During pregnancy, around 28 weeksterm, the doctor of the antenatal clinic faces the task of determining the part of the fetus that can be felt in the lower part of the uterus. This is called the presenting part of the fetus, and it is this part that, having passed through the birth canal, appears first in our world. The most successful option is considered to be the longitudinal position with the head down, also known as the cephalic presentation. This is due to the fact that the head is the largest part of the baby's body in diameter and its passage is associated with the main problems during childbirth. After its exit, the birth of the legs, arms, and body of the baby proceeds easily and is not so painful. Unfortunately, this situation does not always occur, and there are cases when the fetus in the uterus is presented with a shoulder, that is, it is located transversely, or even rests against the lower part of the uterus with its legs or buttocks. I would like to dwell in more detail on the second case, the so-called breech presentation of the fetus. It is worth considering that up to 36 weeks, the position of the fetus can change, so determining the breech presentation of the fetus at 28 weeks of pregnancy cannot be a final diagnosis. In addition, many techniques and special exercises have been developed to date to change the position of the child to a more favorable side. Doctors distinguish between breech, foot, knee, and pelvic presentation of the fetus. In turn, breech is divided into pure breech presentation and mixed. In the first case, the baby's buttocks are presented in the lower part of the uterus, and its legs are extended in the direction of the body, while they are straightened at the knees and bent in the pelvic area. In the second case, the buttocks are located at the entrance to the pelvis together with the legs, which are bent at the knees and hip joints. Foot presentation can be complete and incomplete. In the case of complete foot presentation, both legs are facing the entrance to the small pelvis, slightly straightened at the knees and hip joints. In the incomplete case, only one leg is presented, which is straightened at the joints, and the second lies higher and is bent in the pelvic area. The last type of breech presentation of the fetus is knee presentation, characterized by the location of the baby's bent knees in the lower part of the uterus. As a rule, breech presentation is found in 3-5% of pregnant women, with the most common being pure breech presentation (about 67% of cases), less common are mixed breech (20%) and foot (13%).
Causes of the problem
What causes pelvic pain?presentation of the fetus? In most cases, breech presentation occurs as a result of a decrease in excitability and tone of the uterus. This reduces its ability to contract to change and correct the position of the fetus in the uterine space. According to experts, the most serious factors in the development of breech presentation include:
- Various anomalies in the development of the fetus and low blood pressure, which reduce the mobility of the fetus;
- The presence of increased mobility in the situation of premature pregnancy and polyhydramnios;
- Factors that prevent the fetus from settling in the right position, such as placenta praevia, a narrow pelvis, tumors of the lower region of the uterus and some vices in the ripening of the fetus.
Why is pelvic presentation a pathology?
This is explained by the fact that childbirth in a situationbreech presentation of the fetus is accompanied by various complications (fetal asphyxia, birth injuries) much more often than with cephalic presentation. In addition, in the case of breech presentation of the fetus, there is often a need for surgical intervention. As a rule, this is planned in advance, especially if the breech presentation of the fetus is 38 weeks or more. Determination of breech presentation of the fetus occurs during an examination by an obstetrician-gynecologist, and is subsequently confirmed by ultrasound. In most cases, the diagnosis of this pathology does not cause serious difficulties, but in cases of increased uterine tone, multiple pregnancy, obesity and strong tension of the muscles of the anterior abdominal wall, minor problems may arise. During the examination, the specialist feels a large rounded part of the fetus above the entrance to the small pelvis, which has a soft consistency and flows into the body of the fetus. In the lower part of the uterus, as a rule, the head of the child is palpated, while a high position of the fundus of the uterus is noted. The fetus's heartbeat is usually heard in the area of the mother's navel and slightly higher. In turn, ultrasound, in addition to presentation, allows identifying fetal developmental abnormalities, its size, and determining the location of the placenta. If breech presentation is detected, the type of fetus, the degree of head extension, and the location of the fetal legs and umbilical cord are determined. In addition, Doppler ultrasound (blood flow ultrasound) is performed, which allows examining the uteroplacental blood flow and identifying the presence of umbilical cord pathology. In some cases, doctors use amnioscopy to study the condition of the fetus with this type of presentation. It involves observing the fetus and the surrounding fluid through the fetal membranes by inserting a special tube into the cervix. Due to the risk of damage to the fetal membranes and loss of amniotic fluid, this technique is used exclusively to diagnose conditions that threaten the fetus (post-term pregnancy, hypoxia, etc.). Every expectant mother, regardless of the type of presentation, undergoes pelvic measurements – pelviometry. As a rule, standard external measurements are not enough to identify possible pathologies, so computer tomographic pelviometry and X-ray pelviometry are additionally used. The use of these methods allows for a more accurate determination of the type of breech presentation of the fetus and its diagnosis.
Conducting pregnancy with pelvic presentation of the fetus
The course of pregnancy in the presence of pelvicpresentation in most cases is similar to that of cephalic presentation. When the term reaches 32 weeks, specialists of the antenatal clinic should offer to use a number of exercises to convert the breech presentation to cephalic. The most common exercises are the following:
According to doctors, the effectiveness of thisThe complex is approximately 75%. Special exercises are performed as prescribed by the doctor who is monitoring the pregnancy and determines the breech presentation of the fetus at 33 weeks plus or minus 1-2 weeks. However, there are a number of contraindications for the use of exercises of this kind. These include placenta previa, uterine tumors, uterine scars from previous operations, late toxicosis and complex extragenital diseases. If there is no result from performing gymnastic exercises, it is recommended to perform a preventive external cephalic version. This procedure is performed between the thirty-third and thirty-seventh weeks in an obstetric hospital under the supervision of an ultrasound machine. Before the fetal version, the patient is given special means to relax the uterus. This procedure is not suitable for everyone, and there are a number of contraindications:
- obesity;
- age at first birth more than 30 years;
- scars on the uterus;
- risk of abortion;
- toxicosis;
- too narrow a basin;
- polyhydramnios or hypochlorism;
- placenta previa;
- severe extragenital diseases;
- umbilical cuff;
- pregnancy as a result of the use of reproductive technologies.
In conclusion, I would like to say that formodern medicine, breech presentation is not a serious problem and the baby is born healthy. So don't get upset about it and darken the happiest days - the days of waiting for your miracle! We recommend reading:
