Face presentation of the fetus: consequences and recommendations of doctors

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

From the moment of conception to the very birth, the expectant mother is constantly in fear for her little miracle, which has been in her womb all these 9 months. After all, the baby will have to go through a huge difficult path from a tiny cell to a little man, and on it he faces many problems.

If the pregnancy is going well, the fetus is developing correctly and no problems have been identified, then the woman may well give birth without any extraneous manipulations. But not everything always goes as we would like. One of the frequent pathologies that are a direct indication for caesarean section is the incorrect position of the fetus before childbirth.

A little information for future parents

A little baby literally from the first weeks of its attachment to the uterus begins to actively move and even push off the walls, since it is still too small and there is plenty of space in the uterus for it. But this freedom only lasts until the middle of the second trimester. Further, it becomes more and more difficult for the child to change the position. He is forcedtake the most convenient position for him and for future births in general, and in this state wait for the birth.

That is why obstetricians from the antenatal clinic, starting from 30 - 34 weeks, carefully monitor the location of the fetus in the womb and try to choose the best delivery option. And yet, you should not panic ahead of time: there are cases when a child at the very last moment somehow took the correct position and was born naturally in an absolutely he althy way.

What are the types of pathologies?

Usually an experienced obstetrician-gynecologist can determine the position of the fetus by probing the pregnant woman's abdomen, but the final verdict will be made after the ultrasound examination, and only then the doctors will decide how to deliver. Of course, you shouldn’t be very upset, but every expectant mother is simply obliged to know what pathologies can be and what to expect in a particular case.

So, the fetus can be in breech or cephalic presentation, which, in turn, have separate varieties. We will talk about them below. At the next admission to the LCD, the expectant mother can hear, in addition to the location of the fetus, about the so-called position. This term is used in medicine to compare the back of the child and the uterine wall. The baby can be located longitudinally, that is, head down or up, or across, respectively, head to the right or left.

With a longitudinal arrangement, natural childbirth without complications is possible if the baby's headlocated below, that is, closer to the birth canal. True, even in this case there are small nuances, but in general, a woman in labor is quite capable of giving birth herself.

In cases where the fetus is located transversely, natural delivery is completely excluded. In this case, there is only one way - a caesarean section.

breech presentation

This is the case when the child literally "sits" at the exit. In this case, breech presentation can, in turn, be of several types:

• gluteal (baby's head on top, buttocks below, legs raised closer to the face);
• foot (the child seems to be standing on his feet or, perhaps, only on one leg);

• mixed (with such a presentation, the baby can "sit" on the buttocks, bending the legs at the knees).

Birth in breech presentation is in principle possible, but very risky. During labor, both mother and baby can be seriously injured. Therefore, it is recommended to listen to the doctors and agree to a caesarean section.

Head presentation

This is the most correct and safest position, in which injuries for the baby and the woman in labor are minimized. In cephalic presentation, the baby's head is located at the very birth canal and appears first during childbirth.

Head presentation can also be divided into several types:

• Occipital - the most ideal and natur althe position of the child, in which the baby will move forward through the birth canal with the back of the head.
• Fronthead.

• Frontal - according to doctors, the most dangerous head presentation. In this case, the only way out is a caesarean section.

• Face presentation is almost as dangerous as frontal presentation. When moving through the birth canal, there is a risk of injury to the spine. It is on this type of pathology that we will dwell in more detail below.

What does facial presentation of the fetus mean and why is it dangerous?

This is the extreme degree of extension of the baby's head. Moreover, initially, when lowering, frontal presentation is observed, and only then it passes into the facial one. Usually such a presentation occurs immediately at the time of childbirth, but there are cases when such a condition occurs long before the onset of labor and is diagnosed using an ultrasound study.

According to some clinical data, this presentation is observed in approximately 0.30% of all pregnant women. At the same time, multiparous women are more prone to such pathologies than primiparas.

How is malpresentation diagnosed?

In face presentation, the baby's head leans back strongly and presses against the back, while the baby's chest is close to the walls of the uterus. All these conditions together create a number of characteristic signs with which an experienced obstetrician can easily determine the presence of a facial presentation of the fetus.

In the rightmaking a diagnosis, a vaginal examination will also be useful, which must be carried out very carefully so as not to harm the baby. The doctor can easily feel the chin on one side, and the nose and brow ridges on the other. In this case, the presence of facial presentation is beyond doubt.

Why is this happening?

This malpresentation of the fetus in the uterus is extremely rare, about 1 in 400 births. Multiparous women are more likely to be affected by this pathology. The reasons for the facial presentation of the fetus can be different: the narrow pelvis of the woman in labor, too low tone of the uterus, uneven contraction of its sides.

Face presentation of the fetus (child) can be both primary and secondary. The first option is observed extremely rarely, and is noted long before the onset of labor. The reasons may be different, for example, when a thyroid tumor is observed in a child. Secondary presentation is observed more often. It is formed from the so-called frontal. Basically, this happens with a narrow pelvis in a woman in labor.

Mechanism of labor in face presentation of the fetus

At the very beginning of labor activity with facial presentation, the baby's head, instead of bending, unbends backwards. Next comes the internal rotation of the head, this occurs during the transition from the wide part of the small pelvis to the narrow one. Then the chin is extended anteriorly, while the head is located in the pelvic floor. And finally, the eruption of the baby's face occurs. The end result is a rotation of the shoulders and the head exactly as it happens whenoccipital presentation.

Consequences of natural childbirth with facial presentation for the baby and mother

The consequences of facial presentation of the fetus (child) as a whole depend on the course of labor and the professionalism of doctors. It should be understood that such a pathology cannot but affect the condition of the baby. Immediately after childbirth, there is severe swelling and hemorrhage on the eyelids, lips of the newborn. The tongue and floor of the mouth become extremely swollen, leading to feeding problems in the first days of a baby's life.

The prognosis and consequences of facial presentation of the fetus are relatively favorable. Typically, 93% of women in labor do not require surgery and only 20% have had a perineal tear.

Unfortunately, despite a positive prognosis for face presentation of the fetus, the consequences for the child are not always favorable. Under such circumstances, the number of stillborns increases sharply. The main problem in this case is the entanglement of the umbilical cord, which is much more common than in occipital presentation.

Reviews from experienced moms

If you go through the numerous women's forums on the Internet, we can conclude that the consequences of facial presentation of the fetus, like reviews, may differ depending on the specific situation. Often women note that the primary presentation is not yet a sentence, and everything can change, that is, the baby can still turn as it should, at the most unpredictable moment. Many mothers are advised to perform a series of exercises to correctthe position of the fetus in the uterus, but before listening to their advice, it would be useful to consult a doctor about this.

But still it is worth being realistic and not waiting until the last miracle. If your gynecologist says that there is a facial presentation of the fetus, the consequences and causes of which force you to resort to a caesarean section, then you should not risk your and your baby's he alth, but rely entirely on the doctor's many years of experience.

How is childbirth with a similar pathology

If a facial presentation is established and there is no labor yet, expectant management is used. In other words, doctors will most likely put the expectant mother in the maternity hospital in advance, but they will not do anything. In most cases, nature itself decides everything and childbirth takes place without any serious consequences for the mother and baby. In the case of facial presentation, natural delivery, although complicated, is still possible. With frontal presentation, especially in combination with normal pelvic sizes and full-term pregnancy, natural childbirth is impossible. They will occur if frontal presentation becomes facial or anterocephalic, with a medium-sized fetus and a capacious pelvis.

If the opening of the cervix has begun, it is necessary to put the woman in labor on her back and try not to damage the fetal bladder. In the presence of a large fetus or a narrow pelvis of a woman in labor and a facial presentation of the fetus, the recommendations of doctors always converge in immediate surgical intervention. Otherwise, there is a risk of missing the most favorable time and causing serious harm to both the mother andbaby.

Why can the fetus take the wrong position at all?

As we have already mentioned above, nature is designed in such a way that before giving birth, the child takes the most favorable position for himself and his mother, that is, longitudinally, with the occipital presentation. But, alas, there are cases when something does not go according to plan and the baby is not located as it should. There may be several reasons:

• After repeated curettage, abortions, multiple births, and even cesarean section operations, hypertonicity of the lower parts of the uterus can be observed, while in the upper sections there will be a significant decrease in tone. Due to this condition, the fetus may push off from the entrance to the pelvis and take an unnatural position for him.
• An important role is played by the characteristics of the child himself, for example, a large or too active fetus, prematurity.
• Severe uterine anomalies (bicornuate, saddle uterus, fibroids), narrow pelvis.
• Twisted by the umbilical cord, as a result of which the mobility of the fetus is severely limited.

Methods for correcting malpresentation

There is a set of exercises with which you can adjust the location of the fetus even before the onset of labor. The complex will be recommended by the attending physician. In addition to gymnastics, such methods as diving into the pool, acupuncture, homeopathy, psychological suggestion, aromatherapy and even music therapy can be used. You cantry everything your heart desires, only with the condition: be extremely careful and do not hesitate to contact your gynecologist for any questions (even the most insignificant ones).

The effectiveness of such exercises, according to some reports, can reach 80%. But it is worth remembering that in no case should you do this without first consulting with a leading doctor. After all, the situation in each case is individual and there may be serious contraindications. So, direct contraindications to such gymnastics include scars and tumors on the uterus, placenta previa, preeclampsia, and severe inflammatory diseases. In this way, you can do significant harm instead of good.

And remember: in any case, the doctor must make the final verdict and he knows how serious everything is. And if the decision is made to do a caesarean section, there is nothing wrong with that. The main thing is that a he althy baby is born, and everything is in order with mom.