Breech presentation of the fetus: causes, exercises for turning the baby over, features of childbirth

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

About what is a breech presentation of the fetus, or TPP, many have probably heard, but what exactly is meant? In medical practice, there are many cases, some of them occur more often, while others are quite rare. Pregnancy is no exception here - so many unusual births were taken by obstetricians that it is just right to compose a whole novel, and in several volumes.

But the topic of our article concerns precisely the position of the child on the eve of childbirth. Let us touch on how it should be and what consequences its wrong position threatens. And also we will analyze the features of the position upside down, what can be done in this case.

Introduction to breech presentation

Pregnancy is a complex physiological process, the course of which cannot be predicted. Up to a certain point in time, the child in the womb is free, and he canswim as he pleases. However, as it develops, it grows up, and there is less and less space. In this regard, he occupies a certain position and remains in this state until the birth.

In some cases, a baby under 35 weeks old can change its position in the uterus several times, which in medical practice is called unstable. However, by a later date, he takes a certain position, and in most cases his head is pointing down. This is called head presentation. But sometimes he can take the position of the legs down, which, in turn, is called the breech (or foot) presentation, which is undesirable. Below, for clarity, there is a photo of a breech presentation.

Experts in the field of obstetrics and gynecology consider this position of the child a pathology, since it complicates the course of not only the pregnancy itself, but also the birth itself. Often this becomes one of the main causes of deviations in children's development.

There is a theory according to which there is a relationship between the development of the vestibular apparatus of the child and its position in the uterus. Since this organ of balance in the early stages of pregnancy is still only at the stage of development, it is impossible to diagnose pathology. It can be detected in a child only after his birth.

Before the onset of 33-34 weeks, the child can actively and freely move. In this case, the pelvic position is detected in 35% of pregnant women. As for the prenatal period, this kind of pathology occurs in 4% of pregnant women.women.

Types of pathology

What is typical, like almost every disease, there are several types of breech presentation, and each of them is further subdivided into subspecies. Breech presentation includes the following:

• In its pure form - of all cases of breech or foot presentation, this subspecies is observed in 75% of pregnant women. Only the buttocks of the child are directed to the small pelvis of the woman, while his legs are located along the body.
• Mixed pathology - here the legs of the fetus are bent and, together with the buttocks, are directed towards the exit of the uterus. This position occurs in 20-24% of cases.

Foot presentation has one more subspecies:

• Full - both legs of the fetus are facing the female pelvis.
• Incomplete - in this case, only one leg is in the wrong position.
• Knee - this subspecies holds the record for the number of reported cases - only 0.3%. Here, the child's knees are already turned to the pelvis.

As noted by many experts, the breech presentation of the fetus at 32 weeks of gestation is considered the most dangerous, as it can provoke prolapse of the umbilical cord or the limbs of the child. Asphyxia during childbirth is also not excluded. If the size of a woman's pelvis is impressive in size, then with a simple breech presentation, complications will not occur during childbirth.

Causes of uncharacteristic fetal position

Often, doctors are not able to find out for what reason the child takes an undesirable position before childbirth. However, some factors highlightcan. From the point of view of modern medicine, they include a genetic predisposition. In other words, if the expectant mother herself was born in this position, then her children can be born in the same way. At the same time, this theory has not yet been studied enough, although many obstetricians have recently also adhered to it.

It is very difficult to establish the exact cause of a breech presentation of a child. There will almost always be one or two circumstances leading to this. What kind of position a child takes depends on many factors, both in relation to the fetus and its mother. Let us first consider the so-called maternal causes, and then touch on some features of the development of the fetus.

Uterine problems

Among the main reasons for the incorrect presentation of the child in the womb are deviations in the development of the reproductive organ. The characteristic ones include the saddle uterus, the bicornuate uterus, and the doubling of the reproductive organ. In some cases, such pathologies are detected during pregnancy.

Uterine fibroids are not uncommon. In particular, we are talking about the large size of a benign tumor, which, purely at a mechanical level, creates an obstacle to turning the child upside down. No less serious danger is represented by myomatous nodes that grow into the uterine cavity.

Another reason for the breech presentation of a child is a decrease in the tone of the uterus and its contractility. This condition is typical for those women who have already given birth, and more than once, and in their historycases of abortion or curettage procedures have been recorded. Those women who have undergone a caesarean section (CS) or myomectomy have scars. As a result, the contractility of the middle muscular layer of the uterine wall decreases, and it is more difficult for the child to take a "comfortable" position.

Placenta previa also plays an important role. This is understood as the overlap of the internal os by the placenta, which can be complete or partial. Under normal conditions, the pharynx should be free, and the placenta should be located at least 7 cm from the internal pharynx. Its overlap creates a restriction on the stretching of the lower part of the uterus. The child also has few opportunities for the necessary rollover.

"Guilt" of the umbilical cord

The length of the umbilical cord may be the cause of the breech presentation of the fetus. And if it is short - less than 40 cm, then purely mechanically this also creates problems for moving the fetus in the uterine cavity. But if its length is within the normal range, then cases of spontaneous entanglement of the umbilical cord are not excluded. Often this can happen between the 23rd and 24th weeks of pregnancy. In this case, the baby cannot perform the rollover due to mechanical tension on the umbilical cord.

Amniotic fluid

In some cases, the cause of the pelvic position of the fetus may be polyhydramnios or oligohydramnios.

With polyhydramnios, due to an increase in the amount of amniotic fluid, prerequisites are created for a multiple change in the position of the fetus in the cavity of the reproductive organ. During the entire period of pregnancy, the child runs the risk of taking a pose upside down. But besides this, there is anotherless dangerous risk: the umbilical cord can wrap not only around the baby's body, but also around the neck.

With oligohydramnios, the amount of amniotic fluid, on the contrary, is reduced, which also interferes with the free movement of the fetus in the uterine cavity and leads to breech presentation. He simply does not have the opportunity to take the necessary and only correct position - head down.

Here you can consider one interesting case when the appearance of not one baby, but several is expected. This is a multiple pregnancy. With twins, almost always one child is positioned as needed (the head is pointing down), while the other has the pelvis facing down. The same goes for triplets.

Again, this is due to limited space in the uterine cavity. With the birth of the first baby, the birth canal expands, as a result, there are no problems with the promotion of the second child.

Bone structure

With an anatomical narrowing of the pelvis or bone deformity in a woman, it is also quite difficult for the fetus to take the desired position. Such a feature in the anatomy of a woman can occur due to injuries or any disease. Often it is provoked by rickets, bone tuberculosis or severe scoliosis.

Some features of fetal development

The main difficulty in breech presentation is caesarean section, only in some cases you can do without it. But more on this later, but for now, as promised, we will touch on those features of the intrauterine development of the child, due towhich he cannot assume the right position. First of all, this applies to fetal malformations, and they must be pronounced.

For example, there is an increase in the thyroid gland or cases of hydrocephalus, when the child's head exceeds the allowable size. Fortunately, such an anomaly is quite rare, and it will not be difficult to detect it using ultrasound. And this study, as you know, is highly reliable. And if a similar or any other case with a pronounced severity is diagnosed, a decision is made to terminate the pregnancy due to medical reasons.

If the size of the fetus is small, then he can freely "flounder" in the womb, as he pleases. This can usually indicate intrauterine growth retardation.

Possible consequences

What complications can the undesirable position of a child lead to? Maybe everything is not as bad as it seems, and childbirth with a breech presentation will go smoothly? Here it is immediately worth clarifying that the child’s posture, in which his legs are pointing down, is fraught with a serious danger, and more than one. In most cases, it is the foot presentation that provokes the threat of premature birth. In addition, preeclampsia or fetoplacental insufficiency may develop.

As a result, this negatively affects the formation of many body systems, including the nervous and endocrine systems. Also, such conditions often cause a decrease in the amount of amniotic fluid, fetal hypoxia, impaireddevelopment.

Only this is far from limited, before delivery with a breech presentation of the fetus, there may be the following cases:

• Toward the end of the gestation period, the medulla oblongata lags behind in development, the work of the pituitary gland is disturbed.
• In the testicles or ovaries, depending on the sex of the child, hemorrhage may begin. In some cases, the tissues of the body swell, as a result of which the germ cells die. As a result, this leads to azoospermia (severe male infertility), hypogonadism (testicular insufficiency due to a decrease in the level of sex hormones) and other pathologies.
• The supply of the necessary "life-giving" gas to the fetus is significantly limited, up to oxygen starvation.
• Heart starts beating faster.
• As a particularly severe case - the development of cerebral palsy.

However, all this can threaten the fetus in the womb. But if the risk of preterm birth has passed, then after the birth of the child it becomes very difficult for him to adapt to the environment. Many reviews of breech presentation confirm this. Anti-stress resistance is markedly reduced.

However, every pregnant woman should take into account that the foot presentation of the fetus for up to 34-35 weeks is not yet a pathology.

Signs of pelvic pathology

It is rather difficult to determine the type of TPP on your own, however, there is the only reliable sign - these are tremors that are felt only in the lower abdomen, while in other departments they are less pronounced or absent altogether. Another sign,which can be judged on TPP is the heartbeat of the child. With cephalic presentation, it is clearly heard below the navel, while with the reverse position of the fetus, the work of the heart is felt at the same level with the navel or above it.

As practice shows, many pregnant women are not even aware of TPP, only in the course of diagnostic studies is breech presentation of the fetus at week 32 or at another time. In addition, as is now clear, the abnormal position of the child negatively affects him. Therefore, it is necessary to visit the antenatal clinic as planned and not refuse the necessary examination.

Diagnosis of CCI

To establish the exact position of the baby in the uterine cavity, several methods are used:

• external examination (palpation of the abdomen);
• examination of the vagina;
• ultrasound.

During an external examination, the doctor feels the belly of the future mother to determine the displacement of the baby's head relative to the bottom of the uterus. In this case, it is located above the norm. Other signs of TPP are also detected. However, in some cases, palpation of the abdomen will not work. This applies to those women who are distinguished by a fuller physique or well-developed abdominal muscles. This also includes a double pregnancy, increased uterine tone.

During the examination of the vagina, you can find a soft and large formation directly at the bottom of the reproductive organ, which is the buttocksbaby.

You can finally verify the accuracy of the diagnosis and the need for a cesarean in breech presentation using ultrasound. In addition to breech presentation, this study will reveal other signs:

• Decrease in amniotic fluid.
• The nature of placenta attachment.
• Offset head position.

In some cases, the doctor may prescribe additional examinations such as Doppler ultrasound and KGT. This will establish the functional state of the child.

What should a mom-to-be do?

What is left for a woman to do if her baby is found to be in an undesirable position and there is not much time left before delivery? Is there really no way out?! Do not despair! As you know, the child independently assumes the necessary position, preparing for childbirth, which usually occurs with the onset of the 5th month of pregnancy.

But if he is still upside down during a scheduled checkup at a later date (over 35 weeks), action must be taken. Just do not panic, as stress does not benefit either the baby or the mother herself. Besides, there is still time.

Besides regular visits to the gynecologist and other necessary examinations for breech presentation of the fetus, what else can you do? You should follow the daily routine. In particular, you need a full and restful sleep, during the day you need to rest more, avoid stressful situations. As for nutrition, it is necessary to adhere to a fractional diet. That iseat small meals, but often throughout the day.

Medical support

Features of CCI are such that with the uncharacteristic position of the child in the womb, you need to closely monitor the course of pregnancy. With the advent of 38-39 weeks, she will be offered hospitalization in the clinic in order to determine the date and method of delivery. The examination itself consists of several planned items:

• First of all, the woman's medical history and her past pregnancies, if any, are studied.
• The general condition of the expectant mother is being examined, not only physical, but also emotional.
• When breech presentation of the fetus in the later weeks of pregnancy, a more accurate term is specified based on the obtained ultrasound data and the date of the last menstruation.
• The nature of the pelvic pathology is determined (breech or foot presentation), the degree of readiness of the cervix for childbirth, the condition of the placenta and fetal bladder.
• The size of the woman's pelvis is determined.
• Assessing the developmental status of the child. That is, it turns out its weight, the amount of amniotic fluid, there are any deviations, and so on.
• The sex of the child and the degree of extension of the head are also determined. Tellingly, boys are the most difficult to endure birth stress.

Based on the data obtained during these studies, one or another method of delivery is chosen.

Effective methodology

What else can help with breech presentation? How to turn a child so that there are no dangerous consequences?

There is a whole range of exercises for this:

• "Bridge". For this exercise, you need to choose a flat surface - a bed, a sofa, but the floor is still better. You will need to lie down, after which put 2 or 3 pillows under the lower back, while the pelvis will be 20-30 cm higher than the head. You need to stay in this position for 10-15 minutes. Exercise should be done 2-3 times a day before meals. In this case, the baby's head begins to rest against the fundus of the uterus, as a result of which he has a feeling of discomfort, and he begins to turn to eliminate it.
• Breath. You should take the starting position, legs apart shoulder-width apart, hands should be lowered. While inhaling, raise your arms, palms down, to shoulder level. At the same time, you need to rise on your toes, slightly bending your lower back forward. After that, you can slowly lower. Repeat 4 times per set.
• Gymnastics with breech presentation called "Turn" is no less effective. For this exercise, you need a solid surface, again, the floor will help out. You need to take a prone position and turn on the side towards which the back of the child is facing. Bend and press your legs to yourself and lie down in this way for 5 minutes. After that, you should take a deep breath, exhale and turn to the other side through your back. Also lie down for 5 minutes and breathe in and out. Breathing should be free and even. Depending on the position of the fetus, it is necessary to straighten the leg that is below (with transverse) or the one that is above (with pelvic). Now with every breath it followspress to the stomach, and on the exhale straighten. Movements should be performed slowly and within 10 minutes.
• "Bridge-2". Again, take a prone position, rest your feet on the floor, hands should be along the body. While inhaling, raise the pelvis up, linger for a few seconds, lower it as you exhale. After that, on the next breath, you should tighten the muscles of the perineum, and when you exhale, relax. Repeat this complex several times.

All these exercises for breech presentation of the fetus must be performed in the exact order in which they are given above. In this case, the muscles will be smoothly included in the work, which will avoid a sharp overload of the body. In the event that the child has turned as needed, you should continue to perform only the last exercise as a preventive measure until the very birth. According to many experts, the effectiveness of this method is 75%.

Peculiarities of childbirth at CCI

In cases where the situation could not be corrected at the 38th week of pregnancy, the woman is sent to the hospital and, depending on the situation, the optimal method of delivery is selected. It can be a natural birth, which every mother aspires to, or a surgical intervention (caesarean section).

Both methods differ in their indications. Reasons for caesarean delivery in breech presentation can be:

• Peter or breech (mixed) presentation given that this is the first birth.
• Fetal weight less than 2 kg or more than 3.5 kg.
• Low placenta.
• Dilated veins in the genital area.
• Anatomical constriction of the pelvis.
• Presence of preeclampsia.
• Uterine fibroids or other abnormalities in its development.
• There is a scar on the reproductive organ.
• Primparous women aged 30 and over.
• ECO.

Vaginal childbirth can go smoothly if:

• The size of the pelvis allows the baby to pass freely through the birth canal.
• The woman and her child are in satisfactory condition.
• A woman's body is fully prepared for childbirth.
• Only breech presentation.

In the event that the choice of the expectant mother fell on a natural birth with a breech presentation, a woman needs special preparation. For this, sedative and restorative drugs, including antispasmodics, are prescribed. In this case, the doctor must control the course of drug therapy! The cervix also needs to be prepared. This is done with the help of special injections and gels that are injected into the vagina. But if the cervix is still closed, then surgery is performed.

The wrong position of the baby in the uterine cavity is not a sentence - a woman can give birth, according to natural laws. However, with the existing threat to both the mother and the child, there is nothing left but to resort to CS.

As a conclusion

Pelvic pathology is the case of pregnancy when a lot depends on the actions of not only the woman herself, but also the medical staff. The task of obstetricians and gynecologistsconsists in vigilant and constant monitoring of the patient, the appointment of useful and special exercises. The result of such joint actions will be the birth of a he althy child.

And most importantly - do not panic if the doctor made a disappointing diagnosis - "breech presentation". What to do in this case, the specialist will tell you. Also, every expectant mother should read useful information not only regarding the topic of this article, but also how the pregnancy proceeds in general. No wonder there is one good saying: forewarned is forearmed!