How the birth will take place depends on the location of the fetus in the mother's tummy. If the child has a normal posture, then the woman may well give birth on her own. If the baby is not located as intended by Mother Nature, then a caesarean section is necessary. Among the characteristics of the posture are: the presentation of the fetus, its position and the type of position.

Let's try to figure out what these terms mean.

The fetus grows and develops in the uterus throughout pregnancy. From a tiny embryo, he gradually turns into a little man. In the first half of pregnancy, he can change his position quite often.

With the approach of childbirth, the activity of the fetus decreases, since it is already very difficult to change the position, because it grows, and there is less and less free space in the uterus.

After about 32 weeks, you can already find out the presentation of the fetus, that is, to determine which part of the child's body (head or buttocks) is located at the entrance to the small pelvis. Sometimes doctors talk about the position of the baby in the tummy before 32 weeks.

Some women in position are given this information at 20-28 weeks of pregnancy. However, it should not be taken seriously at such an early date, because the baby can change the position that is objectionable to him several times.

There are the following types of fetal presentation:

1. Pelvic (the pelvic end of the child lies at the entrance to the woman's small pelvis):

• buttock. The fetus is located in the uterus head up. The legs are extended along the body. The feet are practically at the head;
• foot presentation of the fetus. At the entrance to the small pelvis, one or both legs of the baby can be located;
• mixed (gluteal-leg). Buttocks and legs are presented to the entrance to the small pelvis of a pregnant woman.

2. Head (the head of the child lies at the entrance to the female pelvis):

• occipital. The back of the head, facing forward, is the first to be born;
• anterior parietal or anterior head. The head is the first to be born during childbirth. At the same time, it passes through the birth canal several big size than with occipital presentation of the fetus;
• frontal. For this species, it is characteristic that the forehead serves as a conducting point during expulsion;
• facial. This presentation is characterized by the birth of the head with the back of the head.

Types of breech presentation occur in 3-5% of women in position.

Head presentation is the most common (in 95-97% of pregnant women).

Fetal position: definition and types

Obstetricians-gynecologists call the ratio of the conditional line of the child, passing from the back of the head to the coccyx along the back, to the axis of the uterus - the position of the fetus. In the medical literature, it is classified as follows:

• longitudinal;
• oblique;
• transverse.

The pelvic or head presentation of the fetus in the longitudinal position is characterized by the fact that the axes of the uterus and fetus coincide. With an oblique variety, conditional lines intersect at an acute angle. If the doctor has established a pelvic or head presentation of the fetus, a transverse position, this means that the axis of the uterus intersects the axis of the fetus at a right angle.

Together with the presentation and position, obstetrician-gynecologists determine position type. This term refers to the relationship of the child's back to the uterine wall. If the back is facing forward, then this is called the anterior view of the position, and if backward, the posterior view (or posterior presentation of the fetus).

For example, the doctor may say that the baby is in the uterus in the occiput, longitudinal, anterior position. This means that the baby is in the uterus along its axis. Its back of the head is adjacent to the entrance to the small pelvis, and the back is turned to the front side of the uterus.

Anterior presentation of the fetus is most common. The second variety is less common. The rear view of the position, as a rule, becomes the cause of protracted labor.

Incorrect presentation of the fetus: their features, options for childbirth

Head presentation of the occipital type is the most common and correct position in which babies are born. All other types of presentation are incorrect.

Childbirth at various types considered pathological. During delivery, serious complications can occur (for example, hypoxia of the child, infringement and extension of his head, throwing back the handles). Most often, childbirth is carried out by caesarean section, especially if the baby is male. However, natural childbirth is not excluded.

The specific delivery option for mixed, foot, breech presentation of the fetus is chosen by the doctor depending on various factors.

Childbirth with extensor presentation of the fetus (anteroparietal, frontal, facial) rarely passes naturally. With the anterior parietal form, the tactics of delivery is expectant. A caesarean section is performed when there is a threat to the health and life of the mother and baby.

Self-delivery with frontal cephalic presentation is undesirable, since ruptures of the uterus and perineum, asphyxia and death of the child are possible.

With facial presentation, the fetus can be born both through natural childbirth and with the help of surgery. The first option is chosen only if the female pelvis is of normal size, labor is active, and the size of the fetus is small.

Features of low presentation of the fetus

Very often, doctors diagnose pregnant women with a low presentation of the fetus, which implies the premature lowering of the baby's head into the pelvis.

Normally, this process occurs closer to childbirth, 1-4 weeks before them. However, in some pregnant women, due to certain anatomical features, this can happen much earlier.

Low presentation can be determined by the doctor during the examination by palpation of the uterus. The head is located quite low, and at the same time it is motionless or slightly mobile.

The pregnant woman herself can feel the consequences of lowering the baby's head - it will become easier for her to breathe, heartburn will decrease.

The low location of the fetus is a danger to him. The pregnancy may be terminated. To prevent this from happening, a woman should be much more attentive to herself. If the pregnant woman feels unwell due to the low location of the baby, then the specialist can recommend methods of treatment and preventive measures.

Incorrect positions of the fetus: their features, options for childbirth

Incorrect positions are such postures of the child in the mother's tummy, in which the longitudinal axis of the uterus does not coincide with the longitudinal axis of the fetus. They occur in 0.5-0.7% of cases. With women who give birth not for the first time, this happens most often.

Among existing species there are two incorrect positions of the fetus: oblique and transverse. The course of pregnancy with them is not characterized by any features. A woman may not suspect that her baby is not located in the tummy in the way that nature predetermined.

Incorrect positions and presentation of the fetus can be the cause of premature birth. If medical care is not available, then there will be serious complications (early outflow amniotic fluid, loss of fetal mobility, prolapse of a pen or leg, uterine rupture, death).

If a pregnant woman has an oblique position of the fetus, then she is laid on her side during childbirth in order to achieve a change in the position of the child (it can change to longitudinal or transverse), but this is not always possible. If the oblique position is preserved with the pelvic or cephalic presentation of the fetus, then delivery is carried out by surgery.

Causes of incorrect positioning of the child in the uterus

Many experts believe that the child takes a particular position in the uterus due to the influence of a number of reasons. The main ones are the active movements of the child and the reflex activity of the uterus, which does not depend on human efforts and desires.

Other causes of pure gluteal, transverse presentation fetus and any other malposition:

• multiple pregnancy;
• anomalies in the shape of the uterine cavity;
• constitutional features of a woman.

Diagnosis of the location of the fetus in the uterus

The question of how to determine the presentation of the fetus, its position and position is of interest to all pregnant women, because the course of childbirth depends on the location of the fetus in the uterus.

Medical workers a few years ago determined the location of the child in the uterus by external examination. The diagnoses were not always correct. Now it is not difficult to determine the location, since this can be done using ultrasound. The method is very effective, informative and safe for future mother and fetus. With it, you can very accurately and quickly determine the presentation, position, type of position.

How to independently determine the presentation of the fetus?

How to independently determine the presentation of the fetus, and is it possible? This question worries many of the fair sex in position. This is mainly of interest to those who do not want to constantly run for ultrasound, because a child can change his position very often, especially when it comes to a gestational age of less than 32 weeks.

Pregnancy and childbirth is a natural process that occurs in a woman's body. From the moment of conception to the birth of a child, the body of the expectant mother is subject to special laws and needs. New life develops, and the female body serves as a habitat for the fetus for 9 months, supplying it with all the resources for normal growth.

During this mysterious period, it is very important that the mother-to-be stays healthy, as the body needs to focus on maintaining the new life within itself. Otherwise, complications may occur that affect the health of both the mother and the child. One of these complications is the transverse presentation of the fetus.

What is a transverse presentation of the fetus?

The most favorable and natural position of the baby in the uterus at the time of delivery is head down towards the birth canal. And with the normal course of pregnancy, this position is established by itself. The bodies of mother and child are preparing for the difficult process of childbirth. The woman's hips expand, and the baby turns head down into the resulting hollow, facing the mother's back. This position is called head presentation and is considered the most favorable for the safe course of childbirth.

But in some cases, the child is located in the uterus incorrectly and is risky for birth. One of these locations is the transverse presentation of the fetus. This means that the axes of the spines of the mother and child are perpendicular to each other, that is, the child lies across the stomach, and not along.

You should not frighten yourself in advance and look closely at the outlines of the abdomen - only 0.5% of pregnant women are diagnosed with transverse presentation of the fetus. And almost always medicine is able to help mom and baby.

Diagnostics

Inside the fetal bladder, the child feels safe - it is warm there, the beat of the mother's heart is heard, the sound of her voice is heard. And the wonderful aquatic environment, the amniotic fluid, keeps the small body in a state of "weightlessness". The child turns, spins and somersaults. This period of mobility lasts until 34-35 weeks, while the body of the fetus is still small, and there is an active process of formation in it. internal organs.

Therefore, until the end of the seventh month of pregnancy, you are unlikely to hear from the doctor a categorical diagnosis of the abnormality of the fetus. But at 8-9 months, the baby is actively gaining weight, his position becomes stable, and the gynecologist during this period can already objectively judge the location of the child in the uterus.

Sometimes a woman may herself suspect that something was wrong. The transverse oval shape of the abdomen is a sign of the incorrect position of the fetus. But since visits to the obstetrician-gynecologist become more frequent from the seventh month, the doctor closely studies and examines the expectant mother.

The following methods are used to determine the position of the fetus:

• visual inspection. If the baby is large, its location in the womb is obvious and visible to the naked eye.
• Palpation (examination by touch). The doctor puts his hand on the baby's head, and the other on his pelvis or heels. Also listens to the heartbeat transverse position the baby's heart rate can only be heard in the woman's navel. Vaginal examination is usually not performed.
• Ultrasonography(ultrasound). This is the final stage of diagnosis, giving a complete confirmation (or refutation) of the preliminary diagnosis.

Causes

The factors and causes of the incorrect position of the child inside the uterus are diverse - from the characteristics of the intrauterine development of the fetus to the consequences of the mother's diseases and the pathologies of the child himself.

Do not neglect visits to the doctor, even if you are not pregnant for the first time and consider yourself an experienced mother and childbirth . The transverse position of the fetus in women giving birth is more common than in women giving birth for the first time.

Too much or too little amniotic fluid

Factors affecting the volume of amniotic fluid are not fully understood. This is the sacrament of the body of a pregnant woman. The amniotic fluid is generated by the inner epithelium of the amniotic sac, and at the end of pregnancy, its composition is updated every three hours.

With polyhydramnios (the volume of amniotic fluid is 1.5-2 liters or more), it is more difficult for a child to “lie down” head down, since the internal space of the uterus is extensive. Conversely, with a small amount of amniotic fluid (less than 600 ml), the movements of the fetus inside the uterus are so difficult that the child is squeezed by its walls.

Decreased tone of the walls of the uterus and weakness of the abdominal muscles

Most often, weak muscular walls of the uterus are found in women who give birth again. The natural location of the uterus is vertical, inverted pear-shaped. Ideally, the smooth muscles of the reproductive organ are elastic enough to stretch with the growth of the fetus and elastic to maintain its vertical position. And since we are all exposed to gravity, without proper support, the uterine muscle and abdominal wall of the child is located as it suits him, and not as he should.

Misplacement of the placenta

In medical terminology, the incorrect location of the placenta is called "previa" and means attachment " children's place» in the region of the cervix. The placenta completely or completely occupies the place that the baby's head should take by the end of pregnancy. Placenta previa is a categorical indication for caesarean section (CS), since natural childbirth is not possible.

Normal location of the placenta and its presentation in the lower segment of the uterus

Neoplasms in the uterine cavity

Of course, for the well-being of the child, a calm and safe course of pregnancy, it is recommended to carefully monitor the health of the mother. Indeed, in the presence of adenomas, fibrous tumors and polyps in the lower segment of the uterus, the risk of transverse presentation of the fetus increases significantly. Regular visits to a gynecologist and strict adherence to medical recommendations throughout pregnancy are recommended.

Features of the structure of the uterus

Quite rare pathologies are the saddle and bicornuate uterus - only 0.1% of pregnant women can hear a similar diagnosis. It means that the shape of the uterus is not a regular elongated pear-shaped shape, but saddle-shaped (with a deflection in the bottom) or bicornuate (divided in two by a septum in the upper section). And it is clear that it is difficult for a child developing in such conditions to assume the position necessary for an easy exit from the mother's body.

Options for the structure of the uterus in the photo

bicornuate uterus The structure of the uterus is normal

Fetal pathologies

Since cephalic presentation of the fetus is essential for a successful birth process, developmental abnormalities such as hydrocephalus (swelling of the brain) or anencephaly (underdeveloped cerebral hemispheres) can prevent the fetus from taking the desired position inside the uterus.

What threatens the transverse presentation of the fetus?

Pregnancy with a transverse presentation can be absolutely normal, although women who have given birth know that “normal” in recent weeks means aching in the lower back and hips, heaviness, shortness of breath and a state of constant fatigue. The most risky moment comes during childbirth due to the inconvenient position of the child relative to the “exit” from the uterine cavity.

The uterus is pear-shaped with a narrow part pointing down. And it is logical that with the transverse position of the fetus, an increased load falls on the side walls of this organ. Therefore, when diagnosing this condition, a pregnant woman should be under the constant supervision of doctors in a hospital.

Risks and complications:

• Early discharge of amniotic fluid and premature birth;
• Rupture of the uterus and uterine bleeding;
• Hypoxia (oxygen starvation) of the fetus with a long anhydrous state during childbirth;
• Launched transverse position and prolapse of parts of the child's body from the uterine cavity (limbs, shoulder or umbilical cord);
• Death of a child or mother.

With the responsible approach of the expectant mother to her condition and the implementation of the doctor's recommendations, the transverse presentation of the fetus is just a difficulty, but not a stop factor for the happy birth of a child.

The most common and justified solution for transverse presentation is caesarean section. Especially if a number of measures (exercises, external rotation) did not give results, or due to pathological reasons (placenta previa, uterine neoplasms or pathologies), natural childbirth is impossible.

But with a small size and weight of the fetus, it is still possible to resolve the burden in a natural way, albeit risky. In any case, the gynecologist will give recommendations regarding childbirth individually for each woman.

Transverse presentation of twins

Pregnancy is a test for a woman and a child, especially the bearing of twins. Two babies can occupy a variety of positions relative to each other and the axis of the uterine cavity. The optimal positions are cephalic presentations of both fetuses or the head position of one child and the pelvic (booty down) position of the other.

The transverse presentation of one or two twins is extremely rare (1% of the total number of multiple pregnancies) and is a strong argument in favor of surgical intervention during childbirth.

In the event that one child has a vertical position and is born first, then for the second baby lying across the uterus, a turn on the leg may be applicable. But this is a risky and complicated procedure, which is practically not performed in our time. As a rule, an emergency caesarean section is performed.

Gymnastics for flipping the fetus

Some simple exercises help the fetus change its position. But you can do this gymnastics only after consulting a doctor and making sure that there are no contraindications: complete or partial placenta previa, the threat of miscarriage.

It is better to do gymnastic exercises on an empty stomach or a few hours after eating. Relax your body and calm your nerves.

1. In the supine position, spend 7-10 minutes, take a deep and calm breath, turn to the other side. Perform 3-4 visits during the day. It is better to lie on the elastic surface of the sofa or couch, and not on a soft bed.
2. Place one pillow under the lower back, several under the legs so that they are 20-30 cm above the head. Lie in this position for 10-15 minutes 2-3 times a day.
3. A useful stand in the knee-elbow position, which also needs to be done 2-3 times a day for 15-20 minutes.

Sleeping position - on the side, to which the head of the child is facing. Very efficient swimming. During water procedures muscles that do not work "on land" are included. The general tone of the body rises, blood flow to the internal organs improves, and the fetus is stimulated to take the correct vertical position.

A set of exercises according to I.I. Grishchenko and A.E. Shuleshova

1. Lie on the side opposite the fetal head, bend your legs at the hip and knee joints. Hold in this position for about 5 minutes, turn to the other side.
2. Lying on your side, alternately straighten your legs. Lying on the right side - left, on the left - right.
3. Assuming a sitting position, grasp the bent knee opposite the side to which the baby's head rests. Gently lean forward, making a semicircle with your knee and touching the front wall of the abdomen. Inhale deeply and calmly, straighten your leg and relax.

When the child takes the desired position, it is advisable to put on and wear a special prenatal bandage during the day.

External rotation of the fetus

This manipulation consists in forced pressure on the pregnant woman's abdomen in order to turn the child into the desired position. This is an extreme procedure, often painful for the mother and dangerous for the child, because the hands of even the most experienced obstetrician cannot “see” through the skin and the uterine wall. The fetus is turned over only by a doctor in a hospital, since this procedure is fraught with complications - uterine rupture, placental abruption, and premature birth.

To date, external rotations of the fetus are practically not used, and in a number of European countries they are strictly prohibited.

The main thing in diagnosing the transverse presentation of the fetus is to remain calm, rely on common sense and the recommendations of a gynecologist. Listen to fewer "horror stories" from highly experienced friends, do not engage in self-diagnosis and self-treatment. Although the transverse position of the fetus is considered rare, any obstetrician knows exactly what to do in each specific case. And the task of a pregnant woman is to patiently and accurately follow the advice of a doctor and think only about the good. Happy meeting with your baby!

The doctor may say that the baby is in a "wrong position" or "wrong presentation." What is the difference? "Position" is the placement of the fetus relative to the long axis of the uterus: along, across, obliquely. "Previa" indicates that part of the baby's body, which is closest to the "exit".

The ideal position of the baby in the uterus is longitudinal with the occipital presentation, that is, head down, with the chin tightly pressed to the chest. This is a physiological, thoughtful by nature position, when the risk of injury to the baby and mother during childbirth is minimal. And it occurs most often.

Incorrect position or presentation of the fetus is observed in approximately 3.5-6% of cases. The most common of the "non-standard" options is breech presentation, foot or gluteal. There is a facial presentation: the baby's head is thrown back, and not the back of the head appears first, but the face. The most difficult case from the point of view of obstetricians is the transverse or oblique position of the fetus in the uterus.

Some women who, during their first pregnancy, the baby "sat on the priest" or "lay across", are afraid: what if next time it will be the same? But it is important to understand that the incorrect position of the child is a feature of the course of a particular pregnancy, which is in no way connected with subsequent ones.

Why me? Possible causes of presentation

This question worries every mother whose baby is settled in the stomach "not the way it should be." There are several possible reasons.

• Pathological hypertonicity of the lower segment of the uterus and a decrease in the tone of its upper sections. The fetal head is repelled from the entrance to the pelvis and takes a position in the upper part of the uterus. This happens after inflammatory processes, repeated curettage, multiple pregnancies, complicated childbirth, with a scar on the uterus after a cesarean section.
• Features of the behavior and development of the fetus, for example, increased mobility due to polyhydramnios, small head size, prematurity.
• Features of the structure, anomalies of the uterus and pelvis: bicornuate, saddle-shaped uterus, the presence of partitions or fibroids in the uterus, anatomical narrowing or abnormal shape of the pelvis.
• Restriction of fetal mobility: cord entanglement, etc.

Usually the position of the baby in the uterus is fixed to. All these reasons only increase the risk that by this time the child will remain in the wrong position, but they cannot be considered a "final verdict".

Waiting for the hour "X"

At a regular scheduled examination, the doctor, even without the use of technology, is able to roughly determine the position of the baby in the tummy: the head is down or the buttocks. The diagnosis is clarified with the help of ultrasound, simple and three-dimensional echography. Early diagnosis of the type of malpresentation will allow you to develop a corrective program or prepare for natural childbirth with an incorrect position or caesarean section according to indications, which will save you from many injuries and complications.

Until the baby can be in any position. He has enough space for a fateful acrobatic coup and preparation for birth. Sometimes, making mommy and doctors worry, the baby rolls over just before the start of contractions, and sometimes even with their onset.

Plan "coup"

If the due date is approaching, and the baby is still in the wrong position, do not panic. You should never panic at all, and even more so for pregnant women. There is a plan of action!

Step 1. Corrective gymnastics...

It will help to "persuade" the baby to take the right position before childbirth. It is carried out after 24 weeks or at certain times of the third trimester. General contraindications to any set of exercises: pregnancy,. But there are other features of pregnancy in which gymnastics can be dangerous. Before performing any (!) exercises, be sure to consult your doctor!

With breech presentation

1. Lie on your side, but not on a soft surface. Lie down for 10 minutes on one side, turn on the other, lie down for another 10 minutes. Roll from side to side 3-4 times. Such simple exercises should be performed 2-3 times during the day.
2. Lie on your back with your pelvis raised. To do this, place pillows under your legs and lower back. Legs should be 20-30 cm above the head. In this position, you can spend 10-15 minutes 2-3 times a day.
3. Take a knee-elbow pose. Stay like this for 15-20 minutes. Repeat 2-3 times a day.

What's happening: When performing such exercises, the motor activity of the fetus is stimulated, and it gets more opportunity to turn.

In the transverse (oblique) position

1. Lie on your side in accordance with the position of the fetus: the head on the left - on the right side, on the right - on the left. The legs are bent at the knee and hip joints. Lie down for 5 minutes.
2. Deep breath, turn to the opposite side. Lie down for 5 minutes.
3. Straighten the leg (in the 1st position - right, in the 2nd position - left), the other leg remains bent.
4. Grab your knee with your hands, take it to the side opposite to the position of the fetus. Tilt the body forward. Describe a semicircle with a bent leg, touching the anterior abdominal wall, make a deep, elongated exhalation and, relaxing, straighten and lower the leg.

What's happening: Light mechanical "pushing" the baby's muscles into the correct position.

Step 2: Additional steps

1. In a transverse position, it is recommended to sleep on the side where the fetal head is located.
2. In breech presentation, turning the baby head down stimulates swimming (after consulting a doctor!).

Step 3. Visit to the osteopath

After the 35th week, the doctor in a hospital can rotate the fetus (with transverse and oblique, less often with breech presentation). During the entire "operation" the condition of the mother and child is monitored. The procedure has contraindications for carrying out and a high risk of complications and injuries, therefore it is carried out in extreme cases.

Step 4. Consolidation of the result

Once the efforts have been crowned with success and the little "strike" has decided to take the right position, it is important to help him "get a foothold". To do this, get prenatal, wear it during the day and do special exercise(the doctor's consultation!).

Sit on the floor, spread your knees to the sides and press them as close to the floor as possible. Press your feet together. Stay in this position for 10-15 minutes. You can do it several times a day.

What's happening: stretching of the ligaments and muscles of the pelvis, which contributes to the insertion of the head into the pelvis.

Incorrect position of the fetus: truth and myths

... the wrong position of the fetus is a 100% indication of delivery through a caesarean section

No! It is recommended to make a caesarean section in 60-70% of cases of incorrect position of the fetus in the uterus. But most often, the indication for it is not only a non-standard location, but also a number of related reasons. Natural childbirth with breech presentation is classified as pathological: their course and outcome are significantly complicated, which makes it necessary to resolve the issue in favor of caesarean section. And with a transverse or oblique position, facial presentation surgical intervention absolutely necessary.

... in breech presentation are most dangerous for boys.

Yes! When a boy is born from this position, there is a risk of injury to the scrotum, especially if the buttocks and legs are raised high. This can lead to infertility and other problems in the future. Another danger is the direct thermal and painful irritation of the baby's scrotum during a vaginal examination of the mother, moving through the birth canal, which provokes premature breathing of the baby. Therefore, a caesarean section is indicated.

...if you put headphones "with music" on the stomach, the baby will become interested and roll over.

No! In most cases, if the baby rolled over, it means that he has matured to prepare for childbirth and was able to physically do this "trick". And the music has nothing to do with it. If the baby is "unwilling" or unable to roll over, these methods will not work all the more.

... negatively affects the joints.

Yes! Joint underdevelopment and congenital dislocation are possible.

...pregnancy with breech presentation is more often than with head presentation, accompanied by complications.

Yes! Approximately 3 times. Complications are often accompanied by hypoxia and fetal growth retardation, an abnormal amount of amniotic fluid, entanglement of the umbilical cord.

Are we giving birth?

Tactics is chosen by the doctor. Even if you had a dream to give birth "naturally at any cost", and the verdict was "caesarean section", you should not be upset. The main thing is that a healthy baby is born. And in what way? One that is safe for both.

11. Physiological changes in a woman's body during pregnancy.

12. Clinical examination of pregnant women in the antenatal clinic. Continuity in the work of the antenatal clinic and the obstetric and gynecological hospital.

13. Diagnosis of early pregnancy.

14. Diagnosis of late pregnancy.

15. Determination of the term of childbirth. Granting a certificate of incapacity for work to pregnant women and puerperas.

16. Fundamentals of rational nutrition of pregnant women, regimen and personal hygiene of pregnant women.

17. Physiopsychoprophylactic preparation of pregnant women for childbirth.

18. Formation of the functional system "mother - placenta - fetus". Methods for determining the functional state of the fetoplacental system. Physiological changes in the "mother-placenta-fetus" system.

19. Development and functions of the placenta, amniotic fluid, umbilical cord. Placenta.

20. Perinatal protection of the fetus.

21. Critical periods in the development of the embryo and fetus.

22. Methods for assessing the condition of the fetus.

1. Determination of the level of alpha-fetoprotein in the mother's blood.

23. Methods for diagnosing fetal malformations at different stages of pregnancy.

2. Ultrasound.

3. Amniocentesis.

5. Determination of alpha-fetoprotein.

24. Impact on the fetus of viral and bacterial infections (influenza, measles, rubella, cytomegalovirus, herpes, chlamydia, mycoplasmosis, listeriosis, toxoplasmosis).

25. Influence of medicinal substances on the fetus.

26. Impact on the fetus of harmful environmental factors (alcohol, smoking, drug use, ionizing radiation, high temperatures).

27. External obstetric examination: articulation of the fetus, position, position, type of position, presentation.

28. Fetus as an object of childbirth. The head of a full-term fetus. Seams and fontanelles.

29. Female pelvis from an obstetric point of view. Planes and dimensions of the small pelvis. The structure of the female pelvis.

The female pelvis from an obstetric point of view.

30. Sanitary treatment of women upon admission to an obstetric hospital.

31. The role of the observational department of the maternity hospital, the rules for its maintenance. indications for hospitalization.

32. Harbingers of childbirth. Preliminary period.

33. The first stage of childbirth. The course and management of the disclosure period. Methods for registering labor activity.

34. Modern methods of labor pain relief.

35. Second stage of labor. The course and management of the period of exile. Principles of manual obstetric perineal protection.

36. Biomechanism of labor in anterior occipital presentation.

37. Biomechanism of labor in posterior occiput presentation. Clinical features of the course of childbirth.

The course of childbirth.

Birth management.

38. Primary toilet of a newborn. Apgar score. Signs of a full-term and premature newborn.

1. Afo full-term babies.

2. Afo premature and overdue children.

39. The course and management of the afterbirth period of childbirth.

40. Methods for isolating the separated placenta. Indications for manual separation and removal of the placenta.

41. Course and management of the postpartum period. Rules for the maintenance of postpartum departments. Joint stay of mother and newborn.

Coexistence of mother and newborn

42. Principles of breastfeeding. Methods for stimulating lactation.

1. Optimal and balanced nutritional value.

2. High digestibility of nutrients.

3. The protective role of breast milk.

4. Influence on the formation of intestinal microbiocenosis.

5. Sterility and optimal temperature of breast milk.

6. Regulatory role.

7. Influence on the formation of the maxillofacial skeleton of a child.

43. Early gestosis of pregnant women. Modern ideas about etiology and pathogenesis. Clinic, diagnosis, treatment.

44. Late gestosis of pregnant women. Classification. Diagnostic methods. Stroganov's principles in the treatment of preeclampsia.

45. Preeclampsia: clinic, diagnostics, obstetric tactics.

46. ​​Eclampsia: clinic, diagnostics, obstetric tactics.

47. Pregnancy and cardiovascular pathology. Features of the course and management of pregnancy. Delivery tactics.

48. Anemia in pregnancy: features of the course and management of pregnancy, tactics of delivery.

49. Pregnancy and diabetes mellitus: features of the course and management of pregnancy, delivery tactics.

50. Features of the course and management of pregnancy and childbirth in women with diseases of the urinary system. Delivery tactics.

51. Acute surgical pathology in pregnant women (appendicitis, pancreatitis, cholecystitis, acute intestinal obstruction): diagnosis, treatment tactics. Appendicitis and pregnancy.

Acute cholecystitis and pregnancy.

Acute intestinal obstruction and pregnancy.

Acute pancreatitis and pregnancy.

52. Gynecological diseases in pregnant women: the course and management of pregnancy, childbirth, the postpartum period with uterine myoma and ovarian tumors. Uterine fibroids and pregnancy.

Ovarian tumors and pregnancy.

53. Pregnancy and childbirth with breech presentation of the fetus: classification and diagnosis of pelvic presentation of the fetus; course and management of pregnancy and childbirth.

1. Breech presentation (flexion):

2. Foot presentation (extensor):

54. Incorrect positions of the fetus (transverse, oblique). Causes. Diagnostics. Management of pregnancy and childbirth.

55. Premature pregnancy: etiology, pathogenesis, diagnosis, prevention tactics of pregnancy management.

56. Management of preterm labor.

57. Post-term pregnancy: etiology, pathogenesis, diagnosis, prevention tactics of pregnancy management.

58. Tactics of managing late delivery.

59. Anatomical and physiological features of a full-term, premature and post-term newborn.

60. Anatomically narrow pelvis: etiology, classification, methods for diagnosing and preventing anomalies of the bone pelvis, the course and management of pregnancy and childbirth.

61. Clinically narrow pelvis: causes and diagnostic methods, tactics of childbirth.

62. Weak labor activity: etiology, classification, diagnosis, treatment.

63. Excessively strong labor activity: etiology, diagnosis, obstetric tactics. The concept of fast and rapid childbirth.

64. Discoordinated labor activity: diagnosis and management of labor.

65. Causes, clinical picture, diagnosis of bleeding in early pregnancy, management of pregnancy.

I. Bleeding not associated with the pathology of the fetal egg.

II. Bleeding associated with the pathology of the fetal egg.

66. Placenta previa: etiology, classification, clinic, diagnosis, delivery.

67. Premature detachment of normally located placenta: etiology, clinic, diagnostics, obstetric tactics.

68. Hypotension of the uterus in the early postpartum period: causes, clinic, diagnosis, methods of stopping bleeding.

Stage I:

Stage II:

4. Placenta accreta.

69. Coagulopathic bleeding in the early postpartum period: causes, clinic, diagnosis, treatment.

70. Amniotic fluid embolism: risk factors, clinic, emergency medical care. Amniotic fluid embolism and pregnancy.

71. Injuries of the soft birth canal: ruptures of the perineum, vagina, cervix - causes, diagnosis and prevention

72. Uterine rupture: etiology, classification, clinic, diagnostics, obstetric tactics.

73. Classification of postpartum purulent-septic diseases. Primary and secondary prevention of septic diseases in obstetrics.

74. Postpartum mastitis: etiology, clinic, diagnosis, treatment. Prevention.

75. Postpartum endometritis: etiology, clinic, diagnosis, treatment.

76. Postpartum peritonitis: etiology, clinic, diagnosis, treatment. obstetric peritonitis.

77. Infectious-toxic shock in obstetrics. Principles of treatment and prevention. Infectious-toxic shock.

78. Cesarean section: types of surgery, indications, contraindications and conditions for the operation, management of pregnant women with a scar on the uterus.

79. Obstetric forceps: models and device of obstetric forceps; indications, contraindications, conditions for applying obstetric forceps; complications for mother and fetus.

80. Vacuum extraction of the fetus: indications, contraindications, conditions for the operation, complications for the mother and fetus.

81. Features of the development and structure of the female genital organs in different age periods.

82. The main symptoms of gynecological diseases.

83. Tests of functional diagnostics.

84. Colposcopy: simple, extended, colpomicroscopy.

85. Endoscopic methods for diagnosing gynecological diseases: vaginoscopy, hysteroscopy, laparoscopy. Indications, contraindications, technique, possible complications.

86. X-ray methods of research in gynecology: hysterosalpingography, radiography of the skull (Turkish saddle).

87. Transabdominal and transvaginal echography in gynecology.

88. Normal menstrual cycle and its neurohumoral regulation.

89. Clinic, diagnosis, methods of treatment and prevention of amenorrhea.

1. Primary amenorrhea: etiology, classification, diagnosis and treatment.

2. Secondary amenorrhea: etiology, classification, diagnosis and treatment.

3. Ovarian:

3. Hypothalamo-pituitary form of amenorrhea. Diagnosis and treatment.

4. Ovarian and uterine forms of amenorrhea: diagnosis and treatment.

90. Clinic, diagnosis, methods of treatment and prevention of dysmenorrhea.

91. Juvenile uterine bleeding: etiopathogenesis, treatment and prevention.

91. Dysfunctional uterine bleeding of the reproductive period: etiology, diagnosis, treatment, prevention.

93. Dysfunctional uterine bleeding in menopause: etiology, diagnosis, treatment, prevention.

94. Premenstrual syndrome: clinic, diagnosis, methods of treatment and prevention.

95. Post-castration syndrome: clinic, diagnosis, methods of treatment and prevention.

96. Climacteric syndrome: clinic, diagnosis, methods of treatment and prevention.

97. Syndrome and disease of polycystic ovaries: clinic, diagnosis, methods of treatment and prevention.

98. Clinic, diagnosis, principles of treatment and prevention of inflammatory diseases of nonspecific etiology.

99. Endometritis: clinic, diagnosis, principles of treatment and prevention.

100. Salpingo-oophoritis: clinic, diagnosis, principles of treatment and prevention.

101. Bacterial vaginosis and candidiasis of the female genital organs: clinic, diagnosis, principles of treatment and prevention. Bacterial vaginosis and pregnancy.

candidiasis and pregnancy.

102. Chlamydia and mycoplasmosis of female genital organs: clinic, diagnosis, principles of treatment and prevention.

103. Genital herpes: clinic, diagnosis, principles of treatment and prevention.

104. Ectopic pregnancy: clinic, diagnosis, differential diagnosis, management tactics.

1. Ectopic

2. Abnormal uterine variants

105. Torsion of the pedicle of an ovarian tumor clinic, diagnosis, differential diagnosis, management tactics.

106. Ovarian apoplexy: clinic, diagnosis, differential diagnosis, management tactics.

107. Necrosis of the myomatous node: clinic, diagnosis, differential diagnosis, management tactics.

108. Birth of a submucosal node: clinic, diagnosis, differential diagnosis, tactics of management.

109. Background and precancerous diseases of the cervix.

110. Background and precancerous diseases of the endometrium.

111. Uterine fibroids: classification, diagnosis, clinical manifestations, methods of treatment.

112. Uterine fibroids: methods of conservative treatment, indications for surgical treatment.

1. Conservative treatment of uterine fibroids.

2. Surgical treatment.

113. Tumors and tumor-like formations of the ovaries: classification, diagnosis, clinical manifestations, methods of treatment.

1. Benign tumors and tumor-like formations of the ovaries.

2. Metastatic tumors of the ovaries.

54. Incorrect positions of the fetus (transverse, oblique). Causes. Diagnostics. Management of pregnancy and childbirth.

Malposition - a clinical situation in which the fetal axis forms a right or acute angle with the longitudinal axis of the uterus, the presenting part is absent.

Incorrect positions of the fetus include transverse and oblique positions.

Transverse position - a clinical situation in which the axis of the fetus intersects the axis of the uterus at a right angle.

oblique position - a clinical situation in which the axis of the fetus intersects the axis of the uterus at an acute angle. In this case, the lower part of the fetus is located in one of the iliac cavities of the large pelvis. The oblique position is a transitional state: during childbirth, it turns either into a longitudinal or transverse position.

Etiological factors:

a) Excessive fetal mobility: with polyhydramnios, multiple pregnancy (second fetus), with malnutrition or premature fetus, with flabbiness of the muscles of the anterior abdominal wall in multiparous.

b) Limited fetal mobility: with oligohydramnios; large fruit; multiple pregnancy; in the presence of uterine fibroids, deforming the uterine cavity; with increased tone of the uterus with the threat of abortion, in the presence of a short umbilical cord.

c) Obstacle to the insertion of the head: placenta previa, narrow pelvis, the presence of uterine fibroids in the region of the lower uterine segment.

d) Anomalies in the development of the uterus: bicornuate uterus, saddle uterus, septum in the uterus.

e) Anomalies in the development of the fetus: hydrocephalus, anencephaly.

Diagnostics.

1. Examination of the abdomen. The shape of the uterus is elongated in transverse size. The circumference of the abdomen always exceeds the norm for the gestational age at which the examination is carried out, and the height of the uterine fundus is always less than the norm.

2. Palpation. There is no large part in the bottom of the uterus, large parts are found in the lateral sections of the uterus (on the one hand, round dense, on the other, soft), the presenting part is not determined. The fetal heartbeat is best heard at the navel.

The position of the fetus is determined by the head: in the first position, the head is palpated on the left, in the second - on the right. The view of the fetus, as usual, is recognized by the back: the back is facing anteriorly - anterior view, the back is posteriorly - posterior.

3. Vaginal examination. At the beginning of labor with a whole fetal bladder, it is not very informative, it only confirms the absence of the presenting part. After the outflow of amniotic fluid with sufficient opening of the pharynx (4-5 cm), it is possible to determine the shoulder, scapula, spinous processes of the vertebrae, armpit. By the location of the spinous processes and the scapula, the type of fetus is determined, by the armpit - the position: if the cavity is facing to the right, then the position is the first, in the second position, the armpit is open to the left.

The course of pregnancy and childbirth.

Most often, pregnancy in transverse positions proceeds without complications. Sometimes, with increased fetal mobility, there is precarious position- frequent change of position (longitudinal - transverse - longitudinal).

Complications of pregnancy in the transverse position of the fetus: premature birth with prenatal rupture of amniotic fluid, which is accompanied by loss of small parts of the fetus; hypoxia and infection of the fetus; bleeding with placenta previa.

Complications of childbirth: early rupture of amniotic fluid; infection of the fetus; the formation of a neglected transverse position of the fetus - loss of fetal mobility with intensive early discharge of amniotic fluid; loss of small parts of the fetus; hypoxia; overstretching and rupture of the lower segment of the uterus.

When limbs prolapse it is necessary to clarify what fell into the vagina: a pen or a leg. The handle, lying inside the birth canal, can be distinguished from the leg by the greater length of the fingers and by the absence of the calcaneal tubercle. The hand is connected to the forearm in a straight line. Fingers apart, especially retracted thumb. It is also important to determine which handle fell out - right or left. To do this, it is as if they “hello” with the right hand with a dropped handle; if this succeeds, the right handle falls out; if it fails, the left handle falls out. By the dropped handle, the recognition of the position, position and type of the fetus is facilitated. The handle does not interfere with the internal rotation of the fetus on the stem, its reduction is an error that makes it difficult to rotate the fetus or embryotomy. A dropped handle increases the risk of ascending infection during childbirth and is an indication for faster delivery.

Cord prolapse. If, during a vaginal examination, loops of the umbilical cord are felt through the fetal bladder, they speak of its presentation. Determination of loops of the umbilical cord in the vagina with a ruptured fetal bladder is called prolapse of the umbilical cord. The umbilical cord usually falls out during the passage of water. Therefore, for the timely detection of such a complication, a vaginal examination should be performed immediately. Prolapse of the umbilical cord in the transverse (oblique) position of the fetus can lead to infection and, to a lesser extent, to fetal hypoxia. However, in all cases of umbilical cord prolapse with a live fetus, urgent help is needed. With a transverse position, full opening of the cervix of the uterus and a moving fetus, such help is the rotation of the fetus on the leg and its subsequent extraction. With incomplete opening of the pharynx, a caesarean section is performed.

Management of pregnancy and childbirth.

During pregnancy, measures are taken to correct the incorrect positions of the fetus.

2. Corrective gymnastics(see question 1 in the section "Pathological obstetrics")

If the transverse position is maintained, then the woman is hospitalized at 35036 weeks to turn into the longitudinal position by external means.

3. External rotation of the fetus in the longitudinalposition. It is possible with good fetal mobility, compliance of the abdominal wall, normal pelvic dimensions, satisfactory condition of the mother and fetus. An external turn is made on the head or pelvic horses, depending on what is closer to the entrance of the small pelvis. The pregnant woman is emptied her bladder, laid on a hard couch and offered to bend her legs, in order to anesthetize and relieve the tone of the uterus, 1 ml of a 2% solution of promedol is injected subcutaneously. The doctor sits on the right side, puts one hand on the head, the other on the pelvic end of the fetus. Then, with careful movements, he shifts the head to the entrance of the pelvis, and advances the pelvic end of the fetus to the bottom of the uterus. If they make a turn to the pelvic end, then the buttocks are shifted to the entrance of the pelvis, and the head - to the bottom of the uterus. After the turn is completed, to maintain the longitudinal position of the fetus along its back and small parts (belly, chest), two rollers are placed and bandaged in this position to the pregnant woman's stomach. If attempts to make an external rotation were unsuccessful, then further delivery is carried out through the natural birth canal by performing the classic external-internal rotation of the fetus on the leg, followed by its removal, or caesarean section.

4. Combined external-internal rotation of the fetus on the leg. It is carried out with incorrect positions of the fetus, prolapse of small parts of the fetus and loops of the umbilical cord, both in the transverse (oblique) position of the fetus and in its head presentation, with complications and diseases that threaten the condition of the mother and fetus, and other adverse circumstances. To perform this operation, the following conditions are necessary: ​​complete opening of the uterine os, the presence of sufficient mobility of the fetus in the uterine cavity, the size of the fetus corresponding to the size of the mother's pelvis, a whole fetal bladder or fresh water.

Operation steps: insertion of a hand into the vagina and uterus, finding and grasping the pedicle of the fetus, making a turn, followed by extraction of the fetus. Into the vagina and into the uterine cavity, the hand that the doctor has a better command of is inserted. However, it is recommended that the left hand be inserted in the first position, and the right hand in the second position, which facilitates the search and capture of the fetal leg. The fingers of the hand are folded into a cone, inserted into the vagina and carefully advanced to the pharynx. As soon as the ends of the fingers reach the pharynx, the outer hand is transferred to the bottom of the uterus. Then the fetal bladder is torn open and the hand is inserted into the uterus. In the transverse position of the fetus, when choosing the legs, they are guided by the type of fetus: in the front view they capture the underlying leg, in the back view - the overlying one. To find the leg, they grope for the side of the fetus, slide their hand along it from the armpit to the pelvic end and further along the thigh to the lower leg. The lower leg is grasped with the whole hand. Four of her fingers clasp the shin in front, the thumb is located along the calf of the mouse, and its end reaches the popliteal fossa . Having grabbed the leg, the outer hand from the pelvic end of the fetus is transferred to the head and carefully pushed it up, to the bottom of the uterus . At this time, the leg is lowered with the inner hand and brought out through the vagina. The turn is considered complete (the fetus is transferred to the longitudinal position) when the leg is removed from the genital gap to the popliteal fossa . Immediately after turning, they begin to extract the fetus by the leg.

Indications: in older primiparous women; when combined with an incorrect position of the fetus with other aggravating circumstances (narrow pelvis, placenta previa, the presence of a scar on the uterus, large fruit, oligohydramnios); with a running transverse position, a live fetus and no signs of infection; with a threatening rupture of the uterus, regardless of whether the fetus is alive or dead; with prolapse of the umbilical cord, early rupture of amniotic fluid and other conditions.

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Non-standard presentation of the baby is a frequent occurrence in the modern world. It happens that in the last weeks the child himself turns over into the correct position. What to do if it happened that the child did not take the best position for going out? This article will reveal the main questions on the topic, the answers to which were given by practicing doctors.

Types of position of the child in the uterus

In the womb, a baby can take any position:

1. Pelvic. Found in 2-3% of cases out of 100. Breech presentation is divided into 2 types: foot and buttock. With a foot, during childbirth, the legs of the child may come out first, the doctor is obliged to support the fetus with his hand so that the pelvic part comes out first, then the birth process will be easier and safer. Breech presentation is dangerous because during childbirth the process of obtaining oxygen can slow down, you need to control the time of birth and the rate of appearance of crumbs from the womb. Giving birth in this arrangement is considered a difficult process, significant complications are possible for the woman in labor and for the baby. In this case, it is not necessary to use caesarean section, you need to take into account the nuances: type of presentation, size, age of the mother, size of the pelvis, take into account a girl or a boy, since damage to the genital organs is possible with such childbirth, and a previous pregnancy.
2. Oblique. This phenomenon appears with tumors in the uterus, excessive stretching (especially in those who have already given birth), at big weight fetus(more than 4 kg), entwined umbilical cord. Natural childbirth in this state is contraindicated, an operation is required here. This is extremely rare, in about 0.2% of cases out of 100. A few weeks before childbirth, women with a transverse or diagonal position of the fetus should go to the hospital for preventive measures before surgery.

Incorrect presentation of the fetus always causes concern among doctors, as this may require an unscheduled operation.

What is the danger of the wrong position of the child

Head is the biggest part small body crumbs. And if it is in the main presentation before childbirth, then after the head comes out, the rest of the body easily passes through the birth canal. And if baby turned on side, and sits on the fifth point, then high risk of lack of oxygen in the blood and tissues, respiratory failure, dislocation of the leg, prolapse of the umbilical cord, underdevelopment of the joints. In addition, it is dangerous for the mother of the baby.

There may be ruptures of the genital organs, hematomas, weakness of the labor activity, in extremely difficult cases, it can come to the death of the mother or baby, but if you follow all the advice of the doctor and trust the specialists during the operation, this can be avoided.

Let's look at the risk ratio for misplaced baby as a percentage:

How to determine the incorrect position of the fetus

There is a lot of controversy on the net to actually independently determine the baby’s assumption. The obvious answer is that you should not take such actions. It's impossible to do it on your own you need to contact a specialist. If you have such a question, try to immediately contact your doctor. There are several ways to determine the location of the fetus:

1. Ultrasonography. A special ultrasound specifically confirms the position of the fetus, and is rarely wrong, this is the most accurate way to determine the presentation. The safety of the method is confirmed by the Ministry of Health and practitioners. In the first trimester, a transvaginal ultrasound is used to find the fetus inside, and on 2nd and 3rd trimester - abdominal, the device is in contact with the walls of the abdomen and is considered absolutely harmless.
2. Vaginal examination. It is carried out in the initial period of childbirth. An examination is carried out to make sure that the fetus has not entered the small pelvis, uterus dilated by 3-4 cm. In this position, the baby's shoulder, vertebrae, ribs, less often elbows, part of the arm may appear. If such parts of the body become visible, then there is no doubt in the transverse position of the fetus.
3. External examination by palpation through the walls of the abdomen. When feeling the abdomen, small parts of the body are difficult to distinguish, but the head is accurately determined on the right or left side. It is also possible to define the pelvic region. Really find the baby's heartbeat, and hear the beat frequency of the small motor. Significant difficulties in determining the position of the fetus can occur with multiple pregnancies, excessive uterine tone and polyhydramnios.

The oblique position of the fetus during pregnancy can be seen by the doctor with a competent examination of the patient.

Causes of the wrong position

Incorrect lying is caused by a number of reasons. First - excessive mobility of the child inside. As a result, extra intrauterine fluids, frail muscles of the abdominal part of the abdomen, a delay in the development of the baby for several weeks, high uterine tone, anomalies in the structure, and tumors of internal organs may occur in the mother's body.

There are reasons that do not belong to the medical definition. The wrong condition of the baby may occur, when the mother of the baby sleeps only on one side, even the way you fall asleep affects the location in the womb. Having such a tendency, it is better to turn on different sides before going to bed, lie on your back, on your stomach - this is more useful for early term pregnancy. Otherwise, surgery may be required. at the end of pregnancy.

Habits can change if you work on them, especially when it comes to the birth of a new person. Another reason is multiple pregnancy. If the mother is carrying twins, then competition appears already inside the abdomen. Each fetus wants to take the most comfortable place in a cramped space, so the fetus is located in any convenient position.

Important: neglecting the mandatory conditions for the birth of children with improper intrauterine placement, can cause surgical intervention by doctors, which is always difficult for the body of a young mother, because the birth itself is a huge stress and tremendous stress on the woman in labor.

Is it possible to change the position of the fetus

Change is real, there are several effective ways. Talking to the baby gives good results. The child loves to listen to stories and fairy tales, more talk with your hands towards your lower abdomen so that the child turns over in the right direction. Tell her that mom really wants the baby to be born healthy and for this you need to roll over.

Take advantage of your child's curiosity. Put a flashlight on your belly and the baby will begin to move and catch the light, or turn on pleasant music through the headphones and lower it in the right direction. The child craves communication since the womb, this is a chance that it is a sin not to take advantage of. It is important to pay attention to physical exercises.

Good for pregnancy yoga try the half bridge exercise. Lie on your back on a blanket, or mattress, much softer than a simple hard floor, and arch your back. First, try to be in this position minutes 3 then increase the load. A necessary factor will be a healthy and proper nutrition, walks in the park or light sports activities.

Other ways to change the position of the fetus:

1. Try to work out dancing, swimming, this will help the baby to take the correct position.
2. Follow the example of animals, this is absolutely serious! Have you seen how cats behave during pregnancy? They stand on their feet and stretch their back up and down, doctors advise these exercises for the correct position of the fetus.

It is also effective nice exercise, it must be performed lying on your back, arms extended along the body, and slowly lifting, lowering the pelvis down, you must breathe evenly and moderately.

Third exercise: lie down on your side, bend your knees, alternately changing sides, rolling over your back. By doing such exercises, you can help the unborn child to take the correct position before childbirth. Watch how the baby behaves when doing exercises, if he is actively moving or moving, then most likely he is changing his state.

Watch the video on the topic "How to determine the presentation of the fetus yourself":