac region. Sometimes obstetricians attempt to turn the child around, which is also fraught with serious injury.

Birth options in case of abnormal position of the fetus

Regardless of which type of breech presentation the fetus occupies, childbirth with such a diagnosis will be considered pathological. The fact is that a child during natural childbirth, if he took the wrong position, runs the risk of being seriously injured, for example, from acute hypoxia, or pinching and extension of his cervical vertebrae. for a pregnant woman with presentation is the only safe option to give birth to a whole baby, avoiding injuries and ruptures. Of course, in some cases, gynecologists can perform a natural birth, but in medical practice this happens very rarely. In general, the obstetrician-gynecologist, even at the stage of examining the patient, chooses the safest delivery option, taking into account the position of the child, the type of position and the state of health of the woman.

Breech presentation of the fetus requires hospitalization of the pregnant woman in a hospital for a period of 38 years inclusive. During a comprehensive examination of the woman and the fetus, the doctor analyzes the age, number of births, obstetric history, pelvic size, term and readiness of the female body in order to select an effective tactic for the upcoming birth. Incorrect presentation of the fetus does not always become a reason for a surgical operation, and operative delivery is prescribed only in the presence of complicating factors.

When the baby in the uterus occupies an extensor position - frontal, facial or anterior parietal, then natural childbirth is not recommended. An obstetrician-gynecologist with an anterior parietal location of the fetus takes a wait-and-see attitude, and if the birth does not proceed normally, he prescribes a caesarean section. The frontal head position of the child also provokes the appearance of complications, therefore, in order to preserve the health of the woman and the child, doctors deliberately prescribe operative delivery. Natural childbirth with such an arrangement of the fetus is fraught with ruptures of the perineum and uterus, as well as the death of the child from asphyxia.

It is worth noting that a child can be born normally in a natural way, even with a facial presentation. This is possible if a woman has a good constitution - a wide pelvis. It is important that labor activity is active enough from the very beginning, and the fetus is small enough to easily pass through the birth canal. It is very good if labor activity in breech presentation begins arbitrarily, when the child is really ready to be born.

Childbirth with breech presentation of the fetus

If childbirth with the presentation of the fetus begins naturally - without stimulants, the woman is advised to stay in bed during the entire first period. A woman can lie down on the side in which the child turned his back. This avoids complications such as prolapse of the legs of the fetus, premature outflow of fetal fluid, or twisting of the umbilical cord into loops.

In the second stage of childbirth, the woman receives the help of obstetricians, aimed at maintaining the correct position of the child. In breech presentation, the baby's legs and buttocks are the first to pass through the birth canal. For one attempt, the child may appear up to the navel, after the next his shoulder blades are already visible, then his arms and shoulder girdle, and only the head will appear last. The birth of a child in this case is dangerous due to the occurrence of oxygen starvation. With his head, the baby can squeeze the umbilical cord at the first attempt, so after a maximum of 10 minutes he should be fully born. To speed up the process of passing the baby through the birth canal, the gynecologist can make an incision in the perineum, making the passage of the baby's head less traumatic.

Natural childbirth with a foot presentation of the fetus is possible only in a multiparous mother. In addition, labor activity should take place normally and quite actively from the very beginning, the birth canal should reach full readiness, the term should be full-term, and the size of the fetus should be within the normal range - up to 3.5 kilograms. In this case, the birth will be normal, especially if the child is in excellent condition and the head is bent correctly.

During the delivery process, the obstetrician will cover the woman's external genitalia with a special napkin to prevent the baby's legs from falling out prematurely. With the correct holding of the baby's legs, the uterine pharynx has time to fully open and prepare for the passage of the head. The position of the child during attempts at this time resembles the “squatting” position. The baby's legs must be held until the uterine os is fully opened, and only after that the birth takes place without complications and delay.

Characteristics of the low presentation of the fetus

Low presentation of the fetus - lowering the baby's head into the mother's pelvis ahead of schedule. Normally, this omission should occur a maximum of 4 weeks before the expected date of birth. In some situations, with certain anatomical features of the female body, this may happen earlier and not cause concern. Often, a low presentation of the fetus becomes known during a routine ultrasound examination, or when a gynecologist examines the uterus during palpation. The specialist will easily determine that the child's head is too low, and has also become motionless or inactive.

A woman can independently determine the low presentation of the child due to some symptoms: prolonged pain in the lower abdomen, aching pain or bleeding caused by low. The main danger of such an arrangement of the child is that he runs the risk of suffering from hypoxia almost all the time before birth. , as you know, disrupts the process of intrauterine development of the fetus, even during the last few weeks before childbirth. Only in rare cases, the pathological location of the child does not cause the symptoms described above and complications.

Methods for self-diagnosis of fetal presentation

It is very difficult to understand on your own what position the fetus occupies in the uterus. Obstetricians-gynecologists to determine the location of the child in the womb, first analyze which part of the baby's body is located at the bottom of the uterus. To do this, you need to place your palms on the upper abdomen - when the pelvis of the fetus is located there, the stomach will feel soft and motionless to the touch. When the head is directed to the upper part of the abdomen, it is possible to feel the dense part. Sometimes the bottom of the uterus is empty, so the baby's buttocks and head will be palpable on the sides of the abdomen. In this position, the transverse position of the fetus is diagnosed. If parts of the body are palpable in the iliac region of the abdomen, the child in the uterus takes an oblique position.

Doctors also use such a technique as grabbing the lower abdomen with the right hand, thereby covering the presenting part with the middle and thumb. With the head presentation of the child, his head will be easily felt, making movements. With an incorrect presentation, pelvic, in the lower abdomen, signs of head movement will be completely absent.

External rollover of the baby in the womb

When diagnosing an incorrect presentation of a child in the womb at 29-30 weeks of the term, specialists may attempt to turn it over so that the fetus takes the necessary position for normal delivery. Conservative methods include special corrective gymnastics, which is effective in 75-85% of cases. Physical exercises are strictly contraindicated in the presence of pathologies and anomalies in the development of the fetus, scars on the uterus, preeclampsia, placenta previa, oligohydramnios, polyhydramnios, multiple pregnancy, a narrow pelvis in a woman and the presence of serious extragenital diseases.

Non-traditional methods of correcting the position of the child include acupuncture, acupressure, aromatherapy, swimming and homeopathy, and sometimes self-hypnosis methods, sound and light influences on the child from the outside are also used. Specialists in the hospital can perform the so-called turning of the fetus on the head, but only for a period of 35-37 weeks. This preventive action was first used by B.L. Arkhangelsk, but the effectiveness of the reception is relative - it ranges from 35% to 87% of a successful change in the position of the fetus.

It should be understood that the external preventive rotation of the fetus has the right to be carried out only by a qualified specialist in stationary conditions. In the event of any complications, a caesarean section is immediately prescribed and medical care is provided to the newborn. If the coup is successful, you should consolidate the result with a special bandage and certain exercises. Thanks to this, it is possible to fix the baby's head in the correct position before delivery.

Methods for the prevention of malpresentation

Prevention of the incorrect position of the child in the uterus involves ensuring the normal course of the entire pregnancy, regular drug treatment if indicated, as well as the identification and treatment of preeclampsia, FPI and the threat of miscarriage at an early stage. It is important to avoid prolonging a pregnancy with a large fetus, as the baby may take the wrong position. Effective prevention is the implementation of special exercises prescribed by a doctor.

In any case, the pregnant woman must agree to a caesarean section if there are indications for this. In addition, with the help of the doctor's recommendations, it is necessary to prepare the body for childbirth as efficiently as possible. If the first suspicious symptoms appear, you should immediately consult a specialist. After a natural birth or caesarean section, a young mother is recommended to go through a period of recovery of her body, as well as to provide a complete examination for the newborn using clinical and laboratory diagnostic methods.

In the old days, only very experienced midwives could tell how the fetus is located in the womb. Today, thanks to the ubiquity of ultrasound diagnostics, doctors see it on the monitor screen. The data obtained during the ultrasound allows you to determine whether the baby is in the correct position, and to make a probabilistic prognosis of childbirth - whether they will be spontaneous or with the use of a caesarean section.

Position of the fetus in the uterus
The position of the fetus depends on many factors: articulation, position, type. These terms allow you to get a complete picture of exactly how the child is located in the uterus: where are his limbs relative to the head and torso, to which wall of the uterus is he turned back. In addition, presentation is of particular importance, that is, the ratio of a large part of the fetus - the head or buttocks - to the entrance to the small pelvis. The position of the fetus in all sources is defined as the ratio of the longitudinal axis of the fetus to the longitudinal axis of the uterus. For clarity, you can mentally draw a line along the pregnant woman's spine, which will coincide with the longitudinal axis of the uterus, and the same line along the baby's spine. With the correct standard position, which occurs in 99.5%, they will coincide or turn out to be parallel, if they are incorrect, they will intersect: with a transverse position at a right angle, with an oblique position - under a sharp one. Malpositions of the fetus occur in 0.5% of cases, that is, one in approximately every 200 births. In this case, the fetus does not have a presenting part.

Causes of incorrect fetal positions
What are the reasons forcing the child to be located not as intended by nature? There are several of them:
- Polyhydramnios, in which a large volume of amniotic fluid allows the baby to be overly mobile, preventing him from fixing in one position, with his head or buttocks down.
- Multiple pregnancy, when a brother or sister was more agile and took his place. Although the location of children in multiple pregnancies can be so diverse that perhaps none of them will take the correct one.
- Problems with the internal genital organs: a narrow pelvis, a bicornuate uterus, placenta previa, tumors of the uterus or uterine appendages located at the level of the entrance to the pelvis or in the cavity.
- Separately, one can single out such important points as a decrease in the tone of the uterus and flabby muscles of the anterior abdominal wall of the pregnant woman.

Determination of the position of the fetus
If the fetus is located incorrectly, then on examination, a special shape of the abdomen is noted - transversely stretched, since the uterus is elongated across or looks like a ball. Visually, it is not always possible to notice these features due to multiple pregnancies, polyhydramnios, and uterine tone. Then the method of palpation (feeling) comes to the rescue - the methods of external obstetric research, bearing the name of its developer Leopold-Levitsky. The first technique allows you to determine the height of the fundus of the uterus (the height of the fundus of the uterus corresponds to the gestational age) and the part of the fetus that is in the fundus of the uterus. To do this, place the palms of both hands on the bottom of the uterus. The second reception aims to determine the position, position and type of the fetus. To perform it, the palms of both hands of the obstetrician palpate the lateral sections of the uterus, determining the position of the fetus and the location of its back.

The third technique is used to determine the presenting part of the fetus. To perform it, the obstetrician needs to take the thumb of the right hand as far as possible away from the other four, grasp the presenting part of the fetus and determine its mobility in relation to the plane of entry into the small pelvis.
The fourth technique allows you to determine the insertion of the presenting part. During pregnancy, the fetal head may be mobile or pressed against the entrance to the small pelvis.
With a transverse or oblique position of the fetus, the presenting part will not be determined, since the head and pelvic end of the baby will be located above the iliac crests of the mother's pelvis. The final diagnosis of the incorrect position of the fetus is made during ultrasound.

Before childbirth - to the hospital
Pregnancy with a transverse or oblique position of the fetus is fraught with a number of dangers for the mother and baby, and therefore, by the 35-36th week of pregnancy, when the position of the child is stabilized, the patient is recommended to be in the hospital under constant medical supervision. Most often, in women with an incorrect position of the fetus, premature birth occurs, which is accompanied by an early outflow of water due to overstrain of the lower pole of the fetal egg due to the lack of division of water into anterior and posterior. Together with the waters, small parts of the fetus can fall out: the umbilical cord, handle or leg. Since labor activity has developed, further contractions only lead to the fact that the handle that has fallen out, for example, together with the shoulder, is more strongly driven into the bones of the pelvis, not allowing the body and head of the fetus to pass through the birth canal, and this, in turn, can lead to rupture uterus and maternal and fetal death.

Previously, in a similar situation, the doctor performed an external rotation of the fetus, followed by fixation from a transverse or oblique position to a longitudinal one. At present, the method has lost its relevance, since the reason why the child occupies the wrong position cannot be eliminated in this way, and excessive stress on the uterus is fraught with serious complications: placental abruption, tissue ruptures.

Special gymnastics and delivery
The oblique position is transitional and can go into transverse or longitudinal. As the simplest means of correcting incorrect fetal positions, special gymnastics is used. This is a set of exercises prescribed for a period of 29-34 weeks of pregnancy. According to the Dikanem scheme, the expectant mother lying down turns alternately on the right and left side, lies after each turn for 10 minutes; the exercise is repeated 2-3 times three times a day. The systems of Grishchenko and Shuleshova are based on the contraction of the abdominal and torso muscles in combination with rhythmic and deep breathing. This type of exercise is best done in the presence of a doctor. If the result is positive, that is, the child moves to a longitudinal position with his head down, the pregnant woman should definitely wear a bandage with longitudinal rollers on the sides of the baby's body until it is completely stabilized.
Contraindications to corrective exercises are a scar on the uterus, the threat of interruption, uterine fibroids, bloody discharge from the genital tract, heart defects and other problems. Therefore, you need to engage only on the recommendation of a gynecologist.

If the exercises did not produce the desired effect and the position of the fetus remains transverse or oblique, then the only method of delivery is caesarean section. Conducting labor in the transverse position of the fetus through the natural birth canal is possible if the fetus is very premature or is the second child from twins, provided that the first was in the head presentation. In these cases, not external, but internal rotation of the fetus on the leg is performed.

As early as 24 centuries ago, in his book “On the Seed and on the Nature of the Child,” Hippocrates wrote: “If the child, when the shells are torn, will be dominated by the movement of the head forward, then the woman gives birth easily. If he comes out sideways or with his feet, which happens often, then it will be difficult for a woman to give birth. Despite the fact that the problem of malposition of the fetus is still relevant, modern advances in medicine make it possible to give optimistic forecasts even in the most difficult situations. And surgery is such a small price to pay for the happiness of being a mother.

Natalia Tsalko, obstetrician-gynecologist, Perinatal Medical Center

Malposition of the fetus is a condition in which the child is located in the uterus across or in an oblique line. This phenomenon interferes with the normal course of pregnancy and leads to the development of complications. Natural childbirth is not possible. If the fetus does not occupy a longitudinal position by the time the cervix opens, a caesarean section is indicated.

What is the position of the fetus?

Normally, the child occupies a longitudinal position. Its axis coincides with the axis of the uterus. The presenting part is determined - the head or pelvic end.

If the fetus is in the wrong position, its axis is located across or obliquely to the axis of the uterus. The presenting part is not defined. In obstetrics, there are two options for this phenomenon:

Transverse position - the axis of the fetus intersects with the axis of the uterus at a right angle.
Oblique position - the axis of the fetus intersects with the maternal axis at an acute angle. This is a temporary state. In childbirth, the oblique position turns into a longitudinal or becomes transverse.

Causes and risk factors

The exact causes of malposition of the fetus are unknown. There are several risk factors:

excessive fetal activity;
limitation of fetal activity;
obstacles to inserting the head during childbirth;
fetal malformations;
anomalies in the development of the uterus.

Causes of excessive fetal activity:

Polyhydramnios. With a large amount of amniotic fluid, the activity of the child increases, the space for maneuvers increases.
Flabbiness of the muscular corset of the anterior wall of the abdomen. Muscle failure leads to their excessive stretching and the appearance of free space for fetal movements. The likelihood of this condition increases with the second and subsequent pregnancy.
prematurity. The incorrect position of the fetus is considered a variant of the norm up to 32 weeks. With a premature start of labor, the child may not have time to take the desired position. The shorter the gestational age, the higher the likelihood of developing a problem.
Multiple pregnancy. When carrying twins, there is a high risk that one or both fetuses will take the wrong position in the uterus.
Fetal hypotrophy. A child with a low body weight occupies a small space in the uterus and can be located across or along an oblique line to its axis.
Fetal hypoxia. The lack of oxygen causes the baby to actively move towards the uterus, changing its position. It can be unstable and change throughout pregnancy.

Causes of reduced fetal activity:

oligohydramnios. With a lack of amniotic fluid, the fetus has no room to maneuver and may remain in the wrong position until delivery.
large fruit. After 30 weeks, being overweight prevents the fetus from moving in the uterus and can cause misalignment.
Threat of abortion. The increased tone of the uterus prevents the child from moving in the womb, restraining his activity.
uterine fibroids. A tumor located in the bottom or body of an organ reduces the capacity of the uterus and reduces the motor activity of the fetus.
short umbilical cord. The incorrect position of the fetus can also be associated with torsion of the umbilical cord.

Obstacles to the insertion of the head during childbirth lead to the fact that the child is forced to take the wrong position. Risk factors:

cervical myoma of the uterus;
placenta previa - a condition in which the fetal place blocks the exit from the uterus;
anatomically narrow pelvis (including against the background of tumors, exostoses).

Anomalies in the development of the genital organs are a rare cause of malposition of the fetus. Problems arise with a bicornuate uterus, as well as with a septum. Less often, an oblique or transverse position of the fetus occurs with a saddle uterus.

Malformations of the fetus can lead to a transverse and oblique position. The reason is excessive or reduced mobility, incorrect body proportions. This phenomenon is often found in hydrocephalus and anencephaly.

Diagnosis scheme

To determine the position of the fetus in the uterus, the following methods help:

External obstetric examination. With the transverse position of the fetus, the abdomen is extended from left to right, with an oblique position, it is irregular in shape. The height of the fundus of the uterus is less than normal. The circumference of the abdomen exceeds the indicators characteristic for a certain gestational age.
Palpation of the abdomen. The presenting part of the fetus is not defined. A large part is not palpated in the bottom of the uterus. The head and pelvis are found in the lateral parts of the abdomen. The head is palpated as a dense rounded part, buttocks - as soft, balloting.
Auscultation. In a transverse or oblique position, the fetal heartbeat is well heard near the navel.
Vaginal examination. It is carried out only in childbirth after opening the fetal bladder. When opening the cervix by 6-8 cm, you can determine the shoulder, shoulder blades, vertebrae. In the initial stage of childbirth before the outflow of water, a vaginal examination is uninformative and allows only a presumptive diagnosis to be made (according to the characteristic absence of the presenting part of the fetus - the pelvic end or head).
ultrasound. Ultrasound examination in the III trimester makes it possible to determine the position of the fetus and identify concomitant pathology. Particular attention is paid to the amount of amniotic fluid, the size of the umbilical cord. Tumors of the uterus and other conditions that interfere with the normal course of pregnancy are detected. The condition of the fetus is assessed. It is important to remember that the wrong position is associated with hypoxia and malnutrition, malformations of the nervous system.

The final diagnosis is made after 32 weeks. Closer to the term of delivery, a second examination is carried out. Up to 30-32 weeks, the fetus may roll over. The probability of this event decreases along with the increase in time. If at 36-37 weeks the fetus remains in an oblique or transverse position, a caesarean section is planned.

In childbirth, the probability of a spontaneous rollover from a transverse position is extremely low, and you should not count on it. The child always leaves the oblique position, but the outcome is unknown in advance. The fruit can turn both in the longitudinal and in the transverse position. In the latter case, natural childbirth is impossible.

Complications of pregnancy and consequences for the fetus

The incorrect position of the fetus threatens the development of such conditions:

premature rupture of amniotic fluid;
premature birth;
chronic fetal hypoxia.

Against the background of concomitant pathology, the prognosis worsens:

placenta previa increases the risk of bleeding;
a change in the amount of amniotic fluid may be a sign of intrauterine infection of the fetus;
with multiple pregnancy, there is a possibility of feto-fetal transfusion;
the outflow of amniotic fluid is often accompanied by the loss of small parts of the fetus and umbilical cord loops;
against the background of uterine fibroids, the supply of the fetus with nutrients suffers, and malnutrition develops;
excess body weight of the fetus may be a sign of diabetic fetopathy.

Proper pregnancy management reduces the risk of complications and increases the chances of a favorable outcome.

Tactics of pregnancy management

On time, undergo ultrasound and biochemical screenings. It is important to monitor the position of the fetus. A triple ultrasound allows not only to determine the localization of the pelvis and head, but also to assess the condition of the placenta, to identify concomitant pathology.
Visit a doctor regularly. Up to 30 weeks, a visit to the gynecologist is planned every 2 weeks, then once a week.

Keep a sleep schedule. You need to sleep on the side where the head of the fetus is located. It is assumed that such tactics create a certain discomfort for the child, and he seeks to change his position in the uterus.
Limit physical activity. It is not recommended to lift weights, play sports.
Perform corrective exercises. Appointed for a period of 28-36 weeks.
Swim in a pool or open water. Being in water creates favorable conditions for self-turning of the fetus. It is useful to swim on your back, do water aerobics.
Visit an osteopath. The specialist does not turn the child, but creates conditions for the fetus to place itself in the desired position. The osteopath removes muscle clamps, relaxes ligaments, affects the skeletal system. The course of treatment is up to 3 sessions.

According to indications, symptomatic therapy is carried out, other complications of pregnancy are eliminated.

Therapeutic exercises with the wrong position of the fetus

Therapeutic exercises allow you to gently push the baby and help him take the right position in the uterus. Several methods have been developed, but it is difficult to speak unambiguously about their effectiveness. If the child has the opportunity to turn, he will do it without special exercises. If there are serious obstacles, gymnastics will not bring the desired result.

F. Dikan's scheme:

The pregnant woman alternately turns on the left and right side. There should not be sudden movements - everything should be done smoothly, without tension in the muscles of the back and abdomen.
After each turn, the woman lies in the chosen position for 5-10 minutes. You can repeat the procedure 2-3 times. The whole session should take about an hour.
Exercises are performed 3 times a day for 1-2 weeks. You can repeat the practice after a week break.

Methodology of E. V. Bryukhina, I. I. Grishchenko and A. E. Shuleshova:

Lie on the side opposite the position of the fetus (this question should be clarified with the attending physician).
Bend both legs at the knee and hip joints.
Spend in this position for at least 5 minutes.
Gently straighten your top leg.
While inhaling, press the overlying leg to the stomach, while exhaling, straighten it. Give a slight push towards the back of the fetus. It is important not to make sudden movements - everything is done smoothly, without tension.
Repeat the entire set of exercises after a short break (1-2 minutes).
After completing the exercise, lie still for 10 minutes - this will allow the fetus to gain a foothold in the desired position.
Take a knee-elbow pose for 10 minutes after a short rest.

Exercises should be performed 3-5 times a day for a week. During this period, the fetus should turn. If the child has taken a longitudinal position with his head down, the gymnastics stops. The woman begins to wear a support bandage until childbirth to keep the fetus in the desired position. If the child is located with the buttocks down, gymnastics is shown for the breech presentation of the fetus.

Obstetric fetal rotation

The rotation of the fetus can be external and combined. The choice of method depends on the gestational age.

Contraindications:

a scar on the uterus after a caesarean section or other operations;
the threat of uterine rupture;
anatomically narrow pelvis;
uterine fibroids;
large tumors of the ovaries or other pelvic organs;
placenta previa;
threatened miscarriage.

The procedure is not performed for any conditions that may become a contraindication to natural childbirth.

External obstetric turn

The procedure is performed at 35-36 weeks of pregnancy. Until this time, the fetus can turn on its own, and there will be no need for manipulation. After 36 weeks, the baby is in a stable position in the uterus, and the likelihood of its change is extremely low.

Conditions for the procedure:

satisfactory condition of the woman and the fetus;
normal size of the mother's pelvis;
there are no obstacles for the natural course of childbirth;
sufficient fetal mobility;
compliance of the abdominal wall.

Carrying out scheme:

A pregnant woman is emptying her bladder with a catheter. The patient is in a supine position with legs bent.
To anesthetize and relax the uterus, a solution of promedol is injected.
The doctor sits to the right of the patient. The doctor puts one hand on the head, lowers the other on the pelvic end of the fetus. The rotation is carried out on the head or pelvis, depending on which part of the body is closer to the exit from the uterus.
With careful movements, the doctor displaces the head and pelvis of the fetus. The child must take a stable longitudinal position.

After the procedure is completed, rollers are placed along the back and small parts of the fetus and bandaged to the woman's body. This is necessary in order to maintain the position of the fetus in the longitudinal axis.

Combined obstetric rotation

The procedure is carried out in childbirth under the following conditions:

full dilatation of the cervix;
a whole fetal bladder (or opened immediately before the procedure).

The rotation of the fetus on the leg is performed under anesthesia. The procedure takes place in three stages:

Introduction of the hand into the uterine cavity. Dilution of the membranes of the fetal bladder, search for the head. Abduction of the fetal head to the side.
Search for small parts of the fetus. The capture of the leg - the one that is closer to the abdominal wall of the woman.
Fixation of the leg and rotation of the fetus. The doctor brings the child's leg into the vagina. At the same time, the doctor takes the head of the fetus towards the fundus of the uterus (through the abdominal wall with his free hand).

The procedure is considered successful if the fetal knee is brought into the vagina with a fixed head in the fundus of the uterus. Immediately after the removal of the knee joint, the fetus is removed. The third period proceeds without features, the placenta usually comes out on its own.

In modern obstetrics, the classical rotation of the fetus on the leg is practically not carried out. The procedure requires a highly qualified doctor. Possible development of dangerous complications:

uterine rupture and bleeding;
removal of the handle of the fetus instead of the leg;
acute asphyxia and fetal death;
traumatization of the child (traumatic brain injury, fracture of the collarbone, damage to the bones of the arms and legs).

Today, the best option is considered a planned caesarean section without previous attempts to rotate the fetus. Remedial gymnastics and other practices are allowed without risk to the pregnant woman and child.

Tactics of conducting childbirth

Childbirth through the natural birth canal with an incorrect position of the fetus is practically not carried out due to the high risk of complications:

early rupture of amniotic fluid with a high probability of infection of the fetus;
loss of small parts of the fetus;
prolapse of umbilical cord loops;
acute fetal hypoxia;
anomalies of contractile activity of the uterus;
rupture of the uterus when it is overstretched.

In childbirth, a neglected transverse position of the fetus may form. This happens with an early outflow of water and is accompanied by a loss of mobility of the child. The further course of childbirth through the vagina is impossible.

In modern obstetrics, the oblique and transverse position of the fetus is an indication for caesarean section. The operation is performed on a period of 37-41 weeks. The term is determined by the condition of the pregnant woman and the child.

The expectant mother may refuse a caesarean section and insist on natural childbirth. In this case, she needs to be aware of all the possible risks and understand that such childbirth can be fatal. Death threatens the fetus as a result of asphyxia and a woman in labor with a uterine rupture.

The following conditions fall into the high-risk group for the development of complications:

age over 35;
multiple pregnancy;
anomalies in the structure of the uterus;
large and multiple myoma nodes;
anatomically narrow pelvis;
scar on the uterus;
placenta previa;
large fruit (more than 4000 g);
change in the volume of amniotic fluid;
the threat of uterine rupture;
prolapse of umbilical cord loops or parts of the fetus;
neglected transverse position of the fetus.

A caesarean section can be planned for the first stage of labor. In this case, the woman begins independent contractions, and there is a gradual opening of the cervix. There is a chance that the fetus will turn over with the onset of labor. If this does not happen, a caesarean section is performed before the onset of attempts.

A planned caesarean section before the onset of labor is indicated in such situations:

gestational age of 42 weeks or more (overwear);
placenta previa;
anatomically narrow pelvis;
outflow of amniotic fluid before the onset of contractions;
scar on the uterus;
tumors of the reproductive organs.

Features of operative delivery:

With the transverse position of the fetus, it is necessary to expand access. It is not always possible to make an incision in the lower uterine segment. Often, the extraction of the fetus is carried out through a longitudinal incision.
Anesthesia in the wrong position of the fetus is often given general. Epidural anesthesia is not always possible.
During the operation, there is a high risk of complications (including bleeding). A planned caesarean section should be performed by an experienced gynecologist in maternity hospitals that are fully equipped with everything necessary to care for the woman in labor and the newborn.

The technique of the operation is determined after examination of the patient. Early hospitalization in the maternity hospital for a period of 38-39 weeks is recommended. It is important not only to re-evaluate the position of the fetus, but also to identify concomitant disorders. According to the indications, a caesarean section is carried out before the term of a full-term pregnancy.

Prevention

Specific prophylaxis has not been developed. There are no means to prevent the incorrect position of the fetus in the mother's womb. You can only reduce the risk of such a condition, but no specialist will give a 100% guarantee.

Prevention measures:

Timely treatment of gynecological diseases. It is necessary to exclude factors contributing to the incorrect position of the fetus.
Surgical correction for anomalies in the development of the uterus, myomatous nodes, etc.
Planning for pregnancy. Taking folic acid 3 months before conception reduces the risk of developing a pathology of the nervous system. It is important to exclude other factors that impede the development of the fetus (medication in the early stages of pregnancy, radiation exposure).
Physical activity. Sports keep the body in good shape and do not allow the abdominal muscles to overstretch.

When identifying the wrong position of the fetus, it is important not to miss the time. Therapeutic exercises and other measures are effective only up to 36 weeks. Further, the likelihood of spontaneous fetal turnover decreases. If the baby still does not occupy the correct position in the uterus, a caesarean section is indicated.

THEME #29

Malposition
OPERATIONS CORRECTING THE POSITION OF THE FETUS. OB TURNS

ANOMALIES IN THE POSITION OF THE FETUS

The position of the fetus is called correct when the axis (length) of the fetus coincides with the axis of the uterus. If the axis of the fetus crosses the axis of the uterus at any angle, an incorrect position of the fetus occurs, in which the course of labor becomes dangerous for the mother and fetus. Incorrect positions include the transverse and oblique positions of the fetus.

Transverse position of the fetus This position of the fetus is called when its axis intersects the axis of the uterus at a right angle.

Oblique position of the fetus This position of the fetus is called when its axis intersects the axis of the uterus at an acute angle.

It is practically important that in the transverse position of the fetus, both of its large parts are located above the iliac crests, and in the oblique position, one of the large parts of the fetus is located in the iliac fossa, i.e. below the iliac crest. The position of the fetus in the transverse and oblique position is determined by the fetal head: if it is on the left, then this is the first position, if it is on the right, the second position. The type of fetus is determined by the back.

Etiology- decreased excitability of the uterus, insufficiency of the abdominal press, spatial discrepancy between the uterine cavity and the size of the fetus.

Recognition. In the transverse position, the abdomen has a spherical shape, the fetal head or buttocks are located in the lateral sections of the uterus, there is no presenting part above the entrance to the small pelvis.

Childbirth with a transverse position of the fetus can end on its own with good labor activity and a small size of the fetus. Complications are possible: prenatal rupture of amniotic fluid, prolapse of small parts of the fetus and umbilical cord, anomalies of labor forces, fetal hypoxia, neglected transverse position of the fetus, endometritis during childbirth, uterine rupture

Birth management: with a live fetus - caesarean section, with a dead fetus - a fruit-destroying operation

Prevention: gymnastics during pregnancy to correct the incorrect position of the fetus, hospitalization in the maternity ward at 34-35 weeks of pregnancy.

OPERATIONS TO CORRECT THE POSITION OF THE FETUS

Operations that correct the position of the fetus include:

obstetric turn external;

obstetric rotation combined with full opening of the uterine os;

obstetric rotation combined with incomplete opening of the uterine os.

obstetrical twist call the operation, with the help of which the position of the fetus, which is unfavorable in a given obstetric situation, is transferred to another, favorable, and always longitudinal.

EXTERNAL OBSTETRIC TURN OF THE FETUS TO THE HEAD IN PELVIC PRESENTATION (according to B.A. Arkhangelsky)

The indication for surgery is the breech presentation of the fetus.

Preparation for the operation. The operation is performed on an empty stomach, after cleansing the intestines with laxatives or an enema (the night before). The bladder is emptied just before the operation.

The pregnant woman is laid on a hard couch, on her back, dressed only in a shirt. The doctor sits down to her right. The position, position, type and presentation of the fetus are established by external methods. Narcosis is not shown.

Operation technique. Very carefully, manipulating both hands at the same time, they move the buttocks away from the entrance to the pelvis high up - above the iliac crest, and the head - down. The turn is considered complete when the head is located above the entrance to the pelvis, and the buttocks are in the bottom of the uterus.

At the end of the operation, small soft rolls of diapers are placed on both sides of the uterus and the entire abdomen is not tightly bandaged with a long towel to keep the fetus in the uterus in the achieved position.

The outcome of the operation. Not in all cases, even with a successful external rotation, the achieved longitudinal position of the fetus is preserved.

In modern conditions, the operation of the external prophylactic rotation is practically not used due to the lack of effectiveness and the significant incidence of serious complications (PONRP, uterine rupture, premature onset of labor, etc.).

COMBINED OB-BATHER TURN WITH FULL OPENING OF THE UTERINE OCUS

Indications: transverse (and oblique) position of the fetus; unfavorable presentation of the head - frontal insertion, anterior view of the facial insertion (chin backwards) high straight standing of the swept suture; prolapse of small parts of the fetus and umbilical cord - in the transverse position and head presentation; threatened conditions of the woman in labor and the fetus, requiring the immediate end of childbirth.

Conditions: complete or almost complete opening of the uterine os; absolute mobility of the fetus; accurate knowledge of the position of the fetus; the condition of the uterus and solid parts of the birth canal, allowing the birth of the fetus through the natural birth canal; good condition of the fetus.

The first two conditions are absolute; with incomplete opening of the uterine pharynx, it is impossible to penetrate with the whole hand into the uterine cavity, with limited fetal mobility, and even more so with incomplete immobility, the production of a classic turn on the leg in order to avoid inevitable uterine rupture in such cases contraindicated.

Preparation for the operation. Preparing for surgery is the usual for vaginal surgery. Deep anesthesia is indicated to relax the uterus and abdominal wall. The position of the fetus and the state of the birth canal are studied in detail by external techniques and vaginal examination. The doctor performs the operation while standing.

Operation technique consists of three stages:

hand selection and insertion into the uterus;

finding and capturing the legs;

actual turn.

The first stage of the operation - the choice and insertion of the hand

When performing the first stage, you should pay attention to the following three points.

The rotation can be done with any hand inserted into the uterus. However, it succeeds if an easily remembered rule is observed: they introduce a hand of the same position.

The arm is inserted with the hand folded conically. To do this, all five fingers of the hand are pulled out to failure and brought together one with the other in the form of a cone. The fingers of the second ("outer") hand push the labia apart, after which the brush, folded with a cone, the back surface of which is turned backwards, can easily be inserted through the vaginal opening into the uterine cavity, pushing the perineum backwards. The hand is introduced necessarily outside the fight. If the fetal bladder is intact, it is opened in the center, and the brush is immediately carried out into the uterine cavity. In this case, if possible, prevent the rapid outflow of water from the uterus.

The hand should be held past the cape. If the presenting head interferes with the advancement of the brush into the uterine cavity, then it is pushed up with the inner hand and taken away towards the back with the outer hand. In the same way, the presenting shoulder of the fetus is pushed aside in a transverse position.

The second stage of the operation - finding and capturing the leg

At this stage, three points should also be sequentially performed:

For further manipulations, it is advantageous to find the leg lying anteriorly, i.e. closer to the abdominal wall of the woman in labor. This leg usually lies below the other, as a result of which it is easily found.

To find the leg, the hand, the palmar surface of which is facing the abdominal surface of the fetus, is advanced outside the contraction along the fetus. At the same time, the brush inserted into the uterus either moves directly to the place where the legs are supposed to be located, or slides along the posterior side of the fetus along the head to the gluteal region; here the brush is transferred to the front thigh, and then to the lower leg. Following a long path, the obstetrician sequentially determines the parts of the fetus, starting with the head, and the desired leg. That this is a leg, and not a handle, is confirmed by the presence of a calcaneal tubercle on the leg, short fingers arranged in one row, the difficulty and insignificance of abducting the thumb to the side. With a head presentation, it is preferable to look for the leg along a long path, with a transverse presentation - along a short one. To make it easier to reach the fetal pedicle, the outer hand is placed on the bottom of the uterus and fixes it.

In order to avoid breaking the leg, it is best to grab the leg with the whole brush by the shin, placing the thumb along its length.

The third stage of the operation - the actual turn

The rotation is carried out by bringing the legs down immediately after its capture. At the same time, the outer hand takes the head to the bottom of the uterus. With these manipulations, both hands act in combination. The turn is considered complete when the popliteal fossa is shown from the genital slit, and the head is in the bottom of the uterus, i.e. created a complete foot presentation of the fetus. After that, they usually proceed to extract the fetus.

Possible complications:

prolapse of a pulsating loop of the umbilical cord, after opening the fetal bladder;

spasm of the internal os during rotation;

removal of the legs instead of the handle of the fetus;

fetal hypoxia;

inability to make a turn due to insufficient fetal mobility;

uterine rupture.

Exodus the operation is favorable for both the mother and the fetus, if it was performed under strict conditions and technically flawlessly.

From the point of view of modern obstetrics, the classical combined rotation of the fetus can be performed only in the case when a caesarean section is not possible.

COMBINED OBSTETRIC TURN WITH INCOMPLETE OPENING OF THE UTERINE OCUS

(Brexton Geeks turn)

indication Placenta previa was considered for surgery with a premature (non-viable) or dead fetus.

Conditions:

opening of the uterine os by 2.5-3 fingers;

full fetal mobility.

Preparing for the operation the same as for the turn operation at full opening of the pharynx.

Operation technique. The entire hand is inserted into the vagina, after which the index and middle fingers penetrate the uterine cavity. If the fetal bladder is intact, the membranes are torn with forceps within the uterine os. If the lumen of the latter is covered from the inside by the tissue of the placenta previa (with its central presentation), the latter is also drilled with a forceps. After that, two fingers are inserted into the uterine cavity through this artificially created opening. The outer hand strongly presses the pelvic end of the fetus towards the entrance to the pelvis. The buttocks of the fetus are brought closer to the fingers in the uterus. Any leg is captured with fingers and brought down. Grab the leg in the ankle joint. At this time, the outer hand is moved to the head and pushed it up - to the bottom of the uterus.

Having taken the leg out of the genital gap, a loop of gauze bandage is put on it, to which a load of 200 g is suspended; this load is removed after the eruption of the buttocks. The purpose of the operation is to press the placenta previa with the lowered leg and buttocks and stop the bleeding. Therefore, the extraction of the fetus after the rotation is strictly contraindicated, since it usually entails a rupture of the lower segment of the uterus and profuse bleeding from the poorly contracting placental site located here.

Possible complications. It is not always possible to capture the leg, and the captured leg is not always brought out through the pharynx. In this case, under the control of the finger, a gauze loop is brought to the leg, and with a dead fetus, the foot is captured with bullet forceps, which is lowered.

Outcomes. The mother is at risk of bleeding and infection, and sometimes lower segment rupture. Viable fetuses die in childbirth. Therefore, with a viable fetus, a caesarean section is resorted to.

In modern obstetrics, the Braxton-Geeks twist has been completely superseded by caesarean section.

RETRIEVAL BY THE PELVIC END

Extraction of the fetus by the pelvic end is called an operation by which the fetus, born in one of the variants of breech presentation, is artificially removed from the birth canal, starting all manipulations more actively when the entire fetus or most of it is in the birth canal.

There are extraction of the fetus by the leg, both legs and inguinal fold.

Indications: violation of compensation of the cardiovascular system of the woman in labor, severe kidney disease, eclampsia, pneumonia, endometritis during childbirth, fetal hypoxia. The operation of extracting the fetus by the pelvic end is often a continuation of the classic external-internal rotation of the fetus with full opening of the uterine os.

Conditions for the operation: complete opening of the uterine os, correspondence of the fetal head to the birth canal, drainage of the fetal bladder, amniotic fluid has just poured out.

Preparing for the operation: the introduction of antispasmodics and deep inhalation anesthesia.

Operation technique. Extraction of the fetus by the leg. The operation consists of three stages.

First stage- finding, capturing the legs and extracting the fetus to the lower angle of the shoulder blades. The fetal leg is first brought out to the shin, the shin is grasped by hand so that the thumb is located along the gastrocnemius muscle, and the remaining fingers cover the leg in front. The attraction is produced backwards and downwards in such a way that the heel, and then the popliteal fossa, are facing the bosom. When removing the thigh of the fetus, it is necessary to ensure that the body of the fetus fits in the oblique size of the pelvis. After the eruption of the buttocks, the doctor positions the hands so that the thumbs lie along the sacrum, and the remaining fingers cover the pelvic girdle of the fetus. The second leg during traction is born by itself. When the lower corners of the shoulder blades appear from the genital slit, the fetal head enters the entrance to the small pelvis and presses the umbilical cord against the bone ring. In order to prevent deep fetal hypoxia, no more than 5-7 minutes should pass from the birth of the angles of the shoulder blades to the birth of the fetal head.

Second phase- release of the shoulder girdle. The first moment is the release of the rear shoulder and the handle of the fetus. To do this, both legs of the fetus are grasped by hand and its body is taken anteriorly and to the side until the legs take a position parallel to the inguinal fold, opposite to the side of the released handle. The half-hand inserted into the sacral cavity of the small pelvis is carefully carried out along the back, shoulder girdle and fetal arm to the elbow bend. With a washing movement along the front surface of the fetal chest, the rear handle is removed from the birth canal. The second point is the release of the front shoulder and the handle of the fetus. For this, a posterior deviation of the fetal body may be sufficient. If the anterior handle is not born on its own, then to release it is necessary to transfer the anterior handle to the sacral cavity. To this end, the doctor grabs the torso with the born handle in the chest area with both hands and turns the fetus into an oblique size of the pelvis, the opposite position. In this case, the back and nape of the fetus should be facing the bosom.

Third stage- release of the subsequent fetal head (methods of Smellie-Fight and Morisot-Levre).

Possible complications:

rear view formation. This complication can be prevented by rotating the fetal body during traction in one of the oblique dimensions of the pelvis with the back facing the womb.

Throwing the arms over the head of the fetus (three degrees). This complication can be prevented if the assistant presses the bottom of the uterus against the fetal head during traction, preventing it from unbending.

Spasm of the uterine os, perineal rigidity, preventing the release of the fetal head.

Acute hypoxia and traumatic injuries of the fetus.

Fetal death

Extraction of the fetus by both legs. This operation is resorted to with full foot presentation of the fetus or when both legs of the fetus are brought down during the classic obstetric rotation of the fetus. The steps of the operation are the same.

Extraction of the fetus by the inguinal fold. If the buttocks of the fetus are above the entrance to the small pelvis, then the leg of the fetus is lowered and it is removed, as in an incomplete foot presentation. If the buttocks of the fetus are driven into the small pelvis and the leg cannot be brought down, then the extraction is performed by the inguinal fold. The outcome for the fetus, as a rule, is unfavorable.

Of course, every mother wants that during pregnancy there are no deviations from the norm and her baby develops as it should. But women, especially those who have experienced pregnancy for the first time, very often have questions about the conclusions, since they practically understand nothing in medical terminology. Very often, the same problem occurs when the mother is informed about the location of the fetus in the uterus. When she sees the longitudinal position of the fetus in the conclusion from the ultrasound, she immediately has many questions. And due to the fact that very few young expectant mothers have knowledge in this area, doubts do not leave even when the doctor claims that everything is fine with the baby.

Therefore, it is very important to know how exactly the position of the baby in the womb will affect the birth. Most of all, this question is asked by women who are going to give birth for the first time. And how should one react correctly when it is written in the conclusion that the position of the fetus is longitudinal? In this case, you just need to be happy, because this is the best option for the position of the child and it is the best for the birth to be quite successful.

The longitudinal position means that there is a straight line that runs exclusively along the child's spine. In addition, if there is also a head presentation, then there is absolutely no reason for panic. The baby lies in the best position, which means that childbirth will not be so painful.

It is also worth remembering that the longitudinal position of the fetus is the most common and occurs in about 96% of women. In the rest, the presentation of the fetus is pelvic. When this happens, the birth is initially considered pathological. But if, nevertheless, the position of the fetus is longitudinal and at the same time its dimensions are not large, and the mother’s pelvis allows the baby’s head to pass, then the birth will be natural. The child will move gradually through the birth canal and after the head appears, the rest of the body will also slip out.

But what to do if the position of the fetus is pelvic? Very rarely in such cases, doctors risk natural childbirth. Most often, in such cases, they prefer to do a caesarean section. Natural childbirth is very risky and should pass very quickly. Indeed, in such cases, every second is worth its weight in gold. In addition, after the birth of a child, an orthopedist should regularly monitor the development of the hip spine for a year in order to fully control the development of the hip spine. Also, another danger is bleeding, which can be very harmful for both the mother and the child.

How to change the incorrect position of the fetus during pregnancy

Almost before childbirth, it is impossible to accurately determine the position of the child in the womb, because there is still enough space in the uterus for his movements and he can change position several times a day. But if the doctor says that the position is finally taken, but incorrect, and there is still time before the birth, then you can try to correct the position of the child. To do this, the main emphasis should be placed on small physical activity, mainly on walking. It is thanks to walking that you can provoke the child to make certain movements, which must necessarily affect his position.

Also, if the axis of position is slightly shifted, then it is necessary to lie more on the side on which the fetal head is more tilted. Thus, you can try to change the situation at least a little, although these methods cannot guarantee one hundred percent occupation of the desired position by the child. When a certain result is fixed, then in order for the child not to turn back, it is necessary to use a bandage, which will help to fix the position of the fetus in the uterus.

But whatever the position of the child, modern medicine can help the child be born both naturally and surgically.