The position of the fetus is the relationship of its axis (which passes through the head and buttocks) to the longitudinal axis of the uterus. The position of the fetus can be longitudinal (when the axes of the fetus and uterus coincide), transverse (when the axis of the fetus is perpendicular to the axis of the uterus), and also oblique (the average between longitudinal and transverse).
The presentation of the fetus is determined depending on the part of it that is located in the area of the internal os of the cervix, that is, at the point of transition of the uterus to the cervix (presenting part). The presenting part can be the head or pelvic end of the fetus; in a transverse position, the presenting part is not determined.
Up to 34 weeks, the position of the fetus may change, after this period it usually becomes stable.
Head presentation
Head presentation is determined in approximately 95-97% of cases. The most optimal is the occipital presentation, when the fetal head is bent (the chin is pressed to the chest), and when the baby is born, the back of the head moves forward. The leading point (the one that goes first through the birth canal) is the small fontanelle, located at the junction of the parietal and occipital bones. If the back of the fetal head is facing anteriorly and the face is posterior, this is an anterior view of the occipital preposition (more than 90% of births occur in this position), if it is the other way around, then it is a posterior view. In the posterior form of occipital presentation, childbirth is more difficult; during the birth process, the baby can turn around, but labor is usually longer.
With a cephalic presentation, the pelvic end of the fetus may deviate to the right or left, it depends on which direction the back of the fetus is facing.
There are also extension types of cephalic presentation, when the head is extended to one degree or another. With slight extension, when the leading point is the large fontanelle (it is located at the junction of the frontal and parietal bones), they speak of an anterior cephalic presentation. Childbirth through the natural birth canal is possible, but it takes longer and is more difficult than with an occipital presentation, since the head is inserted into the small pelvis with a larger size.
Therefore, anterior cephalic presentation is a relative indication for cesarean section. The next degree of extension is frontal presentation (it is rare, in 0.04-0.05% of cases). If the fetus is of normal size, delivery through the birth canal is impossible; surgical delivery is required. And finally, the maximum extension of the head is a facial presentation, when the fetal face is born first (it occurs in 0.25% of births). Childbirth through the natural birth canal is possible (in this case, the birth tumor is located in the lower half of the face, in the area of the lips and chin), but it is quite traumatic for the mother and fetus, so the issue is often decided in favor of a cesarean section.
Diagnosis of extensor presentations is carried out during vaginal examination during childbirth.
Fetal presentation and methods of delivery
Fetal presentation and methods of delivery are the topic of our conversation today.
Fetal presentation is the position of the baby in the uterus. It can be determined by performing an ultrasound diagnosis. The position, or more correctly, the presentation of the child can be cephalic, transverse, or pelvic.
Head presentation is the most natural and biologically correct, when the baby’s head is directed into the mother’s birth canal. This position of the child before the onset of labor does not cause concern among doctors and, as a rule, the birth proceeds without complications.
With a cephalic presentation, the baby may be directed not with the occipital part towards the birth canal, but with the frontal part. Another option for cephalic presentation is facial presentation. The child begins to move facing forward. In both cases, such a position of the fetus upon the onset of labor is unacceptable - the likelihood of injury to the child is very high. In such cases, a Caesarean section is performed.
Another option for the position of the baby is pelvic or also called gluteal - when the buttocks are tightly pressed to the mother’s pelvic floor, and the baby’s legs are located near his face.
Leg presentation - both or one leg is extended towards the entrance to the birth canal.
Both pelvic and leg presentation of the fetus are always only delivery by Caesarean Section.
Firstly, in this situation, the child will not be able to pass through the mother’s birth canal on his own. The likelihood of receiving a birth injury - a dislocated leg, entanglement in the umbilical cord and, as a result, hyposkia of the fetal brain - is quite high.
Secondly, there is a danger to the woman’s life. If the fetus is in an unnatural position during childbirth, internal organs can be damaged – ruptures, which can cause bleeding.
The transverse position of the baby is also an indication for surgery.
When can you find out in what position the baby is developing? This usually happens by the middle of the second trimester. The baby becomes less mobile and takes up a position in the uterus in which it would normally grow until birth.
At 32 weeks, expectant mothers undergo an ultrasound scan, where special attention is paid to the location of the baby in the mother’s belly.
Incorrect presentation of the fetus and a doctor’s recommendation to undergo surgery are not a reason for grief.
No one can take away your joy from motherhood. But it will only intensify when you see your baby born strong and unharmed. And your health will contribute to this joy.
Breech presentation of the fetus
Breech presentation occurs in 3-5% of cases and is divided into foot presentation, when the fetal legs are presented, and breech presentation, when the baby seems to be squatting and his buttocks are presented. Breech presentation is more favorable.
Birth in a breech presentation is considered pathological due to the large number of complications in the mother and fetus, since the less voluminous pelvic end is born first and difficulties arise when removing the head. In case of pedicle presentation, the doctor delays the birth of the child with his hand until he squats down to prevent the leg from falling out; after such assistance, the buttocks are born first.
Breech presentation is not an absolute indication for cesarean section. The question of the method of delivery is decided depending on the following factors:
- the size of the fetus (with a breech presentation, a large fetus is considered to be more than 3500 g, while during normal childbirth - more than 4000 g);
— the size of the mother’s pelvis;
- type of breech presentation (foot or buttock);
- sex of the fetus (for a girl, breech birth is associated with less risk than for a boy, since a boy may have damage to the genital organs);
- woman’s age;
- the course and outcome of previous pregnancies and births.
To turn the fetus after 31 weeks, the following exercise is recommended: lie on the right side, lie down for 10 minutes, quickly turn over to the left side, after 10 minutes again to the right, repeat 3-4 times several times a day before meals. You need to stand in the knee-elbow position for 15-20 minutes a day. Exercises in the pool also contribute to fetal rotation. If the baby turns over on his head, it is recommended to wear a bandage to fix his correct position.
Contraindications for performing such exercises are complicated pregnancy (preeclampsia, threat of premature birth), a scar on the uterus after a cesarean section in the past, placenta previa, uterine tumors.
Previously, external rotation of the fetus was used (the doctor tried to move the fetal head down through the abdomen). Now it is not used due to low efficiency and a large number of complications, such as premature placental abruption, premature birth, and fetal impairment.
If breech presentation persists, then 2 weeks before birth the pregnant woman is sent to a hospital, where a delivery plan is drawn up.
How to understand that it’s time to go to the hospital
There are two reliable signs that it’s time to go to the maternity hospital. This:
- Leakage of amniotic fluid. The amount of discharge has increased, but is it liquid and transparent? Watch the baby's movements. Change the pads and start calmly getting ready for the maternity hospital. If the waters are green, you need to go to the maternity hospital faster.
- Regular contractions. The first real contractions are quite noticeable and last from 30 seconds with an interval of 10 minutes.
In addition to the obvious symptoms of impending labor, there are several other reasons to go to the maternity hospital. I recommend talking to a doctor and getting additional examination when a woman has:
- Appearance of blood. We saw a bright scarlet spot on the pad, felt local pain in the uterus, we couldn’t hesitate. This may be associated with varicose veins of internal organs and may not be dangerous, but it may indicate placental abruption, which is very serious.
- Pressure change by 20 units. It doesn’t matter whether your blood pressure is high, low or normal, in the last stages of pregnancy it should be monitored by measuring it in the morning and evening. If the indicators increase by more than 20 units, hospitalization in a maternity hospital is required.
- Atypical fetal movement. You are already accustomed to certain movements of the baby, but it happens that their character suddenly changes. Sudden body movements lasting about 2 hours, followed by a period of complete freezing, may be a signal of a lack of oxygen and developing fetal hypoxia.
- Abdominal injury. Expectant mothers try to follow safety precautions, but no one is immune from troubles. A sharp blow to the abdominal area or a fall can cause premature birth. To be on the safe side, you need to go to the maternity hospital and do an ultrasound or CTG.
These symptoms do not mean that you or your baby are in danger. However, reinsurance won't hurt.
Every woman's body is individual. This also applies to the degree to which signs of impending labor appear. The main thing is to treat yourself carefully, listen to your feelings, trust your intuition, and if you have the slightest concerns, consult a doctor.
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Transverse and oblique position of the fetus
Transverse and oblique positions of the fetus are an absolute indication for a cesarean section; childbirth through the birth canal is impossible. The presenting part is not determined. Such situations are determined in 0.2-0.4% of cases. The previously used turns by the leg during childbirth are no longer used due to the high traumatic impact on mother and baby. Occasionally, a similar rotation can be used in case of twins, when after the birth of the first fetus, the second has taken a transverse position.
The transverse position may be due to tumors in the uterus (for example, fibroids), which prevent the normal position from being assumed, in multiparous women due to overstretching of the uterus, with a large fetus, with a short umbilical cord or entwined around the neck.
If there are no reasons preventing the fetus from turning onto its head, you can perform the same exercises as with a breech presentation. In an oblique position, you need to lie more on the side where your back is predominantly facing.
2-3 weeks before giving birth, a woman is hospitalized to prepare for surgical delivery.
How is the baby positioned in the tummy?
In the initial stages of pregnancy, the fetus is small in size, so it can rotate freely in the mother’s tummy. By the end of the second trimester, the baby strives to occupy a permanent position in which it will remain until birth. Around the 18th week, the woman begins to feel the first tremors. The toddler moves his legs, arms, and turns his head. Now his movements are a kind of communication with mommy. In this way, the child can report if something is wrong with him.
From approximately 30-32 weeks, the baby takes a permanent position. Head presentation is considered ideal for childbirth. In this case, the baby's head is lowered into the pelvis. With a breech or transverse presentation of the fetus, the prognosis is not so favorable, but do not panic. With the help of special exercises, you can help the baby roll over into the correct position up to 35 weeks.
If the baby still does not turn over, the gynecologist may prescribe a planned Caesarean section for the patient. This will protect the mother and her baby from the development of various complications during childbirth. Caesarean section is usually performed for breech or transverse presentation of the fetus. Sometimes surgical intervention is also required when the baby is in a cephalic extension position.
Sometimes, based on when the baby turned over in the womb, a specialist can assume that contractions should be expected in a month and a half.
Position of fetuses in twins
With twins, vaginal delivery is possible if both fetuses are in the cephalic presentation, or if the first (which is closer to the exit from the uterus and will be born first) is in the cephalic presentation, and the second in the breech. If, on the contrary, the first is in a breech presentation, and the second is in a cephalic presentation, the situation is unfavorable, since after the birth of the pelvic end of the first fetus, the babies can get their heads caught.
When determining the transverse position of one of the fetuses, the issue is resolved in favor of a cesarean section.
Even with a favorable position of the fetuses, the question of the method of delivery for twins is decided not only based on the position, but also depending on many other factors.
