As you know, during pregnancy, the future little man undergoes fundamental transformations - from a tiny fertilized egg to a complex organism capable of independent life outside the mother's womb. As it grows, there is less and less space in the uterus. The child can no longer move freely inside it and occupies a certain position, more or less permanent (as a rule, after the 32nd week it no longer changes).
To describe the placement of the fetus in the uterus in late pregnancy and just before delivery, experts use three characteristics. This is the type of position, position and presentation of the fetus. It directly depends on them how the birth will take place - naturally or by caesarean section, as well as what difficulties may arise during this process. These characteristics will be discussed in the article.
Position view
The following types of fetal positions are distinguished: anterior and posterior. With front backthe fetus is turned anteriorly, with the posterior, respectively, posteriorly.
What is a presentation
The term "fetal presentation" is used to describe how the baby is positioned in relation to the pelvic inlet. The buttocks or the head of the baby can be turned towards it. Head presentation is the most common, it occurs in almost 97% of cases. This is the most favorable, correct position of the fetus for natural childbirth.
Head presentation: types, characteristics
There are several types of cephalic presentation, and not all of them are equally good for self-delivery. The most natural is the occiput, in which the head of the fetus is cut through, respectively, the back of the head, with an anterior view of the position, that is, one in which both the back and the back of the head of the fetus face anteriorly. Some of the types, namely the anterior head, frontal and facial, are relative indications for a caesarean section. These are the so-called extensor presentations.
Their reasons may be shortening of the umbilical cord, clinically and anatomically narrow pelvis of the woman in labor, decreased uterine tone, small or too large size of the fetus, stiffness of its atlanto-occipital joint, etc.
Extensor type of labor mechanism
Extension types of presentation, in which the fetal head is more or less moved away from the chin, are diagnosed during an internal vaginal examination of the mother. All of them pose a certain danger to the mother and fetus, lead to prolonged labor and complications. There are three types of extensor presentations, depending on the degree of extension of the head: anterior head, frontal and facial.
Face presentation
Opposite in all characteristics to the anterior occipital presentation, the case is the so-called facial presentation, in which the fetus comes out with its chin forward and an extreme, maximum degree of extension of the head is noted. The back of the head can literally lie on the shoulder girdle of the child. Facial presentations are rare (0.5%). Most often, this type of presentation occurs directly during childbirth (secondary), extremely rarely it is established during pregnancy (primary). In this case, the head is cut through the so-called front line, conditionally connecting the center of the forehead with the chin, and, having reached the pelvic floor, it unbends the chin forward.
Despite the difficulty, 95% of these births end on their own. In five percent of cases, emergency assistance is needed. After birth in the face presentation for 4-5 days, the newborn has swelling of the face and a characteristic extension of the head.
Frontal presentation
This type of presentation is quite rare, about 0.1% of cases. It is extremely traumatic, childbirth is characterized by a protracted course (up to a day in primiparas) and ends with the death of the fetus, according to various sources, in 25-50% of cases. According to statistics, only in slightly more than half of cases (approximately 54%) are possible natural childbirth withoutsurgical intervention. The severity of their flow is due to the fact that it is in the frontal presentation that the fetus must pass through the pelvis with the plane of the largest size. For a woman in labor, slow progress of the fetus through the birth canal is fraught with ruptures of the perineum and uterus, the appearance of fistulas and other complications.
The established stable frontal presentation of the fetus is currently considered a 100% indication for a cesarean section, which, in turn, is possible provided that the fetus has not yet had time to fix in this position when entering the pelvis. Since most often this position of the fetus is unstable, and is usually transitional from the anterior head to the front, during childbirth it can spontaneously move both to the occipital (rarely) and to the front, so the choice of expectant tactics of labor management makes sense. However, here it is extremely important not to miss the time for a caesarean section.
Anterior head presentation
In this presentation, the degree of extension of the head is the minimum possible (the chin is somewhat moved away from the chest). Primary anteroposterior presentation is extremely rare, its cause is the presence of a thyroid tumor in a child. More often it occurs during childbirth.
You can determine it by palpable large and small fontanelles, while with occipital presentation, only a small fontanel is available during examination. The head is cut through in the region of the large fontanel, that is, in a circle that corresponds to its direct size. A birth tumor in a child is usually also located in this area.
breech presentation
Pelvic is called this type of presentation, in which the fetus is located with the pelvic end to the entrance to the small pelvis of the woman in labor. The frequency of this pathology, according to various sources, can be 3-5%. Childbirth in this position is fraught with complications for both mother and child.
There are three main types of it:
- Buttock - the fetus is located with the buttocks down, the legs are bent, the knees are pressed to the stomach (up to 70% of cases).
- Leg (may be complete or incomplete) - one or both legs are unbent and located near the exit from the uterus.
- Mixed - hips and knees bent (up to 10% of cases).
Breech presentation has no external signs by which a pregnant woman could identify it. An accurate picture can only be given by an ultrasound examination after the 32nd week. If the breech presentation was not determined in advance, during a vaginal examination during childbirth, the doctor can determine it, depending on the type, by palpable parts - the coccyx, buttocks, feet of the fetus.
A caesarean section is most often recommended for delivery. The decision to choose an operative method or natural childbirth is made based on several indicators: the age of the expectant mother, the presence of certain diseases in her, the characteristics of the course of pregnancy, the size of the pelvis, the weight of the fetus and the type of its presentation, the condition of the fetus. When a boy is pregnant, a caesarean section is preferred, since the likelihood of complications in this case is higher. Most likely, such a decision will beaccepted in the case of foot presentation, as well as if the fetus weighs up to 2500 or more than 3500 g.
When complications occur during natural birth in breech presentation, such as placental abruption, fetal hypoxia, prolapse of body parts or the umbilical cord, a decision is made to perform an emergency caesarean section. This is also true for a situation where there is a weak labor activity and childbirth, respectively, is delayed.
What is the fetal position
There are such types of fetal position: longitudinal, transverse and oblique. In the first case, the axis of the body of the fetus is located along the longitudinal axis of the woman's uterus. In the second, respectively, - across it. The oblique position is intermediate between the longitudinal and transverse, while the fetus is located diagonally. The position of the fetus is longitudinal head - normal, physiological. It is most favorable for childbirth. Transverse, as well as oblique, are classified as incorrect fetal positions (photos can be seen later in the article).
Oblique and transverse position of the fetus
Are unfavorable for natural childbirth. With a transverse and oblique position of the fetus, the presenting part is not determined. Such situations are possible in about 0.2-0.4% of women in labor. As a rule, they are caused by he alth problems in a woman (tumors of the uterus), overdistension of the uterus due to multiple births, as well as entanglement of the umbilical cord in the fetus or its large size. A short umbilical cord is another possible reason for adopting this position.
When the fetus is in a transverse position, pregnancy canproceed without complications, but there is a risk of premature birth. Complications are also possible: leakage of water, rupture of the uterus, loss of parts of the fetus.
The optimal solution for the transverse and oblique position of the fetus is operative delivery by caesarean section. A woman in labor is hospitalized two to three weeks before the expected date of delivery to prepare for the operation.
Ways to fix things
With breech presentation, oblique and transverse position of the fetus, it is possible to perform special exercises for pregnant women in order to correct them. Exercise can be allowed by a doctor if there are no contraindications, such as:
- Placenta previa.
- Multiple pregnancy.
- Uterine hypertonicity.
- Fibroids.
- Scar on the uterus.
- The woman in labor has serious chronic diseases.
- Oligo or polyhydramnios.
- Bleeding
- Preeclampsia and others
Exercise should be combined with deep breathing. The complex might look like this:
- Lying on your back, raise your pelvis 30-40 cm above shoulder level and hold it in this position for up to 10 minutes (the so-called "Half Bridge").
- Standing on all fours, tilt your head. While inhaling, round your back, while exhaling, bend at the waist, raising your head up (this exercise is often called “Cat”).
- Let your knees and elbows on the floor so that the pelvis is higher than the head. Stay in this position for up to 20 minutes.
- Roll from side to side,lingering on each for 10 minutes.
When the fetus is oblique, it is recommended to lie down more often on the side where its back is turned.
It should be remembered that you can do exercises to correct the position of the fetus only on the recommendation and with the permission of a doctor. He may recommend other exercises. Thanks to the implementation of corrective gymnastics, the fetus can take the correct position within 7-10 days. Otherwise, it is considered ineffective.
External obstetric rotation to change the position of the child (according to B. A. Arkhangelsky)
In a hospital for a period of 37-38 weeks, it is possible to perform the so-called external obstetric rotation of the fetus, which is performed externally, through the abdominal wall, without penetration into the vagina and uterus. In this case, the obstetrician places one hand on the head, the other on the pelvic end of the fetus and turns the buttocks towards the back, and the head towards the child's abdomen. Currently, this procedure is practically not used. This is due to its low efficiency, since the fetus can take its former position if its causes have not been eliminated. In addition, there is a possibility of severe complications: the development of fetal hypoxia, placental abruption. In rare cases, even uterine rupture is possible. Therefore, the rotation of the fetus can be recommended only with normal fetal mobility and normal amount of water, normal size of the pelvis and the absence of pathologies in the pregnant woman and the child.
Manipulation is carried out under the control of an ultrasound machine withusing injections that relax the muscles of the uterus (ß-agonists).
Pedal twists, which were widely used earlier during childbirth, are now practically not used, as they can pose a great danger to the mother and fetus. Their use is possible in multiple pregnancies, in the event that one of the fetuses takes the wrong position.
After the transition of the position of the fetus to the head, correct, pregnant women are recommended to wear a special bandage with rollers to fix the baby. It is usually worn until the very birth. If the methods of correcting the position of the fetus described above did not work, two to three weeks before the expected date of delivery, the woman is hospitalized and the issue of choosing a natural or operative method of delivery is decided.
Position for multiple pregnancy
When there are several babies in the uterus, it can be difficult for them to get into the correct position due to lack of space. During pregnancy with twins, options are possible when both fetuses take the correct position, or one of them is presented with the pelvic end to the exit from the uterus. Much less common are cases when they are in different positions (longitudinal and transverse), or the location of both fetuses is perpendicular to the axis of the uterus.
In the normal course of childbirth, after the birth of the first of the babies, there is a pause in labor activity lasting from 15 to 60 minutes, and then the uterus adapts to the reduced size, and childbirth resumes. After the appearance of the second child, both afterbirths are born.
In childbirth with multiple pregnancy, the following complications are possible: discharge of the waters of the first fetus before the onset of labor, its weakness, accompanied by a delay in childbirth, the so-called clutch of twins, etc. With the wrong position of one or both fetuses, the situation is even more complicated. The decision about the method of delivery should be made by the doctor, since in many cases natural childbirth is dangerous for both the mother and the babies.
In closing
As can be understood from the above, the position of the fetus, its position and presentation are the main characteristics that are taken into account by doctors when choosing a method of delivery. It should be understood that in certain situations, natural childbirth is fraught with great complications. Therefore, if a specialist decides to perform a caesarean section, you must trust him. This will save both mother and child from serious he alth problems in the future.
