Oblique presentation of the fetus: causes, possible difficulties, photo

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

Pregnancy is a dynamic process that ultimately ends in delivery. The course of this largely responsible and global stage affects not only the course, but also the tactics of childbirth. One of the most important parameters in this case is the position of the child in the uterine cavity. In some cases, you can meet the oblique presentation of the fetus.

At the same time, many people confuse two concepts that seem to be similar to each other: position and presentation. However, there is a difference here:

• The position is determined by the position of the child relative to the axis of the uterus.
• Previa depends on how exactly the fetus is turned in relation to the “exit” (cervical pharynx) of the reproductive organ.

The position can be longitudinal (the axes of the fetus and uterus coincide),transverse (the axes mentioned are perpendicular to each other) and oblique (the axes of the uterus and the child form a right angle). The only correct position of the child is longitudinal. It is considered the norm and is most common in obstetric practice.

As for the oblique and transverse position or presentation, this is already a pathological condition that creates insurmountable obstacles to the flow of childbirth in a natural way. But what can threaten oblique presentation of the fetus at 37 weeks of gestation?

Types of presentation of the child in the cavity of the reproductive organ

As we now know, the position of the child can be either longitudinal, peppered or oblique. As for the types of presentation, everything here is determined by the part with which the child is turned (head or pelvis).

Both the presentation and the position of the fetus in the cavity of the genital organ can change throughout the entire period of pregnancy. However, with the onset of the 33rd week, the child takes a stable position. By the end of the gestation period, the fetus is quite large, and it is more difficult for him to spin every day, since there is less free space for such maneuvers. The situation can go as far as oblique presentation of the fetus at 30 weeks of gestation.

Starting from the 34th week, the baby is preparing to go out. By this time, women feel contractions that are preliminary or training in nature, while the child begins to sink lower. The last ultrasound shows the final presentation of the fetus.

Head down

Postatistics, this is the most common form of presentation (up to 95% of all cases). At the same time, the very position of the fetus is longitudinal.

As already noted, each type of presentation is divided into several subspecies depending on the level of extension of the head:

• anteriorhead;
• occipital;
• front.
• frontal.

Let's look at each of them in more detail.

Fronthead

This situation is complicated by the fact that the head passes through the small pelvis in the largest size. This makes the birth process difficult. However, cases have been reported when, during delivery, the fetus changed the position of the head in order to facilitate the path of birth. This type of presentation may be considered as an indication for a caesarean section.

The same applies to oblique cephalic presentation of the fetus. However, this moment is purely individual. Each case must be considered separately as other aspects must be taken into account.

Occipital

As for the occiput presentation, this situation is considered the norm. In this case, a woman is able to give birth on her own and without outside interference. This is the most convenient way for the child and his mother to give birth. The baby moves along the birth canal with the back of the head forward, while his face is turned to the back of the woman. In another way, this is called an anterior occipital presentation. Here, a small fontanel acts as the leading point, which appears very first.

Also foundposterior occipital presentation, but such births occur in extremely rare cases (no more than 10%). Here the child's face is turned in the opposite direction to the back. Moreover, during the course of childbirth, the baby turns to take a more comfortable position. But despite this, the oblique presentation of the fetus ends at 32 weeks.

Execution

Like 32-week angulation, this is another rare occurrence (0.05%). This presentation is characterized by an average degree of extension of the head. At the same time, the passage of the baby through the birth canal is not that difficult - it is completely impossible! Therefore, this is another medical indication for a caesarean section.

Face

In this case, there is a maximum degree of extension of the head, which is also extremely rare, 0.25% of all generic cases. From a technical point of view, such childbirth can take place naturally. However, due to the peculiarities of such a presentation, this threatens to injure, not only the child, but also his mother.

For this reason, when a facial presentation is detected, a caesarean section is prescribed. This is the only way to avoid unreasonably high risk. True, it is also present during surgery.

Pelvis and legs out

But not only oblique presentation of the fetus at 35 weeks of gestation is undesirable. This case also does not bode well. Otherwise, this position of the child is called gluteal. Here, the ass is already facing the exit from the birth canal. In this case, too, there are several ways of birthbaby:

• pure glute;
• mixed;
• foot.

This type of presentation in obstetric practice also happens quite rarely, no more than 5%. Often, when it is detected, gynecologists give valuable recommendations or themselves begin to carry out those manipulations that allow you to turn the baby over.

In breech presentation, childbirth is considered pathological, as it can be accompanied by various complications:

• acute fetal hypoxia;
• birth trauma;
• weak labor activity;
• injury to the birth canal;
• squeezing the umbilical cord between the bones of the pelvis and the head of the child, which usually ends in his death.

If childbirth with oblique breech presentation of the fetus proceeds naturally, then almost always there is a certain difficulty associated with the removal of the baby's head. After all, the pelvic part appears first, which is noticeably smaller in size than the head.

In the case of a foot presentation, an important task becomes before the obstetrician: to prevent the legs from falling out until the baby takes the “squatting” position and begins to pass through the birth canal forward with the buttocks.

In any case, the birth of a child in a breech presentation is more difficult. Therefore, women may experience severe pain and therefore, under certain circumstances, doctors may decide in favor of a caesarean section.

Across or oblique?

Both oblique and transverse presentation of the fetus is straightmedical indication for a caesarean section. In this case, it is simply impossible to give birth to a baby.

Earlier in obstetric practice, special manipulations were common that allow you to turn the child by the limbs. However, now such an approach is under the strictest ban, because the implementation of this procedure threatens to cause significant harm not only to the child, but also to his mother.

The only case when such manipulations are allowed to be carried out is the birth of twins. That is, when the first child was already born, and the second at the same time took an inappropriate position (in an oblique or transverse direction with respect to the reproductive organ).

Reasons

Oblique presentation of the fetus in the uterine cavity can be due to a variety of reasons. They can be conditionally divided into two groups:

• features of the structure of the female body;
• diseases of the genital organs.

The features of the anatomical structure include a large or small amount of amniotic fluid, as well as a weakened state of the muscle fibers of the uterine wall. In addition, twin pregnancy and other aspects should be included here.

The number of different diseases and pathologies also varies widely. The most common cases are increased tone of the genital organ, the threat of miscarriage, a narrow pelvis.

Diagnosis

Diagnostic measures that are carried out to determine the posture of the child in the uterine cavity are complex. It is possible to identify the incorrect position of the uterus with the onset of the 30-32nd week of pregnancy. To do this, a number of necessary procedures are carried out:

• visual external inspection;
• visual internal inspection;
• palpation;
• Ultrasound.

During the external visual examination, you can determine exactly what position the child is in. The article contains photos of the oblique presentation of the fetus, so you can visualize the picture. Under normal conditions, the reproductive organ has an oval-elongated shape. The incorrect position of the fetus will be already noticeable visually: in this case, the abdomen will appear obliquely stretched (oblique presentation) or transversely stretched (transverse presentation). Due to the incorrect position of the child, the uterus becomes spherical, and not oval, as it should be. In addition, the bottom of the uterus in this case is not high enough.

Internal visual inspection is relevant when the waters have already receded and the uterine os is open a few centimeters. In this case, a vaginal examination should be carried out with a high degree of accuracy, since there is a risk of the handle or leg falling out, which is undesirable.

When performing palpation, you can also determine what position the baby is in. If the abdomen is soft and inactive in the upper part, and dense, rounded and movable below, this indicates the longitudinal position of the child. If the emptiness of the uterine fundus is felt from above and below, the head and buttocks are felt in the sides, the baby's position is not the most suitable. In the case of oblique presentation, the head is located in the iliaczone.

Ultrasound examination is able to determine the position of the child in the cavity of the reproductive organ with 100% accuracy. The resulting picture is a kind of picture of the oblique breech presentation of the fetus, only without bright colors.

Patrimonial activity

Directly oblique presentation of the child in the uterine cavity is the rarest case (1% of the total pool of pregnancies). This position can be determined by the 32nd week of the term. However, until the very birth, the possibility remains that the child will change position on its own.

Childbirth with such a pathological presentation is considered quite difficult. In extremely rare cases, they are carried out naturally. The main problem is the early discharge of amniotic fluid. There is also a risk of preterm birth. If the birth is natural, then both the mother and the baby can be traumatized.

If in the last weeks of pregnancy the baby continues to maintain the wrong position, the woman is usually hospitalized. In stationary conditions, doctors conduct the necessary additional examinations. In addition, it is necessary to develop tactics for optimal labor activity. Often, with an oblique presentation, a caesarean section is done as the only sure and safe way to have a baby.

Unwanted consequences

With oblique presentation of the fetus, favorable natural childbirth is unlikely. That is why, in most cases, doctors insist on an operation. Oblique position of the child in mostcases is accompanied by various complications:

• Prolapse of parts of the baby during the rapid discharge of amniotic fluid. If the umbilical cord is clamped, severe circulatory failure can occur and childbirth is usually fatal for the baby.
• Oxygen deficiency of the baby in the acute stage.
• Premature discharge of amniotic fluid. This happens due to the lack of pressure on the entrance to the small pelvis.
• Infection of the female genital organs. At the end of labor, as a rule, necessary therapy is required.
• Injury to the child during his passage through the birth canal.

If a number of problems arise, only a highly qualified obstetrician-gynecologist with extensive experience in conducting such childbirth can cope with the situation.

Special exercises

It is worth noting that the photo of the oblique presentation of the fetus should not intimidate expectant mothers.

As noted, this presentation is extremely rare, so the problem may be reversible. There are a large number of exercises that help the child turn in order to take the only correct presentation.

At the same time, it is impossible to show amateur activity in any case, since there are certain contraindications:

• myoma;
• placental presentation;
• previous pregnancy ended in caesarean section;
• a woman has a whole bunch of various diseases.

Howobstetric practice shows that in 50% of cases women managed to change the presentation of the child due to exercises. There are also cases when the baby independently changed its position a couple of days before delivery. So, even if surgery is scheduled, women should not panic, because the baby needs a happy mother. It is worth remembering that childbirth in this way in most cases proceeds without complications, the child is born he althy.

Advice from experts

But what can a woman do with an oblique presentation of the fetus in the uterine cavity? Experts recommend lying alternately on each side for 10 minutes, repeating 3-4 times a day. Another exercise that should be performed at least 3 times during the day will also be useful. A woman needs to lie with her pelvis raised 20-30 cm above the level of her head for 10-15 minutes.

Good results can give a knee-elbow posture. It must be done at the same frequency as the other exercises discussed.