What to do if the fetus lies incorrectly? Incorrect presentation of the fetus during pregnancy The fetus lies incorrectly for 30 weeks.

Among the reasons for the formation of incorrect positions of the fetus, the main importance belongs to a decrease in the tone of the muscles of the uterus, a change in the shape of the uterus, excessive or sharply limited fetal mobility. Such conditions are created with developmental anomalies and tumors of the uterus, fetal developmental anomalies, placenta previa, polyhydramnios, oligohydramnios, multiple pregnancies, flabbiness of the anterior abdominal wall, as well as in conditions that make it difficult to insert the presenting part of the fetus into the entrance to the small pelvis, for example, with tumors of the lower segment of the uterus or with a significant narrowing of the size of the pelvis. Abnormal position, especially oblique, may be temporary.

How to recognize the wrong position of the fetus?

The transverse and oblique position of the fetus in most cases is diagnosed without much difficulty. When examining the abdomen, the shape of the uterus, which is elongated in the transverse direction, attracts attention. The circumference of the abdomen always exceeds the norm for the corresponding gestational age at which the examination is carried out, and the height of the uterine fundus is always less than the norm. When using Leopold's techniques, the following data are obtained:

in the bottom of the uterus there is no large part of the fetus, which is found in the lateral sections of the uterus: on the one hand, a round dense (head), on the other hand, soft (pelvic end);
the presenting part of the fetus above the entrance to the small pelvis is not determined;
the fetal heartbeat is best heard in the navel;
the position of the fetus is determined by the head: in the first position, the head is determined on the left side, in the second - on the right;
the type of fetus is recognized by the back: the back is facing forward - front view, the back is backward - rear. If the back of the fetus is turned down, then there is an unfavorable option: it creates unfavorable conditions for the extraction of the fetus.

A vaginal examination done during pregnancy or at the beginning of labor with a whole fetal bladder does not provide much information. It only confirms the absence of the presenting part. After the outflow of amniotic fluid with sufficient opening of the cervix (4-5 cm), you can determine the shoulder, shoulder blade, spinous processes of the vertebrae, inguinal cavity.

Ultrasound is the most informative diagnostic method that allows you to determine not only the incorrect position, but also the expected body weight of the fetus, the position of the head, the location of the placenta, the amount of amniotic fluid, entanglement of the umbilical cord, the presence of an anomaly in the development of the uterus and its tumor, anomalies in the development of the fetus, etc. .

The course and tactics of pregnancy

Pregnancy with the wrong position of the fetus passes without any special deviations from the norm. The risk of premature rupture of amniotic fluid increases, especially in the third trimester.

The preliminary diagnosis of malposition of the fetus is established at 30 weeks of gestation, the final diagnosis is at 37-38 weeks. Starting from the 32nd week, the frequency of spontaneous rotation decreases sharply, so it is advisable to correct the position of the fetus after this period of pregnancy.

In the antenatal clinic in the period of 30 weeks. to activate the self-rotation of the fetus on the head of the pregnant woman, it is necessary to recommend corrective exercises: position on the side opposite to the position of the fetus; knee-elbow position for 15 minutes 2-3 times a day. From the 32nd to the 37th week, a set of corrective gymnastic exercises is prescribed according to one of the existing methods.

Contraindications to the implementation of gymnastic exercises are the threat of premature birth, placenta previa, low attachment of the placenta, anatomically narrow pelvis II-III degree. Do not carry out an external prophylactic rotation of the fetus on the head in the conditions of the antenatal clinic.

External rotation of the fetus on the head

Further management of pregnancy is to attempt external rotation of the fetus on the head during full-term pregnancy and further induction of labor or expectant management of pregnancy and an attempt to rotate the fetus with the onset of labor if its incorrect position persists. In most cases, with expectant management of pregnancy, fetuses that had wrong position, are located longitudinally to the beginning of childbirth. Only less than 20% of the fetuses that were located transversely before 37 weeks. pregnancy, remain in this position until the onset of labor. At 38 weeks. determine the need for hospitalization in an obstetric hospital of the III level according to such indications: the presence of a burdened obstetric and gynecological history, a complicated course of this pregnancy, extragenital pathology, the possibility of external rotation of the fetus. In an obstetric hospital, in order to clarify the diagnosis, ultrasound is performed, the condition of the fetus is assessed (BPP, if necessary, Doppler is performed), the possibility of external rotation of the fetus to the head, and the readiness of the female body for childbirth are determined.

The birth plan is developed by a council of doctors with the participation of an anesthesiologist and a neonatologist and coordinates it with the pregnant woman. In the case of a full-term pregnancy in a hospital of level III, by the beginning of labor, it is possible to perform an external rotation of the fetus on the head with the informed consent of the pregnant woman. The external rotation of the fetus on the head in the case of a full-term pregnancy leads to an increase in the number of physiological births in the cephalic presentation.

Carrying out an external rotation to the head during full-term pregnancy makes it possible to more often spontaneously rotate the fetus. Thus, waiting for delivery reduces the number of unnecessary external rotation attempts. In full-term pregnancy, in the event of complications of rotation, emergency abdominal delivery of a mature fetus can be performed. After a successful external cephalic rotation, reverse spontaneous rotations are less common. The disadvantages of external fetal rotation at full term is that it may be prevented by premature rupture of the membranes or labor that began before the planned attempt at this procedure. The use of tocolytics in external rotation reduces the failure rate, facilitates the procedure, and prevents the development of fetal bradycardia. These benefits of using tocolytics should be weighed against their possible side effects on the maternal cardiovascular system. It should be noted that the risk of complications during external rotation is reduced, since the procedure takes place directly in the maternity ward with continuous monitoring of the fetal condition.

Conditions for carrying out an external turn

estimated fetal weight

Contraindications for external rotation

Complicated course of pregnancy at the time of making a decision on external rotation (bleeding, fetal distress, preeclampsia), burdened obstetric and gynecological history (recurrent miscarriage, perinatal losses, history of infertility), polyhydramnios or oligohydramnios, multiple pregnancy, anatomically narrow pelvis, the presence of cicatricial changes in the vagina or cervix, placenta previa, severe extragenital pathology, uterine scar, adhesive disease, fetal anomalies, uterine anomalies, tumors of the uterus and its appendages.

Technique

The doctor sits on the right side (face to face of the pregnant woman), places one hand on the head of the fetus, the other on its pelvic end. With careful movements, the fetal head gradually shifts to the entrance to the small pelvis, and the pelvic end to the bottom of the uterus.

Complications during external rotation

Premature detachment of a normally located placenta, fetal distress, uterine rupture. In the case of careful and skilled external rotation of the fetus on the head, the frequency of complications does not exceed 1%.

The course and tactics of labor in the transverse position of the fetus

Childbirth in the transverse position is pathological. Spontaneous delivery through the natural birth canal with a viable fetus is impossible. If childbirth begins at home and there is not enough observation of the woman in labor, then complications can begin already in the first period. With the transverse position of the fetus, there is no division of amniotic fluid into anterior and posterior, therefore, untimely discharge of amniotic fluid is often observed. This complication may be accompanied by prolapse of the loops of the umbilical cord or the handle of the fetus. Deprived of amniotic fluid, the uterus tightly fits the fetus, a neglected transverse position of the fetus is formed. During normal labor, the fetal shoulder descends deeper and deeper into the pelvic cavity. The lower segment is overstretched, the contraction ring (the border between the body of the uterus and the lower segment) rises and takes an oblique position. There are signs of a threatening rupture of the uterus and, in the absence of adequate assistance, it may rupture.

In order to avoid such complications, 2-3 weeks before the expected birth, the pregnant woman is sent to an obstetric hospital, where she is examined and prepared for the completion of the pregnancy.

The only way of delivery in the transverse position of the fetus, which ensures the life and health of the mother and child, is a caesarean section in the period of 38-39 weeks.

Classical obstetric rotation of the fetus on the leg

Previously, the operation of the classical external-internal rotation of the fetus on the leg was often used, followed by extraction of the fetus. But it gives many unsatisfactory results. Today, with a live fetus, it is carried out only in the case of the birth of a second fetus with twins. It should be noted that the operation of the classic obstetric pediculation of the fetus is very complicated and, therefore, given the trends in modern obstetrics, is performed very rarely.

Conditions for the obstetric classic rotation operation

full dilatation of the cervix;
sufficient fetal mobility;
correspondence between the size of the fetal head and the mother's pelvis;
the fetal bladder is whole or the water has just passed;
live fruit of medium size;
accurate knowledge of the position and position of the fetus;
absence of structural changes in the uterus and tumors in the vaginal area;
the consent of the woman in labor to turn.

Contraindications to the operation of obstetric classic rotation

neglected transverse position of the fetus;
threatening, initiated or completed uterine rupture;
congenital malformations of the fetus (anencephaly, hydrocephalus, etc.);
fetal immobility;
narrow pelvis (II-IV degree of narrowing);
oligohydramnios;
large or giant fruit;
scars or tumors of the vagina, uterus, small pelvis;
tumors that prevent natural delivery;
severe extragenital diseases;
severe preeclampsia.

Preparation for surgery includes the activities necessary for vaginal surgery. The pregnant woman is placed on the operating table in the supine position with legs bent at the hip and knee joints. Empty the bladder. Disinfect the external genitalia, inner thighs and anterior abdominal wall, cover the stomach with a sterile diaper. The obstetrician's hands are treated as for abdominal surgery. With the help of external techniques and vaginal examination, the position, position, type of fetus and the condition of the birth canal are studied in detail. If the amniotic fluid is intact, the fetal bladder is torn immediately before the rotation. The combined rotation should be performed under deep anesthesia, which should provide complete muscle relaxation,

Stage I

Any hand of the obstetrician can be inserted into the uterus, however, it is more easy to turn when introducing the hand, the same position of the fetus: in the first position - the left hand, and in the second - the right. The hand is inserted in the form of a cone (fingers are extended, their ends are pressed against each other). With the second hand, the genital gap is bred. The folded inner arm is inserted into the vagina in the direct size of the exit from the small pelvis, then with light helical movements it is transferred from the direct size to the transverse one, while moving towards the internal pharynx. As soon as the inner hand is fully inserted into the vagina, the outer hand is moved to the bottom of the uterus.

Stage II

The advancement of the hand in the uterine cavity may be hindered by the shoulder of the fetus (in the transverse position) or the head (in the oblique position of the fetus). In this case, it is necessary to move the fetal head towards the back with the inner hand or grab the shoulder and carefully move it towards the head.

Stage III

When performing the III stage of the operation, it should be remembered that today it is customary to make a turn on one leg. An incomplete foot presentation of the fetus is more favorable for the course of the birth act than a full foot presentation, since the bent leg and buttocks of the fetus represent a larger part, which better prepares the birth canal for the passage of the next head. The choice of the stem to be grasped is determined by the type of fetus. In the anterior view, the lower leg is captured, in the posterior view, the upper one. If this rule is observed, the rotation ends in the anterior view of the fetus. If the leg is chosen incorrectly, then the birth of the fetus will occur in the posterior view, which will require turning to the anterior view, since birth in the posterior view with breech presentation through the natural birth canal is impossible. There are two ways to find the stem: short and long. At the first, the obstetrician's hand moves directly from the side of the tummy of the fetus to the place where the legs of the fetus are approximately located. More accurate is the long way to find the legs. The obstetrician's inner hand gradually slides along the lateral surface of the fetal body to the ischial region, further to the thigh and lower leg. With this method, the obstetrician's hand does not lose touch with the parts of the fetus, which allows you to navigate well in the uterine cavity and correctly find the right leg. At the moment of finding the leg, the outer hand lies on the pelvic end of the fetus, trying to bring it closer to the inner hand.

After finding the leg, it is captured with two fingers of the inner hand (index and middle) in the ankle area or with the entire hand. Capturing the leg with the whole hand is more rational, since the leg is firmly fixed, and the obstetrician's hand does not get tired as quickly as when grasping with two fingers. When capturing the lower leg with the whole hand, the obstetrician places an extended thumb along the tibial muscles so that it reaches the popliteal fossa, and the other four fingers clasp the lower leg in front, and the lower leg, as it were, is in the tire along its entire length, which prevents its fracture.

Stage IV

The rotation itself is performed, which is carried out by lowering the legs after it has been captured. With the outer hand, the fetal head is simultaneously moved to the bottom of the uterus. Traction is carried out in the direction of the leading axis of the pelvis. The turn is considered complete when the leg is removed from the genital gap to the knee joint and the fetus has taken a longitudinal position. After that, following the rotation, the fetus is removed by the pelvic end.

The leg is grasped with the whole hand, placing the thumb along the length of the leg (according to Fenomenov), and with the rest of the fingers covering the lower leg in front.

Then traction is carried out down, it is possible with both hands.

Under the symphysis, the region of the anterior inguinal fold and the wing of the ilium appear, which is fixed so that the posterior buttock can be cut above the perineum. The front thigh, captured with both hands, is lifted up, and the back leg falls out on its own; after the birth of the buttocks, the obstetrician's hands are placed in such a way that the thumbs are placed on the sacrum, and the rest on the inguinal folds and thighs, then the traction is carried out on itself, and the torso is born in an oblique size. The fetus is turned back to the symphysis.

Then the fetus is rotated 180° and the second handle is removed in the same way. The release of the fetal head is carried out by the classical method.

When performing an obstetric turn, a number of difficulties and complications may arise:

rigidity of the soft tissues of the birth canal, spasm of the uterine pharynx, which are eliminated by the use of adequate anesthesia, antispasmodics, episiotomy;
prolapse of the handle, removal of the handle instead of the leg. In these cases, a loop is put on the handle, with the help of which the handle moves away while turning towards the head;
Uterine rupture is the most dangerous complication that can occur during rotation. Accounting for contraindications to the operation,
examination of a woman in labor (determining the height of the contraction ring), the use of anesthesia are necessary to prevent this terrible complication;
prolapse of the umbilical cord loop after the end of the turn requires the mandatory rapid extraction of the fetus by the leg;
acute fetal hypoxia, birth trauma, intranatal fetal death are frequent complications of internal obstetric rotation, which generally lead to an unfavorable prognosis of this operation for the fetus. In this connection, in modern obstetrics, the classic external-internal rotation is rarely performed;
infectious complications that may occur in the postpartum period also worsen the prognosis of the internal obstetric turn.

In the case of a neglected transverse position of the dead fetus, childbirth is completed by performing a fruit-destroying operation - decapitation. After the classic pedunculation of the fetus or after a fruit-destroying operation, a manual examination of the walls of the uterus should be performed.

How the birth will take place depends on the location of the fetus in the mother's tummy. If the child has a normal posture, then the woman may well give birth on her own. If the baby is not located as intended by Mother Nature, then a caesarean section is necessary. Among the characteristics of the posture are: the presentation of the fetus, its position and the type of position.

Let's try to figure out what these terms mean.

The fetus grows and develops in the uterus throughout pregnancy. From a tiny embryo, he gradually turns into a little man. In the first half of pregnancy, he can change his position quite often.

With the approach of childbirth, the activity of the fetus decreases, since it is already very difficult to change the position, because it grows, and there is less and less free space in the uterus.

After about 32 weeks, you can already find out the presentation of the fetus, that is, to determine which part of the child's body (head or buttocks) is located at the entrance to the small pelvis. Sometimes doctors talk about the position of the baby in the tummy before 32 weeks.

Some women in position are given this information at 20-28 weeks of pregnancy. However, it should not be taken seriously at such an early date, because the baby can change the position that is objectionable to him several times.

There are the following types of fetal presentation:

1. Pelvic (the pelvic end of the child lies at the entrance to the woman's small pelvis):

buttock. The fetus is located in the uterus head up. The legs are extended along the body. The feet are practically at the head;
foot presentation of the fetus. At the entrance to the small pelvis, one or both legs of the baby can be located;
mixed (gluteal-leg). Buttocks and legs are presented to the entrance to the small pelvis of a pregnant woman.

2. Head (the head of the child lies at the entrance to the female pelvis):

occipital. The back of the head, facing forward, is the first to be born;
anterior parietal or anterior head. The head is the first to be born during childbirth. At the same time, it passes through the birth canal somewhat larger than with the occipital presentation of the fetus;
frontal. For this species, it is characteristic that the forehead serves as a conducting point during expulsion;
facial. This presentation is characterized by the birth of the head with the back of the head.

Types of breech presentation occur in 3-5% of women in position.

Head presentation is the most common (in 95-97% of pregnant women).

Fetal position: definition and types

Obstetricians-gynecologists call the ratio of the conditional line of the child, passing from the back of the head to the coccyx along the back, to the axis of the uterus - the position of the fetus. In the medical literature, it is classified as follows:

longitudinal;
oblique;
transverse.

The pelvic or head presentation of the fetus in the longitudinal position is characterized by the fact that the axes of the uterus and fetus coincide. With an oblique variety, conditional lines intersect at an acute angle. If the doctor has established a pelvic or head presentation of the fetus, a transverse position, this means that the axis of the uterus intersects the axis of the fetus at a right angle.

Together with the presentation and position, obstetrician-gynecologists determine position type. This term refers to the relationship of the child's back to the uterine wall. If the back is facing forward, then this is called the anterior view of the position, and if backward, the posterior view (or posterior presentation of the fetus).

For example, the doctor may say that the baby is in the uterus in the occiput, longitudinal, anterior position. This means that the baby is in the uterus along its axis. Its back of the head is adjacent to the entrance to the small pelvis, and the back is turned to the front side of the uterus.

Anterior presentation of the fetus is most common. The second variety is less common. The rear view of the position, as a rule, becomes the cause of protracted labor.

Incorrect presentation of the fetus: their features, options for childbirth

Head presentation of the occipital type is the most common and correct position in which babies are born. All other types of presentation are incorrect.

Childbirth in various types is considered pathological. During delivery, serious complications can occur (for example, hypoxia of the child, infringement and extension of his head, throwing back the handles). Most often, childbirth is carried out by caesarean section, especially if the baby is male. However, natural childbirth is not excluded.

The specific delivery option for mixed, foot, breech presentation of the fetus is chosen by the doctor depending on various factors.

Childbirth with extensor presentation of the fetus (anteroparietal, frontal, facial) rarely occurs naturally. With the anterior parietal form, the tactics of delivery is expectant. A caesarean section is performed when there is a threat to the health and life of the mother and baby.

Self-delivery with frontal cephalic presentation is undesirable, since ruptures of the uterus and perineum, asphyxia and death of the child are possible.

With facial presentation, the fetus can be born both through natural childbirth and with the help of surgery. The first option is chosen only if the female pelvis is of normal size, labor is active, and the size of the fetus is small.

Features of low presentation of the fetus

Very often, doctors diagnose pregnant women with a low presentation of the fetus, which implies the premature lowering of the baby's head into the pelvis.

Normally, this process occurs closer to childbirth, 1-4 weeks before them. However, in some pregnant women, due to certain anatomical features, this can happen much earlier.

Low presentation can be determined by the doctor during the examination by palpation of the uterus. The head is located quite low, and at the same time it is motionless or slightly mobile.

The pregnant woman herself can feel the consequences of lowering the baby's head - it will become easier for her to breathe, heartburn will decrease.

The low location of the fetus is a danger to him. The pregnancy may be terminated. To prevent this from happening, a woman should be much more attentive to herself. If the pregnant woman feels unwell due to the low location of the baby, then the specialist can recommend methods of treatment and preventive measures.

Incorrect positions of the fetus: their features, options for childbirth

Incorrect positions are such postures of the child in the mother's tummy, in which the longitudinal axis of the uterus does not coincide with the longitudinal axis of the fetus. They occur in 0.5-0.7% of cases. With women who give birth not for the first time, this happens most often.

Among the existing types of fetal position, two incorrect ones are distinguished: oblique and transverse. The course of pregnancy with them is not characterized by any features. A woman may not suspect that her baby is not located in the tummy in the way that nature predetermined.

Incorrect positions and presentation of the fetus can be the cause of premature birth. If medical care is absent, then serious complications will arise (early rupture of amniotic fluid, loss of fetal mobility, prolapse of a pen or leg, uterine rupture, death).

If a pregnant woman has an oblique position of the fetus, then she is laid on her side during childbirth in order to achieve a change in the position of the child (it can change to longitudinal or transverse), but this is not always possible. If the oblique position is preserved with the breech or head presentation of the fetus, then delivery is carried out by surgery.

Causes of incorrect positioning of the child in the uterus

Many experts believe that the child takes a particular position in the uterus due to the influence of a number of reasons. The main ones are the active movements of the child and the reflex activity of the uterus, which does not depend on human efforts and desires.

Other causes of pure breech, lateral presentation of the fetus and any other malposition:

multiple pregnancy;
anomalies in the shape of the uterine cavity;
constitutional features of a woman.

Diagnosis of the location of the fetus in the uterus

The question of how to determine the presentation of the fetus, its position and position is of interest to all pregnant women, because the course of childbirth depends on the location of the fetus in the uterus.

Medical workers a few years ago determined the location of the child in the uterus by external examination. The diagnoses were not always correct. Now it is not difficult to determine the location, since this can be done using ultrasound. The method is very effective, informative and safe for the expectant mother and fetus. With it, you can very accurately and quickly determine the presentation, position, type of position.

How to independently determine the presentation of the fetus?

How to independently determine the presentation of the fetus, and is it possible? This question worries many of the fair sex in position. This is mainly of interest to those who do not want to constantly run for ultrasound, because the child can change his position very often, especially when it comes to a gestational age of less than 32 weeks.

The expectant mother is usually informed about the position of the fetus in when there is very little time left before the birth. As you know, throughout the entire period of intrauterine development, the baby behaves quite actively. He smiles, winces, moves his arms, legs and can even roll over. But until the baby is large enough to take a stable position in the uterus, it is difficult to predict exactly how it will be born. But closer to childbirth, when the baby is finally formed, grows and gains normal weight, it stops in a certain position, in which it is born.

There are two options for the presentation of the fetus - head and pelvic. Head presentation, when the baby is pressed against the exit of the uterus, of course, is preferable. Since in the process of childbirth, it is the big head that will go first, and the rest of the body behind it, experiencing less stress and experiencing a lower risk of birth injuries. Breech presentation is considered more dangerous. Since if the childbirth is carried out incorrectly, the risk of injury to the child increases significantly, and the onset of serious consequences for the woman in labor is also likely.

There are the following types of breech presentation:

foot, when one or two unbent legs of a child approach the entrance to the small pelvis
knee, when the bent knees of the baby are directed to the entrance to the small pelvis
gluteal, when the buttocks are presented to the entrance to the small pelvis. In this case, the legs can be bent at the knees and also be near the buttocks or bent at the knees and extended along the body. It is the breech presentation that occurs in most cases.

Another incorrect position of the fetus, which is diagnosed for some women in labor during the examination, is transverse. In this case, the head and legs of the child are located in the lateral sections of the uterus. A shoulder and a handle are presented to the exit from the uterus. This is the most unfortunate option, in which in 100% of cases they do. In all other cases, the tactics of childbirth is determined based on the condition of the mother and child, as well as depending on the characteristics of the course of pregnancy.

Causes of malposition of the fetus

There can be quite a lot of reasons why there are incorrect positions and presentation of the fetus. Most often this happens with polyhydramnios, when an excess amount of fluid gives the child the opportunity to actively move, preventing him from fixing in a normal position. Also, twins and triplets are often born in the wrong position. It is good if at least the first child goes head first, but often all the children are positioned incorrectly. Also, quite often there are such reasons for the incorrect position of the fetus as a narrow pelvis, placenta previa, pathologies of fetal development, prematurity, insufficient weight of the child (less than 2500 grams), anomalies in the structure of the uterus, a bicornuate uterus, tumors of the uterus or appendages, decreased uterine tone and weak muscles of the anterior abdominal wall. Often, problems with fixation of the fetus occur during repeated pregnancy, when the abdominal muscles have already been stretched earlier and have not regained their elasticity. Genetics is also a major risk factor. If a mother was born in a breech presentation, the chances of repeating the same situation with her own baby increase significantly.

Gymnastics with the wrong position of the fetus

If during an ultrasound scan at the 30th week of pregnancy you were informed that the baby is lying incorrectly, you should not be upset. According to statistics, 90% of babies have time to change their position to a more comfortable head presentation for childbirth. Although in the breech presentation, about 3% of children are still born. Therefore, already after the 32nd week of pregnancy, doctors recommend expectant mothers to perform special exercises with the wrong position of the fetus. A woman should lie on a hard sofa or rug and lie on one side for 10 minutes, then she should roll over and spend 10 minutes on the other side. Then the exercise is repeated 2-3 more times. This should be done several times a day, and after 1-2 weeks you can expect results. It is also very useful to lie with your legs and lower back elevated on pillows. In this position, you can spend 10-15 minutes after breakfast, lunch and dinner. But before eating, expectant mothers are recommended to stand in a knee-elbow position, also with the pelvis raised up. The logic of the exercises is to place the child in an uncomfortable position for him with his head down, and thereby stimulate him to roll over and cling to the entrance to the small pelvis. For the same reason, pregnant women are advised to sleep on the side where the fetal head is located. The child will feel discomfort and will try to roll over. In addition, as you know, it is very useful for all expectant mothers. swimming and water aerobics. With breech presentation, it is doubly useful.

The effectiveness of these exercises is 70-90%. That is, the result is usually always positive. But there are times when gymnastics in the wrong position of the fetus is categorically contraindicated. Therefore, any actions must first be coordinated with the doctor. A doctor may prohibit a pregnant woman from exercising if she is diagnosed with: placenta previa, uterine fibroids, other serious diseases not related to the reproductive system, and also if she has scars on her uterus from previous operations. If there are no contraindications to gymnastics, it can also be done for prevention purposes. In addition, some mothers additionally turn to various alternative medicine techniques, such as reflexology, light therapy, and music therapy. It is believed that even while in the womb, the child already reacts to light and sound. Therefore, some parents bring a light source, as well as a player with light pleasant music, to the lower abdomen to stimulate the baby to move his head closer to the pelvis. This is not only very cute, but extremely useful. After all, the more natural the child turns into the correct position, the safer and easier it is for him and for his mother.

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.

The doctor may say that the baby is in a "wrong position" or "wrong presentation." What is the difference? "Position" is the placement of the fetus relative to the long axis of the uterus: along, across, obliquely. "Previa" indicates that part of the baby's body, which is closest to the "exit".

The ideal position of the baby in the uterus is longitudinal with the occipital presentation, that is, head down, with the chin tightly pressed to the chest. This is a physiological, thoughtful by nature position, when the risk of injury to the baby and mother during childbirth is minimal. And it occurs most often.

Incorrect position or presentation of the fetus is observed in approximately 3.5-6% of cases. The most common of the "non-standard" options is breech presentation, foot or gluteal. There is a facial presentation: the baby's head is thrown back, and not the back of the head appears first, but the face. The most difficult case from the point of view of obstetricians is the transverse or oblique position of the fetus in the uterus.

Some women who, during their first pregnancy, the baby "sat on the priest" or "lay across", are afraid: what if next time it will be the same? But it is important to understand that the incorrect position of the child is a feature of the course of a particular pregnancy, which is in no way connected with subsequent ones.

Why me? Possible causes of presentation

This question worries every mother whose baby is settled in the stomach "not the way it should be." There are several possible reasons.

Pathological hypertonicity of the lower segment of the uterus and a decrease in the tone of its upper sections. The fetal head is repelled from the entrance to the pelvis and takes a position in the upper part of the uterus. This happens after inflammatory processes, repeated curettage, multiple pregnancies, complicated childbirth, with a scar on the uterus after a cesarean section.
Features of the behavior and development of the fetus, for example, increased mobility due to polyhydramnios, small head size, prematurity.
Features of the structure, anomalies of the uterus and pelvis: bicornuate, saddle-shaped uterus, the presence of partitions or fibroids in the uterus, anatomical narrowing or abnormal shape of the pelvis.
Restriction of fetal mobility: cord entanglement, etc.

Usually the position of the baby in the uterus is fixed to. All these reasons only increase the risk that by this time the child will remain in the wrong position, but they cannot be considered a "final verdict".

Waiting for the hour "X"

At a regular scheduled examination, the doctor, even without the use of technology, is able to roughly determine the position of the baby in the tummy: the head is down or the buttocks. The diagnosis is clarified with the help of ultrasound, simple and three-dimensional echography. Early diagnosis of the type of malpresentation will allow you to develop a corrective program or prepare for natural childbirth with an incorrect position or caesarean section according to indications, which will save you from many injuries and complications.

Until the baby can be in any position. He has enough space for a fateful acrobatic coup and preparation for birth. Sometimes, making mommy and doctors worry, the baby rolls over just before the start of contractions, and sometimes even with their onset.

Plan "coup"

If the due date is approaching, and the baby is still in the wrong position, do not panic. You should never panic at all, and even more so for pregnant women. There is a plan of action!

Step 1. Corrective gymnastics...

It will help to "persuade" the baby to take the right position before childbirth. It is carried out after 24 weeks or at certain times of the third trimester. General contraindications to any set of exercises: pregnancy,. But there are other features of pregnancy in which gymnastics can be dangerous. Before performing any (!) exercises, be sure to consult your doctor!

With breech presentation

Lie on your side, but not on a soft surface. Lie down for 10 minutes on one side, turn on the other, lie down for another 10 minutes. Roll from side to side 3-4 times. Such simple exercises should be performed 2-3 times during the day.
Lie on your back with your pelvis raised. To do this, place pillows under your legs and lower back. Legs should be 20-30 cm above the head. In this position, you can spend 10-15 minutes 2-3 times a day.
Take a knee-elbow pose. Stay like this for 15-20 minutes. Repeat 2-3 times a day.

What's happening: When performing such exercises, the motor activity of the fetus is stimulated, and it gets more opportunity to turn.

In the transverse (oblique) position

Lie on your side in accordance with the position of the fetus: the head on the left - on the right side, on the right - on the left. The legs are bent at the knee and hip joints. Lie down for 5 minutes.
Deep breath, turn to the opposite side. Lie down for 5 minutes.
Straighten the leg (in the 1st position - right, in the 2nd position - left), the other leg remains bent.
Grab your knee with your hands, take it to the side opposite to the position of the fetus. Tilt the body forward. Describe a semicircle with a bent leg, touching the anterior abdominal wall, make a deep, elongated exhalation and, relaxing, straighten and lower the leg.

What's happening: Light mechanical "pushing" the baby's muscles into the correct position.

Step 2: Additional steps

In a transverse position, it is recommended to sleep on the side where the fetal head is located.
In breech presentation, turning the baby head down stimulates swimming (after consulting a doctor!).

Step 3. Visit to the osteopath

After the 35th week, the doctor in a hospital can rotate the fetus (with transverse and oblique, less often with breech presentation). During the entire "operation" the condition of the mother and child is monitored. The procedure has contraindications for carrying out and a high risk of complications and injuries, therefore it is carried out in extreme cases.

Step 4. Consolidation of the result

Once the efforts have been crowned with success and the little "strike" has decided to take the right position, it is important to help him "get a foothold". To do this, get prenatal, wear it during the day and do a special exercise (doctor's consultation!).

Sit on the floor, spread your knees to the sides and press them as close to the floor as possible. Press your feet together. Stay in this position for 10-15 minutes. You can do it several times a day.

What's happening: stretching of the ligaments and muscles of the pelvis, which contributes to the insertion of the head into the pelvis.

Incorrect position of the fetus: truth and myths

... the wrong position of the fetus is a 100% indication of delivery through a caesarean section

Not! It is recommended to make a caesarean section in 60-70% of cases of incorrect position of the fetus in the uterus. But most often, the indication for it is not only a non-standard location, but also a number of related reasons. Natural childbirth with breech presentation is classified as pathological: their course and outcome are significantly complicated, which makes it necessary to resolve the issue in favor of caesarean section. And with a transverse or oblique position, facial presentation, surgical intervention is absolutely necessary.

... in breech presentation are most dangerous for boys.

Yes! When a boy is born from this position, there is a risk of injury to the scrotum, especially if the buttocks and legs are raised high. This can lead to infertility and other problems in the future. Another danger is the direct thermal and painful irritation of the baby's scrotum during a vaginal examination of the mother, moving through the birth canal, which provokes premature breathing of the baby. Therefore, a caesarean section is indicated.

...if you put headphones "with music" on the stomach, the baby will become interested and roll over.

Not! In most cases, if the baby rolled over, it means that he has matured to prepare for childbirth and was able to physically do this "trick". And the music has nothing to do with it. If the baby is "unwilling" or unable to roll over, these methods will not work all the more.

... negatively affects the joints.

Yes! Joint underdevelopment and congenital dislocation are possible.

...pregnancy with breech presentation is more often than with head presentation, accompanied by complications.

Yes! Approximately 3 times. Complications are often accompanied by hypoxia and fetal growth retardation, an abnormal amount of amniotic fluid, entanglement of the umbilical cord.

Are we giving birth?

Tactics is chosen by the doctor. Even if you had a dream to give birth "naturally at any cost", and the verdict was "caesarean section", you should not be upset. The main thing is that a healthy baby is born. And in what way? One that is safe for both.