During pregnancy, about 28 week period before the physician prenatal problem arises in determining that part of the fruit, which can be felt in the lower part of the uterus. It is called the presenting part of the fetus, and that she passed the birth canal, the first appears in our world.
The most successful variant is considered longitudinal position head down, it is cephalic presentation. This is due to the fact that the head is the largest part of the baby's body in diameter and with its passage of the main challenges during childbirth. After the birth of her exit legs, handles, and body baby is mild and not as painful.
Unfortunately, this situation is not always, and there are cases when the fetus is in the uterus predlezhit a shoulder that is located laterally or at all rests on the lower part of the uterus feet or buttocks. I would like to elaborate on the second case, the so-called breech position of the fetus.
It should be borne in mind that up to 36 weeks fetal position may change, so the definition of breech fetus at 28 weeks of pregnancy can not be the final diagnosis. In addition, to date, developed a variety of techniques and special exercises aimed at changing the position of the child in a more favorable direction.
Doctors distinguish breech, foot and knee, breech presentation of the fetus.
In turn breech divided into pure and mixed breech presentation. In the first case the bottom of the uterus predlezhat buttocks of the child and his feet stretched out in the direction of the body, and they are unfolded in the knees bent and the pelvis. In the second case at the entrance to a basin located buttocks with the legs are bent at the knees and hips.
Foot previa can be complete or incomplete version. In a situation of complete previa foot to the entrance of the pelvis, both feet are turned slightly to straighten the knee and hip joints. Incomplete - predlezhit only one leg, which straighten the joints, and the second is above and is bent in the pelvis. The latter type of breech - the knee, characterized by an arrangement in the lower part of the uterus bent knees child.
As a rule, breech presentation is diagnosed in 3-5% of pregnant women, the most common is purely breech presentation (about 67%), rarely can be found mixed gluteal (20%) and foot (13%).
The causes of the problem
What is the cause of the breech fetus? In most cases, breech presentation is a result of the fall of excitability and uterine tone. Thereby reducing its ability to shrink to change and adjust the position of the fetus in the uterus area. According to experts, the most serious factor of breech fetus include:
- Various abnormalities in fetal development and water scarcity, which reduces the mobility of the fetus;
- The presence of increased mobility in a situation of incomplete pregnancy and polyhydramnios;
- Factors that interfere with the fetus stay in the correct position, such as placenta previa, narrow pelvis, tumors of the lower region of the uterus and some defects in the maturation of the fruit.
Why breech is pathology?
This is due to the fact that the labor situation in the breech fetus accompanied by various kinds of complications (asphyxia, birth trauma) much more frequently than in the head. Besides, in the case of the breech, it is often necessary surgical intervention. Typically, such pre-planned, especially if it breech 38 weeks or more.
Definition of breech fetus takes place during the examination obstetrician-gynecologist, and later confirmed by the passage of ultrasound. In most cases the diagnosis of this disease does not cause serious problems, but in cases of increased tone of the uterus, multiple pregnancy, obesity and severe muscle tension anterior abdominal wall may have a little trouble.
During the inspection specialist at the entrance to the pelvis feels large rounded part of the fruit, which has a soft texture and flows into the body of the fetus. In the lower part of the uterus, usually detectable head of the child, while there is high fundal. The beating heart of the subject of the fetus is usually tapped into the navel and just above the mother.
In turn, the US, in addition to presentation, reveals abnormalities in fetal development, its size, and set the location of the placenta. If you find breech determine its type, degree extension of the head, the arrangement of the legs of the fetus and umbilical cord. Furthermore held Doppler (ultrasound blood flow), which allows you to explore the utero-placental blood flow and detect the presence of umbilical cord pathology.
In some cases, to examine the status of the fetus in this type of previa doctors use amnioscopy. It is to monitor the fetus and surrounding water through the membranes by means of introduction of the cervix special tube. In view of the risk of damage to the membranes and loss of amniotic fluid, this technique is used solely for the diagnosis of conditions threatening the fetus (prolonged pregnancy, hypoxia, etc.).
Every expectant mother, regardless of the type of presentation, the measurement is the size of the pelvis - pelviometriyu. As a rule, the external measurement standard to identify possible pathologies enough, so further used computer tomography and rentgenpelviometriya pelviometriya. Using these methods can more accurately determine the type of breech fetus and diagnose it.
Prenatal breech fetus
Pregnancy in the presence of breech in most cases similar to that in the cephalic presentation. Upon reaching a period of 32 weeks prenatal specialists have to offer a series of exercises used to transfer breech in the head. The most common are the following exercises:
- It is necessary to lay down on the sofa with a flat surface on one side, which offset the fetal head. Lying on this side for 3-10 minutes after which the same time to hold at the other side. This exercise is to be performed 2-3 times daily. Thus it is desirable to sleep on the side, which is biased toward the head of the child.
- Take the position of lying on his back, after placing a pillow under your lower back to lift the hips 20-30 cm above the level of the head. This situation should be maintained for 5-15 minutes. This activity allows gravity baby's head rests against the bottom of the uterus, and the fruit itself often rotated in cephalic presentation. Perform it should be 2 times a day on an empty stomach.
According physicians effectiveness of this complex is approximately 75%. Special exercises performed by a physician who is pregnant and determines breech fetus 33 weeks plus or minus 1-2 weeks. However, there are contraindications to the use of this kind of exercise. These include placenta previa, uterine cancer, uterine scar from previous operations, late toxicosis and complex extragenital diseases.
In the absence of results from the execution of gymnastic exercises it is recommended that prophylactic external cephalic version. This procedure is carried out between the thirty-third and thirty-seventh week in a hospital under the supervision of obstetric ultrasound machine. Before the turn of the fetal patient is administered special means to relax the uterus.
Suitable such a procedure is not for everyone, and there are a number of contraindications:
- age at first birth for over 30 years;
- scars on the uterus;
- the risk of miscarriage;
- too narrow pelvis;
- polyhydramnios or oligohydramnios;
- placenta previa;
- severe extragenital diseases;
- cord entanglement;
- pregnancy resulting from the use of reproductive technologies.
In conclusion, I would like to say that modern medicine breech presentation is not serious and the baby is born healthy. So do not be upset about it, and mar the happiest days - the days of waiting for your miracle!