Types of presentation. Position and presentation of the fetus

From the moment of conception to the very birth, the expectant mother is constantly in fear for her little miracle, which all these 9 months has been in her womb. After all, the baby will have to go through a huge difficult path from a tiny cell to a little man, and on it he faces multiple problems.

If the pregnancy is going well, the fetus is developing correctly and no problems have been identified, then the woman may well give birth without any outside manipulation. But everything does not always go as we would like. One of the common pathologies that are a direct indication for a cesarean section is the incorrect position of the fetus before childbirth.

A little information for future parents

A small crumb literally from the first weeks of its attachment to the uterus begins to actively move and even push off the walls, since it is still too small and there is plenty of room for it in the uterus. But this freedom only lasts until the middle of the second trimester. Further, it becomes more and more difficult for the child to change the position. He is forced to take the most convenient position for him and for future childbirth in general and in this state wait for the birth.

That is why obstetricians from the antenatal clinic, starting from 30 - 34 weeks, carefully monitor the location of the fetus in the womb and try to choose the best delivery option. And yet, do not panic ahead of time: there are often cases when a child at the very last moment somehow took the correct position and was born naturally and absolutely healthy.

What are the types of pathologies?

Usually, an experienced obstetrician-gynecologist can determine the position of the fetus by feeling the belly of a pregnant woman, but still the final verdict will be delivered after an ultrasound examination, and only then the doctors will decide how to give birth. Of course, you should not be very upset, but every expectant mother is simply obliged to know what pathologies can be and what to expect in a particular case.

So, the fetus can be in a breech or cephalic presentation, which, in turn, have separate varieties. We will talk about them below. At the next admission to the LCD, the future mother can hear, in addition to the location of the fetus, about the so-called position. This term is used in medicine to compare the back of a child and the uterine wall. The kid can sit longitudinally, that is, head down or up, or across, respectively, with the head to the right or left.

With a longitudinal arrangement, natural childbirth without complications is possible if the baby's head is below, that is, closer to the birth canal. True, even in this case there are small nuances, but in general the woman in labor is quite capable of giving birth herself.

In cases where the fetus is located transversely, natural delivery is completely excluded. In this case, there is only one way - a cesarean section.

Breech presentation

This is the very case when the child literally "sits" at the exit. In this case, the breech presentation can, in turn, be of several types:

gluteal (baby's head from above, buttocks from below, legs are raised closer to the face);

foot (the child seems to be standing on his feet or, possibly, only on one leg);

mixed (the baby with this presentation can "sit" on the buttocks, bending the legs at the knees).

Breech delivery is in principle possible, but very risky. During labor, both mother and baby can be seriously injured. Therefore, it is recommended to listen to doctors and agree to a caesarean section.

Head presentation of the fetus

This is the most correct and safe position in which injuries for the baby and the woman in labor are minimized. With a cephalic presentation, the baby's head is at the very birth canal and appears first during childbirth.

The cephalic presentation can also be divided into several types:

The occipital is the most ideal and natural position of the child, in which the baby will move through the birth canal with the back of the head forward.

Forehead.

Frontal - according to doctors, the most dangerous head presentation. In this case, the only option is a cesarean section.

The facial presentation of the fetus is almost as dangerous as the frontal presentation. When moving along the birth canal, there is a risk of spinal injury. It is on this type of pathology that we will dwell in more detail below.

What does facial presentation of the fetus mean and why is it dangerous?

This is the extreme degree of extension of the baby's head. Moreover, initially, when lowering, a frontal presentation is observed, and only then it turns into a facial presentation. Usually, such a presentation occurs immediately at the time of childbirth, but there are cases when such a condition occurs long before the onset of labor and is diagnosed using an ultrasound study.

According to some clinical data, such a presentation is observed in about 0.30% of all pregnant women. At the same time, multiparous women are susceptible to such pathologies more often than primiparas.

How is abnormal presentation of the fetus diagnosed?

With a facial presentation, the baby's head leans back strongly and presses against the back, while the baby's chest is closely adjacent to the walls of the uterus. All these conditions together create a number of characteristic signs with the help of which an experienced obstetrician can easily determine the presence of a facial presentation of the fetus.

In the correct formulation of the diagnosis, it will be useful and which must be carried out very carefully so as not to harm the baby. The doctor can easily feel the chin on one side, and the nose on the other, and in this case, the presence of a facial presentation is beyond doubt.

Why is this happening?

Such an abnormal presentation of the fetus in the uterus is extremely rare, about 1 in 400 births. Multiparous women are more often susceptible to this pathology. The reasons for the facial presentation of the fetus can be different: a narrow pelvis of the woman in labor, too low tone of the uterus, uneven contraction of its sides.

Facial presentation can be either primary or secondary. The first option is extremely rare, and is noted long before the onset of labor. The reasons can be different, for example, when there is a tumor of the thyroid gland in a child. Secondary presentation is observed more often. It is formed from the so-called frontal. Basically, this happens with a narrow pelvis in a woman in labor.

The mechanism of labor with a facial presentation of the fetus

At the very beginning of labor with a facial presentation, the head of the child, instead of bending, is unbent backward. Next comes the internal rotation of the head, this occurs during the transition from the wide part of the small pelvis to the narrow one. Then the chin is extended anteriorly, while the head is located in the pelvic floor. And finally, the baby's face erupts. Ultimately, there is a turn of the shoulders and head exactly as it happens in the occipital presentation.

Consequences of natural childbirth with facial presentation for the baby and mother

The consequences of facial presentation of the fetus (child) as a whole depend on the course of labor and the professionalism of doctors. It should be understood that such a pathology cannot but affect the condition of the baby. Immediately after childbirth, there is severe swelling and hemorrhage on the eyelids, lips of the newborn. The tongue and floor of the mouth become extremely swollen, which leads to feeding problems in the first days of the baby's life.

The prognosis and consequences of facial presentation of the fetus are relatively favorable. Typically, 93% of women in labor do not require surgery and only 20% have a perineal rupture.

Unfortunately, despite a positive prognosis for facial presentation of the fetus, the consequences for the child are not always favorable. Under such circumstances, the number of stillbirths rises sharply. The main problem in this case is the entanglement of the umbilical cord, which is observed much more often than in the occipital presentation.

Experienced mothers reviews

If you go through the numerous women's forums on the Internet, you can conclude that the consequences of facial presentation of the fetus, like the reviews, may differ depending on the specific situation. Often women note that the primary presentation is not yet a sentence, and everything can change, that is, the baby can still turn as expected at the most unpredictable moment. Many mothers advise to perform a number of exercises to correct the position of the fetus in the uterus, but before listening to their advice, it would be useful to have a professional doctor's consultation on this matter.

But still it is worth being realistic and not waiting for a miracle until the last. If your gynecologist says that there is a facial presentation of the fetus, the consequences and reasons of which force you to resort to caesarean section, then you should not risk your health and the baby, but rely entirely on the doctor's many years of experience.

How is childbirth carried out with a similar pathology

If a facial presentation is established and there is no labor yet, expectant tactics are used. In other words, doctors are likely to put the expectant mother in advance, but will not do anything. In most cases, everything is decided by nature itself and childbirth takes place without any serious consequences for the mother and baby. In the case of facial presentation, natural delivery, although complicated, is still possible. With a frontal presentation, especially in combination with a normal pelvic size and full-term pregnancy, natural childbirth is impossible. They will occur if the frontal presentation goes over to the front or frontal presentation, with a medium-sized fetus and a roomy pelvis.

If the cervix begins to open, it is necessary to put the woman in labor on her back and try not to damage the fetal bladder. In the presence of a large fetus or a narrow pelvis of a woman in labor and a facial presentation of the fetus, the recommendations of doctors always agree on immediate surgical intervention. Otherwise, there is a risk of missing the most favorable time and seriously harm both the mother and the baby.

Why can the fetus take the wrong posture at all?

As we already wrote above, nature is laid down so that before childbirth, the child takes the most favorable position for himself and the mother, that is, longitudinally, with an occipital presentation. But, alas, there are often cases when something does not go according to plan and the baby is not located as it should. There may be several reasons:

After repeated curettage, abortions, multiple births and even undergone cesarean section operations, hypertonicity of the lower parts of the uterus can be observed, while in the upper parts there will be a significant decrease in tone. As a result of this condition, the fetus can push off from the entrance to the pelvis and assume an unnatural position for it.

An important role is played by the characteristics of the child himself, for example, a large or too active fetus, prematurity.

Pronounced anomalies of the uterus (two-horned, saddle uterus, fibroids), narrow pelvis.

Entanglement with the umbilical cord, as a result of which the mobility of the fetus is severely limited.

Methods for correcting misrepresentation

There is a set of exercises with which you can correct the position of the fetus even before the onset of labor. The complex will be recommended by the attending physician. In addition to gymnastics, methods such as diving in a pool, acupuncture, homeopathy, psychological suggestion, aromatherapy and even music therapy can be used. You can try whatever your heart desires, only with the condition: be extremely careful and do not hesitate to contact your gynecologist for any questions (even the most insignificant).

The effectiveness of such exercises, according to some reports, can reach 80%. But it is worth remembering that in no case should you do this without first consulting the leading doctor. After all, the situation in each case is individual and there may be serious contraindications. So, direct contraindications to such gymnastics include scars and tumors on the uterus, placenta previa, gestosis, and severe inflammatory diseases. Thus, you can do significant harm instead of good.

And remember: in any case, the doctor should make the final verdict and he knows better how serious everything is. And if the decision is made to have a cesarean section, there is nothing wrong with that. The main thing is that a healthy baby is born, and everything is in order with mom.

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

Causes of the facial presentation of the fetus of the child

Fetal defects (found in 15% of newborns with a facial presentation). Serious central nervous system (CNS) defects such as anencephaly and meningomyelocele are most common. Various tumors of the cervical spine can also contribute to the extension and formation of the facial presentation.
Prematurity.
Moderate discrepancy between the size of the fetal head and the size of the pelvis. Perhaps, in some cases with an antero-cephalic presentation, with a comparative disproportionality of the fetal head and the size of the pelvis, the head can be fully extended, and a facial presentation will form.
Excessive tone in the extensor muscles of the neck. It has been suggested that this condition may be a prerequisite for the formation of a facial presentation. This theory has been used to explain the causes of the primary facial presentation, formed before the onset of labor. The formation of a facial presentation during childbirth is called a secondary facial presentation.
High parity. In most cases of facial presentation, no obvious reason was found for its development, other than a high parity.

Diagnostics of the facial presentation of the fetus of the child

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

Quite rarely, the diagnosis can be made before the onset of labor. Nevertheless, it is possible to suspect an abnormal presentation of the fetus during an examination of the abdomen of a pregnant woman, if the fetus is easily palpated, and its back is located strictly anteriorly. In the case of a normal flexion position of the fetal head, palpation of the back and head can determine a small depression corresponding to the cervical spine. In the facial presentation, this depression is significantly pronounced. The diagnosis is clarified using ultrasound.

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

In most cases, the anterior chin appearance is found.

Management tactics for facial presentation of the fetus

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

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

“When the chin is turned in the direction of the pubis at the lower part of the pubic bone, the woman in labor should be laid on her back and the forceps should be prepared ... and only when the collection is pulled out from under the pubis, it is necessary to pull the head up in an arc of a circle, as a result of the forehead and the back of the head will be brought out and appear in the crotch "

If, in the anterior-chin view, which corresponds to the vertical size (equal to the small oblique size in the occipital presentation), the fetus is medium-sized and its size clinically corresponds to the size of the pelvis, it can be assumed that childbirth will pass through the natural birth canal. In most cases, the fetus in the transverse chin presentation will unfold into a clinically more favorable anterior chin appearance.

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

“When identifying at the beginning of labor (lateral-chin) type in five cases, I was able to correct the presentation of the fetus and transfer it to the occipital by simple intrauterine manipulation, which consisted of“ engaging ”the occipital protuberance with the fingers while simultaneously squeezing up the chin and the brow region with the thumb, after which childbirth always proceeded normally. "

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

It is necessary to carry out traction very carefully. Even in the case when the face crashes, the bones of the skull can be located in the plane of the entrance to the small pelvis. The guideline in this case is: "The head is higher than you think." If forceps are to be used, the head should not be felt over the pubic arch, and the sacral cavity should be filled with the fetal head. Both classic and Killand forceps can be used. In the case of facial presentation, the chin is the main landmark instead of the occipital protuberance. If using Killand forceps, the grooves on the handles should point towards the chin. When using forceps of both types, the spoons are guided in the same way as in the anterior occipital presentation - along the chin-occipital diameter of the head. The curvature of the traditional forceps' spoons resembles the curvature of the birth canal of the pelvis, with the chin at the base of the spoons and the face just below the level of the handles. When using the Killand forceps, the upper segment of the spoons is at the level of the browbone line, and the face of the fetus is above the level of the intersection of the handles.

Once the forceps are secured in position, the handles are lowered slightly to give the head maximum extension, so that it moves into the smallest position. At the height of the contraction, traction is performed slightly downward, asking the patient to push until the chin is under the pubic symphysis. When using classic forceps, at this point, the handles are gradually raised to a level of 45 °, so that the occipital protuberance is formed. When using the Killand forceps, the curvature of which is less, the handles should only be lifted to a horizontal level, after which the head flexes and gives birth.

With the posterior chin presentation, which does not unfold into the anterior chin during childbirth. In the past, in such situations, Killand forceps were applied and rotated from the posterior-chin and transverse-chin views to the antero-chin. However, in modern obstetrics, such manipulation is considered high-risk and the patient is delivered by cesarean section.

How and how easy the delivery will be depends on how the fetus is located in the mother's tummy during pregnancy. When a child has a normal position, a woman can give birth on her own, in a natural way. When the location of the baby is not as intended by Mother Nature, the likelihood of a cesarean section is high. Among the characteristics of intrauterine posture: presentation of the fetus, the position of the fetus and the type of position. Let's figure out what these terms mean for the expectant mother and her baby.

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· What is fetal position and presentation - what's the difference?

Fetal position - this is the so-called ratio of its axis (a conventional line passing through the baby's head and pelvis) to the longitudinal axis of the woman's uterus. The position of the fetus is longitudinal (when the axes of the fetus and the uterus coincide), transverse (when the axes of the fetus and the uterus are perpendicular), and oblique (the middle position between the transverse and longitudinal).

Fetal presentation determine depending on which part of the body the child is directed to the area of the internal pharynx of the female cervix - the place where the uterus passes into the cervix, in medicine it is called the presenting part. Presentation of the fetus can be head - when the head is directed towards the exit from the uterus, or pelvic - when the baby lies with his buttocks towards the exit. When the fetus is transversely located, the presenting part is not determined.

Up to 33-34pregnancy weeks presentation and the position of the fetus may change, the baby may roll over. After 34 weeks pregnant it, as a rule, becomes stable, that is, the baby remains in the position in which he will be born.

Head fetal presentation

Cephalic presentation occurs in approximately 95-97% of pregnancies. The most optimal is the cephalic presentation of the fetus, when the head is tilted (the baby's chin is pressed against the chest), and the baby at birth goes forward with the back of the head. The leading point (going first through the birth canal) in this case is the small fontanelle, which is located at the junction of the occipital and parietal bones of the skull. If the back of the head of the child is facing forward, and the face is backward (in relation to the mother's body), this is called anterior occipital presentation(this is how more than 90% of births take place), if it is located the other way around, then it is posterior. When posterior view of the occipital presentation of the fetus childbirth is more difficult, the baby in the process of childbirth may well turn around and take the "correct" position, but one way or another, and this usually seriously delays and complicates the birth process.

With a head presentation, the baby's buttocks and legs may deviate to the left or right, depending on where the fetal back is facing.

In addition, the cephalic presentation is subdivided into extensor types, when the fetal head is unbent to a certain extent (raised, so to speak). In the case of slight extension, when the large fontanelle, also located at the junction of the parietal and frontal bones of the skull, becomes the leading point, this is antero-cephalic presentation... Natural childbirth in this case is possible, however, they proceed more difficult and longer than in cases of occipital presentation, since the baby's head is inserted into the mother's small pelvis with its large size. In fact, the antero-cephalic presentation of the fetus is a relative indication for a cesarean section - everything is decided individually, according to the situation.

The next degree of extension is frontal presentation of the fetus(it happens rarely, literally in 0.04-0.05% of births). With the normal size of the baby, the passage of childbirth by the natural birth canal is impossible, this situation requires prompt delivery.

And finally, the maximum extension of the head is facial presentation of the fetus- the baby's face is born first (this occurs in 0.25% of all births). At the same time, natural childbirth is possible (the resulting birth tumor is located in the lower part of the child's face, in the chin and lips), but they are quite traumatic for both the woman in labor and the fetus, which often adds "points" in favor of performing a cesarean section.

Diagnosis of extensor presentations of the fetus is carried out by an obstetrician during vaginal examination directly during labor.

Pelvic / gluteal fetal presentation

This arrangement of the fetus during pregnancy occurs in 3-5% of births. Breech presentation is leg presentation, when the legs are present, and gluteal presentation, when the child seems to squat down, and the buttocks are located towards the exit. Breech presentation of the fetus is more favorable for childbirth.

When does it take place pelvicpresentation of the fetus, childbirth are considered pathological due to the large number of complications in the woman in labor and the fetus. Since the smallest pelvic end of the fetus is born first, difficulties often arise when removing the head. In the case of a foot presentation, the obstetrician delays the birth of the child, hinders his progress with his hand, preventing the leg from falling out until the infant squats. Thus, they ensure that the buttocks are born first. Of course, this complicates the process of childbirth and brings additional painful sensations.

Breech presentation of the fetus is not an absolute, sufficient indication for a cesarean section. The question of how the delivery will take place is decided taking into account several factors that determine the method of delivery:

1. the size of the fetus (if the presentation is breech, then the fetus over 3500 grams is considered large, in normal childbirth, to be considered large - the weight of the baby must exceed 4000 grams);

2. the size of the mother's pelvis;

3. a specific type of breech presentation of the fetus (leg or breech);

4. the sex of the fetus (breech delivery for a girl is associated with a much lower risk than for a boy, since a boy may experience damage to the genitals);

5. the age of the woman in labor;

6. the course and outcome of a woman's previous pregnancy and childbirth.

· What to do for the child to turn from the pelvic to headpresentation ?

To rotate the baby in the uterus after 31 weeks of gestation, the following actions are recommended:

1. Lie on your right side, lie down for 10 minutes, and then quickly roll over onto your left side and, 10 minutes later, again onto your right side. Repeat the exercise 3-4 times in a row several times throughout the day, before meals.

3. The rotation of the fetus is facilitated by classes in the pool.

4. If the baby turns over on its head, it is advised to wear the bandage for a couple of weeks so that the correct position of the fetus is fixed.

The implementation of such exercises has contraindications, which include: complications during pregnancy (gestosis of pregnant women, the threat of premature birth), placenta previa , a scar on the uterus as a result of a cesarean section in the past, a tumor of the uterus.

Previously, they tried to correct the breech presentation of the fetus, which he calls it manually, by external rotation of the fetus - through the stomach, the doctor tried to move the baby's head downward. To date, this has been abandoned, since the method has low efficiency and a high percentage of complications, such as premature birth, premature placental abruption, and impaired condition of the child.

If the breech presentation of the fetus persists, then the pregnant woman is sent to the hospital 2 weeks before the expected date of birth. There, under supervision, a delivery plan is drawn up, the most favorable in this situation.

Oblique and transverse

The transverse and oblique position of the fetus is an absolute indication for a cesarean section, the passage of natural childbirth through the birth canal is impossible here. Presentation in this case is not defined. Oblique and transverse positions occur in 0.2-0.4% of pregnancies. The previously used twists for the leg during childbirth are not used today, since they are very traumatic for the mother and child. However, occasionally such a turn of the fetus is used in multiple pregnancies - twins, in cases where, after the birth of the first, the second baby has taken a transverse position.

The reasons why there is a lateral position of the fetus may lie in the formation of tumors in the uterus (for example, uterine fibroids) - they prevent the child from assuming a normal position. In addition, this happens when the fetus is large, when the umbilical cord is short or wrapped around the baby's neck, as well as in women who have multiparous due to overstretching of the uterus.

In the absence of reasons that prevent the fetus from turning into a cephalic presentation, it is recommended to perform the same exercises as in the case of a breech presentation described above. In an oblique position, you should lie on that side for more time, towards which the back is mainly turned.

If there is an oblique or transverse position of the fetus, then the woman is hospitalized 2-3 weeks before the onset of labor to prepare for surgical delivery.

· Fetal position with twins

With twins, natural childbirth is possible if both children occupy a cephalic presentation, or the first baby (located closer to the exit from the uterine cavity and will be born first) takes the head, and the second breech presentation of the fetus. The opposite situation - the first fetus in the pelvic, and the second in the cephalic presentation - is unfavorable, because after the birth of the pelvic part of the first fetus, babies can catch on with their heads.

In cases where the transverse position of one of the children is determined, the issue is unambiguously resolved in favor of performing a cesarean section, that is, delivery occurs by surgery.

Even with a favorable position of the fetuses in the uterus, the question of the method of delivery for twins is decided taking into account many factors, and not only based on the location occupied by the babies.

Yana Lagidna, specially for MyMom . ru

And a little more about the position and presentation of the fetus during childbirth, video:

During the nine months of carrying a baby, a pregnant woman often hears about fetal presentation. Obstetricians-gynecologists talk about him at the examination, specialists of ultrasound diagnostics. About how it happens and what it affects, we will tell in this material.

What it is?

During pregnancy, the baby repeatedly changes its position in the womb. In the first and second trimester, the baby has enough free space in the uterus to roll over, somersault and take a variety of positions. Presentation of the fetus at these dates is voiced only as a fact and nothing more, this information has no diagnostic value. But in the third trimester, everything changes.

The baby has little room for maneuvers, by the 35th week of pregnancy, a permanent location in the uterus is established and a coup becomes very unlikely. In the final third of the gestation period, it is very important what position the baby is in - right or wrong. The choice of delivery tactics and the likely risk of complications for both the mother and her baby depend on this.

When talking about presentation, it is important to understand exactly what it is about. Let's try to get into the terminology. Fetal presentation is the ratio of a large part of the fetus to the exit from the uterine cavity to the pelvic area. The baby can be turned towards the exit either by the head or by the buttocks, or be in an oblique position, across the uterus.

The position of the fetus is the ratio of the location of the longitudinal axis of the baby's body to the same axis of the uterine cavity. The crumb can be located longitudinally, transversely or obliquely. The longitudinal position is considered the norm. The position of the fetus is the ratio of its back to one of the walls of the uterus - left or right. The type of position is the ratio of the back to the back or front wall of the uterus. The relationship of the arms, legs, and head of the baby in relation to his own body is called penile dislocation.

All these parameters determine the posture of the baby, and it must be taken into account when deciding how a woman will have to give birth - natural, natural with stimulation or by caesarean section. A deviation from the norms in any of the listed parameters can affect this decision, but the presentation is usually decisive.

Views

Depending on which part of the body is closest to (adjacent) to the exit from the uterus into the small pelvis (and this is the beginning of the baby's path at birth), there are several types of presentation:

Pelvic

In about 4-6% of pregnant women, the baby is located at the exit with the booty or legs. Full breech presentation is a position in the uterus in which the baby is aimed towards the exit with the buttocks. It is also called gluteal. Foot presentation is considered to be such a presentation in which the child's legs "look" towards the exit - one or both. Mixed (combined or incomplete) breech presentation is a position in which both the buttocks and legs are adjacent to the exit.

There is also a knee presentation, in which the baby's legs bent at the knee joints are adjacent to the exit.

Breech presentation is considered a pathology. It can be very dangerous for both the mother and the baby. The most common presentation is breech presentation, with which the prognosis is more favorable than with the leg, especially with the knee.

The reasons why the baby has a breech presentation may be different, and not all of them are obvious and understandable for doctors and scientists. It is believed that children whose mothers suffer from pathologies and anomalies in the structure of the uterus, appendages, ovaries are most often located with the head up and the booty down. Women who have undergone many abortions and surgical curettage of the uterine cavity, women with scars on the uterus, who often give birth a lot, are also at risk.

The cause of breech presentation may be a chromosomal disorder in the child himself, as well as anomalies in the structure of his central nervous system - the absence of the brain, microcephaly or hydrocephalus, impaired structure and functions of the vestibular apparatus, congenital malformations of the musculoskeletal system. Of the twins, one baby can also take a sitting position, and it is dangerous if this baby lies first to the exit.

Head

The cephalic presentation is considered correct, provided as ideal for the child by nature itself. With him, the baby's head is adjacent to the exit into the small pelvis of the woman. Depending on the position and type of position of the child, several types of cephalic presentation are distinguished. If the baby is turned towards the exit with the back of the head, then this is the occipital cephalic presentation. The back of the head will be the first to appear. If the baby is positioned towards the exit in profile, this is an antero-parietal or temporal presentation.

In this position, childbirth is usually a little more difficult, because this size is wider and it is a little more difficult for the head to move along the woman's genital tract in this position.

Frontal presentation is the most dangerous. With him, the baby "breaks" his way with his forehead. If the baby is turned to face the exit, this means that the presentation is called facial, it is the facial structures of the crumbs that will be born first. The occipital variant of the cephalic presentation is considered safe for the mother and fetus during childbirth. The rest of the types are extensor variants of the cephalic presentation, it is rather difficult to consider them normal. When passing through the birth canal, for example, with facial presentation, there is a possibility of injury to the cervical vertebrae.

Also, the cephalic presentation may be low. They talk about him on the “finish line”, when the stomach “goes down”, the baby presses his head against the exit into the small pelvis or partially enters it too early. Normally, this process takes place during the last month before childbirth. If head drooping occurs earlier, pregnancy and presentation are also considered pathological.

In the cephalic presentation, up to 95% of all babies are usually located by 32-33 weeks of gestation.

Transverse

Both the oblique and transverse position of the baby's body in the uterus, characterized by the absence of the presenting part as such, are considered pathological. This presentation is rare, only 0.5-0.8% of all pregnancies occur with this complication. The reasons why the baby can sit across the uterus or at an acute angle to the exit into the small pelvis are also quite difficult to systematize. They do not always lend themselves to a reasonable and logical explanation.

Most often, the transverse position of the fetus is characteristic of women whose pregnancy occurs against the background of polyhydramnios or low water. In the first case, the baby has too much space for movement, in the second, his motor capabilities are significantly limited. Women who have given birth often suffer from overstretching of the ligamentous apparatus and muscles of the uterus, which do not have sufficient elasticity to fix the position of the fetus, even at long periods of pregnancy, the child continues to change the position of the body.

Often the fetus is located transversely in women with uterine fibroids, because the nodes prevent the child from positioning normally. In women with a clinically narrow pelvis, the baby often fails to lock in the correct position.

Diagnostics

Before 30-32 weeks, the diagnosis of presentation of the fetus does not make sense. But at this time, an obstetrician-gynecologist can draw conclusions about which part of the body the baby is adjacent to the exit from the uterus at a regular external examination. Usually, if the baby is in the wrong position in the womb, the height of the uterine fundus exceeds the norm (with the pelvic) or lags behind the norm (with the transverse presentation).

With the transverse arrangement of the baby, the belly looks asymmetrical, like a rugby ball. This position can be easily determined on your own, simply by standing upright in front of the mirror.

The baby's heartbeat, if the position is incorrect, is heard in the mother's navel. On palpation in the lower part of the uterus, a dense, rounded head is not determined. With a breech presentation, it is palpated in the area of the bottom of the uterus, with a transverse presentation - in the right or left side.

The doctor also uses a vaginal examination to clarify the information. An undeniable confirmation of the diagnosis is an ultrasound scan (ultrasound). With it, not only the exact position, position, presentation, posture are determined, but also the weight of the fetus, height and other parameters necessary for a more careful choice of the method of delivery.

Possible complications

No one is safe from complications in childbirth and during childbirth, even if the baby is located correctly at first glance. However, the most dangerous are the breech and transverse presentation.

The main danger of breech presentation of the fetus lies in the likelihood of premature birth. This happens in about 30% of pregnancies in which the baby is in the mother's belly, head up. Very often, such women experience a premature rupture of amniotic fluid, it is of a rapid nature, along with the waters, parts of the baby's body often fall out - a leg, a handle, and umbilical cord loops. All of these complications can lead to serious injury, which can make a toddler disabled from birth.

At the beginning of labor, women with a breech presentation often develop weakness of labor forces, contractions do not bring the desired result - the cervix does not open or opens very slowly. During childbirth, there is a risk of tipping the baby's head or arms, injuries to the cervical spine, brain and spinal cord, placental abruption, the onset of acute hypoxia, which can lead to the death of the child or total disruption of the functioning of his nervous system.

For a woman in labor, the pelvic position of the fetus is dangerous with severe ruptures of the perineum, uterus, massive bleeding, pelvic injuries.

Quite often, breech presentation is combined with cord entanglement, fetal hypoxia, pathologies of the placenta. Babies in breech presentation often have less body weight, they are hypotrophic, have metabolic disorders, suffer from congenital heart defects, pathologies of the gastrointestinal tract, as well as kidneys. By the 34th week of pregnancy, if the baby does not take the correct position, the rate of development of some structures of the baby's brain slows down and is disrupted.

If the baby is positioned in the cephalic presentation with the back of the head towards the exit longitudinally, no complications should arise either during pregnancy or during childbirth. Other options for cephalic presentation can cause difficulties in childbirth, because it will be more difficult for the head to move along the birth canal, its extension will not occur towards the mother's sacrum, which can lead to hypoxia, weakness of labor forces. In this case, if there are concerns for the child's life, doctors use forceps. In itself, it raises a lot of questions, because the number of birth injuries received by children after the application of obstetric forceps is very large.

The forecasts are most unfavorable for the frontal presentation. It increases the likelihood of rupture of the uterus, its cervix, the appearance of fistulas, and the death of the baby himself. Almost all types of cephalic presentation can be admitted to natural childbirth, except for the frontal presentation. Low cephalic presentation is fraught with premature delivery, and this is its main danger.

This childbirth will not necessarily be complicated or difficult, but the baby's nervous system may not have time to mature to an independent life outside the mother's abdomen, as sometimes his lungs do not have time to mature.

The danger of transverse presentation is that natural childbirth can hardly be carried out without severe deviations. If the oblique position of the baby can somehow be tried to correct already in the process of childbirth, if it is nevertheless closer to the head position, then a complete transverse correction is practically impossible.

The consequences of such childbirth can be severe trauma to the baby's musculoskeletal system, limbs, hip region, spine, as well as the brain and spinal cord. These injuries are rarely dislocated or fractured, but are usually more serious injuries that effectively render the child disabled.

Often children in transverse presentation experience chronic hypoxia during pregnancy, prolonged oxygen starvation leads to irreversible changes in the nervous system and the development of sense organs - vision, hearing.

How to give birth?

This issue is usually resolved at 35-36 weeks of gestation. It is by this time, by the standards of doctors, that any unstable position of the fetus in the mother's womb becomes stable and constant. Of course, there are isolated cases when an already large fetus literally a few hours before giving birth changes the wrong body position to the correct one, but it is at least naive to count on such an outcome. Although it is recommended to believe in the best both the pregnant woman and her doctors.

Many factors influence the choice of delivery tactics. The doctor takes into account the size of the pelvis of the expectant mother - if the head of the fetus, according to ultrasound, is larger than the size of the pelvis, then with a high degree of probability the woman will be offered a planned cesarean section for any presentation of the fetus. If the fetus is large, then this is the reason for the appointment of a planned cesarean section in the breech and transverse presentation, and sometimes in the head presentation, it all depends on how much weight the specialists of ultrasound diagnostics "predict" for the crumb.

An immature cervix can also be a reason for prescribing a caesarean section, regardless of presentation. In addition, doctors try not to take risks and perform an operation on women who become pregnant as a result of IVF - their childbirth can present a lot of unpleasant surprises.

With a breech presentation, natural childbirth is possible if the fetus is not large, the birth canal is wide enough, the size of the pelvis allows the child's bottom, and then his head to pass unhindered. Natural childbirth is allowed for women with a full breech presentation, and also sometimes with a mixed presentation. If the child has low weight, there are signs of hypoxia, entanglement, they will not be allowed to give birth.

With a foot presentation or its knee version, the best way to carry out childbirth is a cesarean section. It will allow you to avoid birth trauma in the baby and bleeding in the mother.

With a frontal head presentation, doctors also try to prescribe a cesarean section so as not to risk the life and health of the baby. If one of the two babies is in the wrong position during multiple pregnancies, a cesarean section is also recommended, especially if the baby is sitting or lying across the uterus, who will begin to be born first. With transverse and oblique presentations, they most often try to prescribe a planned cesarean section. Vaginal childbirth is very dangerous.

A planned cesarean section is usually performed at 38-39 weeks of gestation, without waiting for the onset of spontaneous labor. The central importance in the choice of the method is laid on the individual characteristics of the female body, on the anatomical features of her baby. There is no universal risk assessment system. There can be so many nuances that only an experienced doctor can take them into account. Low

The longer the gestation period, the less opportunity for the child to actively move, since there is very little space in the uterus. Therefore, by the beginning of the eighth month, as a rule, the fetus already takes a stable position, that is, it turns with a certain part of the body to the exit of the birth canal. This can be: head, buttocks, legs, knees, shoulder or handle. In the later stages, in addition to the general condition of the mother, gynecologists are concerned about the presentation of the fetus and its size (approximate height and weight).

All expectant mothers dream of a natural delivery. But there are a number of factors that determine how a baby is born: by caesarean section or naturally. One of these factors is fetal presentation. What is it? Fetal presentation is the accepted position of the fetus in the last weeks of pregnancy or just before the onset of labor, that is, which large part it is closest to the pelvic floor.

Views

Depending on which part of the body the child turned to the exit of the birth canal, the following types of presentation of the fetus differ:

pelvic,
head,
oblique,
transverse.

With oblique or transverse - a woman always undergoes a cesarean section, with a head section, if there are no other indications, childbirth takes place in a natural way, and with a breech presentation, doctors, as a rule, recommend an operation, but a woman can safely give birth on her own.

Head presentation of the fetus

The most optimal and correct presentation is the head presentation. In almost all cases of such an arrangement of the fetus, childbirth occurs naturally. The most favorable and easy for a woman is the process of delivery, when the child is turned by the occipital region to the birth canal. But in obstetric practice, there are other positions of the fetal head, which depend on flexion or extension of the neck.

In the case of an anterior cephalic presentation, the baby's head passes through the birth canal for the most part. In such a situation, a woman is allowed to give birth on her own, but the risk of birth trauma to the baby and mother increases. To prevent undesirable consequences, it is better for a woman to resort to a cesarean section.

The head presentation of the fetus can also be frontal. In this position, the baby's neck is very unbent, the head area is too large, and it cannot pass through the birth canal. If the fetus has taken a frontal presentation during childbirth, then the woman is shown an emergency cesarean section, and if before childbirth, then a planned one.

Facial presentation is considered to be the most dangerous, since the neck is completely unbent and the fetus passes not by the back of the head, but by the face. In this position, during natural childbirth, the child's neck can be severely injured or, in general, broken. As a rule, a woman is offered to resort to a caesarean section.

Breech presentation of the fetus

The position of the baby in the uterus with the legs or buttocks down is called the breech presentation of the fetus. In obstetric practice, it is customary to distinguish between two of its varieties: breech presentation and foot presentation. Depending on the complexity of the proposed natural birth, gynecologists recommend that a woman choose a caesarean section as the main method of delivery.

In breech presentation, it is the breech that is most often found, it occurs in 35% of cases. With this arrangement of the fetus, its buttocks are facing the exit of the birth canal, the legs are unbent at the knees and bent at the hip joint. As a rule, there are two types of breech presentation: mixed and pure breech presentation. If the baby is in breech presentation, then a natural birth is possible, but there is a possibility of a number of complications. For example, loss of umbilical loops, asphyxia in a child and other serious injuries. In turn, the birth of a child with such a presentation will certainly lead to tears and tissue damage in the mother.

Incomplete presentation or pure breech presentation occurs when the child's legs are extended along their torso, and flexion occurs only in the hip joint. And it is in this position that the baby prepares for birth. With a mixed presentation or full, the buttocks are facing the exit of the mother's small pelvis together with the legs. In this case, flexion is observed in both the knee joints and the hip joints.

Leg presentation is less common than breech presentation and, as a rule, occurs during vigorous labor. There are several types of this presentation: complete, incomplete and knee. Full is called when two legs are slightly unbent at the hip and knee joints and are facing the bottom of the woman's small pelvis. With incomplete presentation, one leg is completely bent in the hip joint, and the other is straight, that is, it is unbent in both the hip and knee joints. Knee is extremely rare. It is characterized by presentation of both legs bent at the knee joint, facing the exit of the birth canal.

Oblique or transverse presentation

The presentation of the fetus during pregnancy can change repeatedly. It depends on the child's activity and the anatomical structure of the mother's body. With oblique presentation, there is a possibility that the child will change position during active labor, but doctors recommend that the woman not take risks and give birth using a cesarean section.

If the transverse presentation of the fetus, then natural delivery is impossible. In this case, the axis of the child and the axis of the woman's uterus intersect at a right (90 degrees) angle, and the largest anatomical parts of the fetus are located above the ridges (edges) of the ilium. In very rare cases, with the help of doctors, the child can be deployed, but this, as a rule, leads to injury to the fetus.

How to determine the type of presentation

Diagnostics of the presentation of the fetus before the start of active labor is carried out in the antenatal clinic and maternity hospitals. Doctors make the most reliable conclusion about the presentation of the fetus after 35 weeks, since before this period there is a possibility that the child will independently assume the proper position before childbirth. With an incorrect presentation (oblique, pelvic, transverse), gynecologists advise the woman to perform special exercises that can contribute to the rotation of the fetus. After 36 weeks of pregnancy, there is practically no room for the baby to move, and he takes a pose in which he will be born.

How to determine the presentation of the fetus? The diagnosis is made by a gynecologist based on the results obtained. The expectant mother must undergo a vaginal and obstetric examination. In addition to objective data, a woman needs to undergo an ultrasound scan, preferably a three-dimensional echography. This type of research is most important in the breech presentation, to determine its type.

Determination of fetal presentation is an integral part of pregnancy management. This is necessary to make a decision on the method of delivery, as well as to prevent the occurrence of complicated labor. It is very important with a breech presentation to determine what kind it is. With a headache, doctors pay attention to the position of the head and the degree of extension of the neck, since its excessive extension can lead to serious injuries during the passage through the birth canal. For example, trauma to the spinal cord, cerebellum and other injuries.

Causes

The reasons for an incorrect presentation of the fetus are very diverse. The following factors lead to this pathology:

polyhydramnios or low water;
a rather narrow pelvis of a woman;
too low presentation (location) of the placenta;
double or triple umbilical cord entanglement of the neck;
very short umbilical cord;
tumors in the uterus (myoma, fibroma);
the presence of a postoperative scar on the uterus;
abnormal development of the uterus;
hypotonia of the uterus (decreased tone);
multiple pregnancies or repeated;
dystrophy of the myometrium;
saddle or two-horned uterus.

All of the above reasons are predisposing factors for a pelvic or transverse presentation.

Indications for cesarean section

The presence of disorders or diseases in both the woman and the fetus can lead to delivery by cesarean section. Indications from a woman: genital cancer or herpes, myopia, severe symphysitis, narrow or deformed pelvis, pronounced scars on the uterus or vagina, tumors in the uterus, severe diseases of the heart, kidneys, lungs, the presence of transplanted organs, eclampsia.

On the part of the fetus or placenta: malformations of the child (omphalocele, gastroschisis), chronic hypoxia, developmental delay, transverse or breech presentation of the fetus, as well as abnormal headache, Siamese twins or twins, triplets, etc., large fetus, and so on complete or incomplete detachment of the placenta.