About 3-4% of full -term pregnancies, the child retains pelvic presentation by the time of birth. Why is this happening? How to prevent this situation? What to do if the baby does not manage to roll down down your head? Future mothers who are faced with the pelvic presentation of the fetus, tormented a lot of questions. Let's put all the dots over "and."
Types of pelvic presentations of the fetus.
Several types of pelvic presentations are distinguished depending on what part of the lower half of the child’s body is located at the entrance to the pelvis.
Perenial presentation:
- Pure gluteal presentation - the child’s buttocks are directed to the birth canal, and the legs are stretched along the body, the feet are located next to the head.
- Mixed gluteal presentation - the child’s buttocks are directed to the birth canal, and next to them are the feet, that is, the legs are bent at the knees.
Night presentation:
- Full - the baby’s legs are unbent in such a way that both of his feet are presented to the entrance to the small basin;
- incomplete - at the birth canal there are buttocks and one foot of the baby, while the second leg is extended upwards;
- The knee - one or both knees of the baby are directed to the birth canal.
Why does the fetus take pelvic presentation?
Obstetrician-gynecologists are convinced that if the fetus develops in normal conditions, and nothing prevents its growth and activity, then by the time of birth it will necessarily turn the head down. Nature is arranged in such a way that it is the head presentation that is the most optimal for the favorable process of birth. Therefore, for the development of the pelvic presentation of the fetus, there are necessarily certain predisposing factors. Unfortunately, in most cases, it is impossible to establish the exact cause of this condition. The proven method of preventing pelvic presentation also does not exist.
The risk factors of the pelvic presentation of the fetus include:
- boring two or more fruits;
- There are too many or too few amniotic fluids in the uterus;
- excessive activity or, conversely, the sluggish mobility of the baby;
- preceding births in the pelvic presentation;
- fetal growth or premature baby growth;
- narrow pelvis or its other structural features;
- Congenital abnormalities of the development of the uterus: saddle, bicolny, with a full partition;
- uterine fibroids or tumor of appendages;
- placenta presentation;
- short umbilical cord;
- Congenital malformations of the fetus.
Pay attention!
If the baby is born earlier than the 28th week, then the rate of pelvic presentation is 35%. And when the gestational age reaches 34–36 weeks, the risk of this situation is no more than 8%.
How does pregnancy flow with the pelvic presentation of the fetus?
Despite the presence of the above prerequisites for the development of pelvic presentation, most children are born completely healthy. Therefore, this diagnosis should not scare and upset future mothers.
If pregnancy is not accompanied by concomitant complications, then a woman may not feel at all that the fetus is located in the pelvic end. Nevertheless, some mothers note a slight soreness in the field of subordinate, since the hard head of the fetus presses on the bottom of the uterus. And if the legs are presented to the birth canal, the pregnant woman notes that most of the baby’s movements are localized in the lower abdomen.
How is the diagnosis of pelvic presentation?
In order to determine the intrauterine position during pregnancy, you do not need to resort to some sophisticated diagnostic methods.
The doctor conducts an external inspection of the abdomen, during which the bottom of the uterus is determined higher than usual. The obstetrician-gynecologist will easily determine where the head is located, since it is more dense to the touch than the buttocks.
In order to confirm the pelvic presentation of the fetus, an ultrasound study is performed by the future mother. Ultrasound allows you to additionally evaluate the estimated weight of the baby, the amount of amniotic fluid and the location of the placenta, which is necessary for planning the optimal method of delivery.
It is extremely important to confirm the pelvic presentation of the fetus for a period of 36 weeks of pregnancy, since after that the probability of a spontaneous coup of the baby is almost zero.
How to turn the baby with a pelvic presentation?
On the Internet, future mothers can come across many recommendations regarding how to turn the fetus while it is inside the womb. The most common of them are various gymnastic exercises and acupuncture. In fact, the effectiveness of either one or the other is not proven.
If you are convinced that gymnastics or acupuncture can help the fetus change the situation, then you can certainly use these methods. But first, be sure to consult with the obstetrician-gynecologist to exclude possible contraindications.
What are the peculiarities of conducting childbirth in the pelvic presentation?
In the modern world, women study a lot of literature in the process of preparing for childbirth. Increasingly, you can hear the desire to give birth to a natural way from expectant mothers. Nevertheless, the frequency of operational birth with a pelvic presentation is higher than vaginal.
This is due to a large number of related risk factors that the obstetrician-gynecologist evaluates, determining the tactics of delivery.
A planned operation, unlike emergency, allows expectant mothers to experience less stress. Therefore, if possible, the delivery plan is drawn up with a doctor in advance.
Indications for Kesarev section in a planned order:
- pregnancy period is less than 32 weeks;
- the presence of additional indications for the operation;
- a scar on the uterus after the previous cesarean section;
- any form of foot presentation of the fetus;
- Too small or large mass of the fetus (<2500 g or> 3600 g).
It would seem, why is the recommendation in favor of Caesarean section at a short time or with low weight? After all, the baby is smaller in size, which means it should be easier to go through the birth canal?! But this is not entirely true.
If the expectant mother has no indications for early births, the planned cesarean section is recommended to be carried out after 39 weeks of pregnancy. This period is optimal in order for the baby to reach its physiological maturity.
Is it possible to give birth to the pelvic presentation of the fetus?
Natural birth with a pelvic presentation is possible. If the expectant mother really wants to give birth herself, she can be offered vaginal birth subject to the following conditions:
- pregnancy period of more than 36 weeks;
- The cervix gradually expands as the baby omitives in the pelvic cavity;
- The mother’s pelvis is not too narrow that the baby can safely go through the birth canal;
- good health of the fetus without signs of hypoxia, growth retardation and developmental abnormalities;
- The estimated mass of the baby in the range is 2500–3600 g;
- gluteal form of presentation;
- There are no signs of extension of the head or throwing the handles;
- The absence of a scar on the uterus after the previous cesarean section or other operations.
When the attempts come, the condition of the child is under continuous CTG monitoring. This allows you to control the fetal heartbeat and, if signs of hypoxia appear, carry out a cesarean section. The doctors of our maternity hospital have appropriate skills for conducting such childbirth.
Is it possible to give birth to the pelvic presentation of the fetus?
If a woman opens her choice at natural birth, she should be warned of possible consequences.
During contractions with a pelvic presentation, complications such as:
- premature output of amniotic fluid;
- weakness of labor;
- loss of small parts of the fetus or umbilical cord;
- intrauterine hypoxia;
- a protracted process of childbirth.
Nevertheless, vaginal birth with a pelvic presentation is almost as safe as in the case of head presentation. To date, complications are very rare, because thorough selection of pregnant women, who are allowed to give birth independently.
If your baby, by the time of birth, decided to stay in the pelvic presentation, be sure that obstetrician-gynecologists of our maternity hospital will choose the optimal tactics of delivery so that only pleasant memories leave the birth. In the nine months of this year, in our hospital, 25% of the birth in the pelvic presentation were successfully carried out through the natural birth canal.
The publication was prepared by the obstetric observation department.
