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Transverse position of the fetus at 30 weeks. Transverse presentation of the fetus

The transverse position of the fetus in the uterus is rare. If we turn to statistics, then only 0.5% of pregnant women experience a similar phenomenon, when the axis of the spine of the mother and child are not parallel to each other. In general, the transverse and oblique position of the fetus in obstetrics is considered problematic. Natural childbirth is almost impossible, as it is very risky. The baby is usually born by caesarean section. However, it is not uncommon for a woman to correct the transverse position of the fetus with exercises and special gymnastics, and she gave birth on her own. One of effective methods to correct the position of the child is a set of exercises (how to perform everything correctly will be shown in the physical room of the antenatal clinic) and rest on the side where the child's head is located.

What is meant by transverse presentation of the fetus and what are its causes

The transverse position is the position of the baby when he is located in the uterus not along its axis, but at an angle. Its head and buttocks are across the exit from the uterus and pelvic organs. This position of the fetus is revealed during screening.

The condition of a pregnant woman, whose baby lies down in a transverse position, does not affect health in any way. Pregnancy can proceed absolutely calmly for the first two trimesters. But the third trimester can present a lot of not very pleasant surprises. These are bleeding, and premature birth, and even a threat to the life of both the mother and the fetus. Among other troubles, there is an early departure amniotic fluid, prolapse of body parts of the child, umbilical cord, damage and rupture of the organ of the uterus.

It does not matter if the transverse, oblique or unstable transverse position of the fetus, the pregnant woman must be constantly under the supervision of doctors. Inpatient treatment is unconditional in case of the slightest suspicion of bleeding.

If there is an incorrect position of the fetus during the second trimester, then there is hope that the baby will still take the correct position before the moment of birth. The baby in the mother's womb is constantly in motion. He swims in the amniotic fluid, often changing his posture. But after 33-35 weeks, the child is unlikely to be able to change its position in the mother's tummy. He has already grown enough, and he is cramped.

Doctors clearly determine the causes of the transverse position of the fetus. Firstly, this is the overstretching of the uterus as a result of previous pregnancies and a large number of amniotic fluid (at the same time, such a presentation can also lead to oligohydramnios). Secondly, early abortions, numerous abortions and spontaneous miscarriages may cause transverse presentation of the fetus. Thirdly, if a woman has an abnormal pathological shape of the uterus (saddle-shaped, horn-shaped, bicornuate), then there is a risk that the child will take the wrong position in the womb.

During pregnancy, babies change their position in the uterus many times. As long as the fetus has enough room to move, it can roll over as it is more convenient for it. But from a certain point, the presentation and position of the child is important for doctors, because the prognosis for the upcoming birth depends on it. In this material, we will talk about what the transverse position of the fetus is and what to do if the baby decides to settle down in the mother's womb in this way.

What it is?

They say about the transverse position when the baby is in the uterus across. If you mentally draw a line along the child's spine, then with an oblique presentation it will intersect with the axis of the uterus at a right angle. The thigh and elbow of the baby can thus be turned towards the exit from the uterus. The head will be located in one side, and the butt - in the opposite.

There are several options for the transverse position. If the baby is facing the mother's anterior abdominal wall, then we are talking about a transverse facial presentation, if the baby is turned forward with its back, then the transverse position of the fetus with dorsal presentation is diagnosed. In all cases, transverse or oblique transverse presentation (if the axis of the baby does not create a straight line, but an acute angle when crossing with the central axis of the uterus) are considered a pathology of pregnancy.

This pathology is rare. Less than 1% of pregnant women experience a transverse baby in the womb. In 97% of pregnant women, the babies are located in the cephalic presentation, in 2 -2.5% - in the pelvic. And only in 0.5-0.6% of cases do children take an unusual transverse presentation from the point of view of the laws of nature.

Most often, this arrangement of the fetus is typical for women who have given birth a lot and often. In the first pregnancy, transverse presentation is isolated cases. Until 34-35 weeks of pregnancy, there is no talk of pathology, because the baby has practical and theoretical opportunities for an independent coup in the uterus for childbirth, but after 35 weeks, the coup becomes almost impossible, because there is no free space for such wide movements in the uterus

Danger and risks

This situation has little effect on the course of pregnancy itself. However, it should be remembered that any incorrect position of the child in the uterus is a significant risk factor. premature birth. In the case of the transverse position, this happens in 40% of cases. A child who will be born much earlier than the planned obstetric period cannot always adapt to a new environment for himself. So, with the immaturity of the lung tissue, there may be problems with independent breathing, acute respiratory failure may develop, and with a low weight of a child born ahead of time, it will be difficult for the baby to keep warm.

In the event of the onset of spontaneous labor in a child, small parts of the body and loops of the umbilical cord may fall out along with the outpouring of water. This is fraught with the death of the child, injuries, deformities, disability, the development of severe complications from acute hypoxia. For a woman, such childbirth is dangerous with injuries to the pelvic bones, ruptures of the perineum, cervix and body of the uterus, vagina, and heavy bleeding. In severe cases, everything can end in the death of both the child and the woman in labor.

With rapid spontaneous childbirth, the child’s shoulder is often “knocked” into the small pelvis, this is how the neglected transverse position of the fetus develops, in which an independent birth of a child is impossible. It is when the transverse position is neglected that traumatic rupture of the uterus most often occurs.

If the position of the child is oblique, then it is considered transitional. Theoretically, even in childbirth, it can change either to longitudinal or to transverse. Naturally, no one will wait for the baby to turn, the risks are too high.

That is why, with a transverse presentation, it is recommended to give birth by surgical intervention - a cesarean section operation allows you to remove the child from their wombs without the risk of severe birth injuries, hypoxia. For the future mother, the operation will also guarantee that her small pelvis and perineum will not suffer from ruptures and fractures.

Causes

Most often, babies are in the transverse position, which is easy and free to move in the uterus, even for long periods. Polyhydramnios contributes to such motor activity. If the amount of amniotic fluid is higher than normal, then the baby may well take this position and “get stuck” in it. Also, active movements for long periods are facilitated by weak and overstretched walls of the uterus. Weakness and some sagging of smooth muscles are characteristic of women who give birth a lot and often.

No matter how strange it may sound, but the transverse position is also facilitated by low physical activity, or rather, the inability for the child to move. This condition is characteristic of low water. Also, large hypertrophied children experience difficulties with movements and coups.

The risk of transverse presentation of one of the children or both at once is present in a woman with multiple pregnancy, which is why the position and condition of each of the fetuses is so closely monitored throughout the entire multiple pregnancy.

The baby can take a transverse position as the only convenient one if a woman almost constantly has increased tone uterus, and there are also tumors or other neoplasms in the lower uterine segment. The establishment of the usual head presentation because of this becomes unacceptable for the child. In addition, transverse or oblique presentation is often observed during pregnancy in women with congenital anomalous features of the main reproductive organ - a saddle or bicornuate uterus.

Quite often, the placenta interferes with the baby, if it is located low, they have its full or partial presentation. When the entrance to the small pelvis is blocked by something, the baby cannot stand in the correct position - head presentation. Across the womb, a child can also be located in a woman with a clinically narrow pelvis.

Sometimes the reason for the incorrect position of the child lies not in maternal factors, but in the child himself. So, with hydrocephalus (dropsy of the brain) or anencephaly (absence of the brain), the baby does not take the head position, but remains either sitting in a breech presentation, or lying across the uterine cavity.

Diagnostics

Transverse presentation can be determined by an obstetrician-gynecologist during an external examination of a pregnant woman, as well as during a vaginal examination. Usually, the height of the uterine fundus, which is measured at each scheduled appointment in a consultation, is below normal in the transverse position, and the pregnant tummy itself even visually looks like a torpedo melon. On palpation, the position of the fetus is determined by the location of the head - this is the hardest and most mobile part of the child's body. With a head presentation, it is palpable in the lower abdomen, above the pubis, with a pelvic presentation, near the bottom of the uterus (in the upper abdomen), with a transverse head, it is either in the right or left side of the expectant mother.

The baby's heartbeat is determined near the navel of the expectant mother. Vaginal examination allows you to exclude the presentation of the head or priests. Then expectant mother an ultrasound is recommended. Only ultrasound scanning allows you to get the most accurate data about the position in which the child lies, what are the features of his position, which part of the body is located towards the exit to the small pelvis, and also to assume the weight of the baby. All this data is needed so that the doctor can more carefully assess the risks and choose the right delivery tactics, in which neither mother nor child will suffer.

What to do?

If a woman has a transverse presentation at 24-25 weeks of gestation, as well as earlier or later than this period, there is no need to panic. Up to 35 weeks, the baby has time to turn over. The expectant mother needs to try with all her might to help her child take the right position in the uterine cavity.

For this, special gymnastics is recommended, in which each exercise is thought out in such a way as to relax the muscles of the uterus as much as possible, to give the baby the opportunity to turn around. The set of exercises includes sets of exercises by Dikan, Shuleshova, Grishchenko. There are other complexes developed by gynecologists specifically for women who need help turning their baby around. It should be noted that with a positive attitude and daily exercises, the effectiveness of gymnastics reaches about 70-75%. It is this percentage of babies from an unstable transverse or oblique arrangement that nevertheless passes into the head one.

Gymnastics for the coup of the fetus is not recommended for everyone. So, exercises are forbidden for women suffering from diseases of the heart and blood vessels, kidneys, liver. A scar or several scars on the uterus from a previous caesarean section or other surgical operations are also a contraindication.

If a pregnant woman has edema, signs of preeclampsia, threatened miscarriage, spotting, placenta previa, or low location of the placenta, gymnastics should not be done.

It is advisable to do gymnastics for those to whom it is not contraindicated from 30 to 36 weeks of pregnancy. If the baby stubbornly does not want to take another position, doctors can offer an obstetric coup in Arkhangelsk. It is done in a hospital under ultrasound control. The baby is unwrapped by hand. But such an intervention is quite dangerous, it can provoke a rupture of the membranes, an outpouring of amniotic fluid, the onset of preterm labor, and injury to the fetus. That is why doctors themselves rarely decide on an obstetric reversal.

Separately, I would like to emphasize the importance of a positive attitude of a pregnant woman. Many experts say that the methods of persuading the baby, affectionate persuasion, combined with corrective gymnastics, give amazing results.

If the expectant mother herself is set up for the best, keeps calm, harmonious mood, then her baby's chances of an independent coup closer to childbirth will increase significantly.

With a transverse presentation, it is important to prevent premature birth. That is why a woman should be extremely careful - do not lift weights, do not jump, do not make sharp inclinations of the body.

Care should be taken to have sex, because an orgasm and even ordinary sexual arousal in a woman cause short-term spasms of the smooth muscles of the uterus. If a low position or placenta previa is diagnosed simultaneously with a transverse presentation, then it is recommended to refuse sex altogether, as well as masturbation. Stress should be avoided.

Additionally, a woman should wish only on her side, completely repeating the position of her baby. How to do this correctly, the doctor will tell after the ultrasound, as he will see the exact location of the body and body parts of the child.

You can not skip scheduled visits to the doctor in the antenatal clinic. Most likely, the attending physician will suggest an early hospitalization - at 36-37 weeks of pregnancy, and this will be the only reasonable solution to avoid unwanted complications. Under no circumstances should you refuse it.

If, despite all the precautions, a woman began to give birth prematurely, regular painful contractions appeared, the waters broke, it is important to take a horizontal position in order to prevent the baby’s handle, which is in a breech presentation, from falling out of the genital gap. After that, you need to immediately call an ambulance.

The woman will receive emergency care, with a probability of 99% she will undergo an emergency C-section immediately after delivery to the hospital.

Can you give birth on your own?

Childbirth with a transverse presentation can be dangerous, we talked about this above. In this position of the baby, in 99% of cases, a caesarean section is performed. It is better if it is carried out before the onset of spontaneous labor activity, which is why early hospitalization in the maternity hospital is recommended.

Absolute indications for surgery are post-term pregnancy in transverse or oblique presentation, fetal hypoxia, as well as the presence of scars on the uterus. If a pregnant woman was taken to the maternity hospital in an "ambulance" with a discharge of water, doctors will definitely make sure that parts of the child's body have not fallen out. If a prolapse is detected, it is forbidden to set the pen or umbilical cord back.

If a woman is brought to the ambulance after a long anhydrous period, a caesarean section will be carried out in any case, regardless of the degree of cervical dilatation.

Late treatment is dangerous for a woman's life by the occurrence of sepsis. Often in such situations, after a caesarean section, you have to perform another operation - a hysterectomy (complete total removal of the uterus). A woman will never be able to become a mother.

Considering the high risks, a planned caesarean section at 37-38 or 38-39 weeks of pregnancy looks like a more reasonable way out of the situation. The operation lasts about 40 minutes, after 10-12 hours the woman will be able to get up. Modern methods of anesthesia allow the expectant mother to be conscious during the extraction of the crumbs and not feel pain, and therefore, as in natural childbirth, she will immediately be able to look at her son or daughter, the baby will immediately be applied to the breast.

With the approach to childbirth, the fetus takes a certain position in the uterus. Head presentation is considered the norm - the child is head down, pressing his chin to his chest. This position ensures the correct biomechanism of childbirth, reducing the risk of injury to the mother and baby. But sometimes at 37-38 weeks the child remains in a pathological position. It includes the transverse and oblique position of the fetus. This condition occurs 1 time in 200 births, which is 0.5-0.7%.

What is considered a transverse position

The birth axis runs vertically from the uterus to the exit of the genital tract. The axis of the fetus is considered a conditional line that connects its coccyx and the back of the head. In normal delivery, these two lines coincide. But sometimes the axis of the fetus is perpendicular to the axis of the uterus. This state is considered the transverse position. If these two lines are at an angle, they speak of an oblique position.

Transverse presentation

The pelvic transverse presentation of the fetus means that the baby's buttocks are located closer to the exit from the small pelvis. Another situation, when the baby lies slightly higher with the legs, is called the head transverse presentation of the fetus.

Normally, throughout pregnancy, the baby is able to occupy any position in the uterine cavity. The more room for movement, the more likely it is to change position and presentation. But at 34-36 weeks, the baby occupies the final position, which will not change until the moment of birth.

After this period, the amount of amniotic fluid decreases somewhat, the uterus descends. Women honor that breathing is easier. And the fetus is more pressed against the entrance to the small pelvis. Therefore, he will not be able to roll over on his own.

Therefore, at each visit to the doctor for a long time, palpation through the anterior abdominal wall, he determines where the head of the child and his legs are.

Causes of pathological presentation

Myoma

Large nodes can deform the uterine cavity. If the fibroid is located subserous and grows mainly in the abdominal cavity, it is less dangerous than the submucosal or interstitial node. The last two can significantly change the size of the uterine cavity.

It should also be remembered that in women with a small size of nodes that were stable before pregnancy, after conception, accelerated growth. It is associated with an increase in progesterone and big amount receptors for it on myomatous nodes. The child, in an attempt to take a comfortable position, will stumble upon a protruding tight knot and will not be able to roll over with his head down.

High birth parity

The reasons for the transverse position of the fetus may lie in multiple births. This condition is much less common in primiparas, but the frequency increases with 4-5 births. The increased risk is explained by a decrease in the tone of the abdominal muscles, more flabby tissues capable of significant stretching.

Congenital malformations of the uterus

oligohydramnios

With an insufficient amount of amniotic water, the situation is reversed. The child cannot take the correct position due to the limited space in the uterine cavity.

Polyhydramnios

A large amount of amniotic fluid stretches the uterus, allows the fetus to swim freely in its cavity and change its location. happens due to infection, fetal pathology, combined with intrauterine hypoxia. At the same time, the motor activity of the child increases, the woman hears active movements, and the likelihood of a transverse or oblique location increases.

Threat of preterm birth

With a constant or frequently repeated tone of the uterus, the child experiences pressure from its walls. They do not allow him to move to the required position. Therefore, the transverse or oblique presentation may not change by the required date to the correct one.

Fetal hypotrophy

Feto-placental insufficiency leads to chronic. This affects the weight of the child: there is a lag in the set of length and body weight, sometimes for several weeks. Lack of weight allows free movement in the uterine cavity and by the time of delivery may maintain an incorrect position relative to the axis.

large fruit

The risk increases in the presence of a narrow pelvis of 1-2 degrees. The child does not have enough space to move, he cannot descend into the small pelvis, so he takes the wrong position.

Multiple pregnancy

With twins, one or both children may take a position that is most convenient for them, but makes childbirth difficult naturally. Sometimes the first baby is located correctly, and the second lies across, forming a kind of belt around it. Natural childbirth in this case is impossible, they will lead to a neglected transverse position and death of the fetus.

Sometimes the transverse position is observed in preterm birth, which occurs at 28-29 weeks and up to 37 weeks. Adnexal tumors located above the pelvic inlet are also a risk factor.

Signs of a change in position

Symptoms cannot be recognized on their own. This condition may be suspected by a doctor who examines a woman when she comes to the antenatal clinic. Pay attention to the following signs:

the abdomen in the transverse position of the fetus looks stretched to the sides;
with an oblique arrangement, the abdomen is obliquely stretched;
the uterus in shape approaches the ball, instead of the ovoid appearance;
palpation fails to determine the presenting part.

The head, when palpated through the anterior wall of the abdomen, is palpated to the left or to the right of the midline of the abdomen.

Fetal presentation options

During CTG records the sensor will pick up the signals of the baby's heartbeat in an uncharacteristic place - below the navel of the pregnant woman.

Turning technique

Manipulation is carried out by the doctor only by exposure through the abdominal wall, the introduction of hands into the vagina is not required. The procedure requires the following conditions:

good fetal mobility;
normal dimensions of the pelvis (external conjugate 8 cm);
lack of indications for the rapid end of labor (fetal asphyxia according to CTG, placenta previa, bleeding).

In multiparous women with a well-stretched abdominal wall, external rotation is performed without anesthesia. In other cases, a woman in labor is administered a solution of Promedol in 30 minutes. The patient is located on a hard couch, pulling her legs to her. The doctor probes the head and pelvic end of the fetus. He puts his hands in such a way that they are located on top of these parts and grab them.

Then they begin to put pressure on the head, shifting it to the entrance to the small pelvis. The second hand presses on the pelvic end of the fetus and moves it up. Manipulation requires a certain strength and perseverance and at the same time caution. If the uterus began to tone up, then the turn is done during the rest period. When a contraction appears, it must be skipped, but at the same time the hands do not let go of the fetus, thereby fixing its position and not allowing it to slip back.

External rotation of the fetus

After the manipulation, the pregnant woman is prescribed to wear a bandage with special rollers. Outward rotation does not eliminate the cause of the misposition. Therefore, in Lately it is used less and less, given the high risks of complications of the procedure. They may be:

premature rupture of amniotic fluid;
the beginning of labor activity;
placental abruption;
bleeding.

delivery

Only the right way to end the pregnancy in the transverse position of the fetus is a caesarean section. The operation is carried out as planned. To reduce the risk of complications, a pregnant woman is hospitalized at 36-37 weeks for observation and preparation for surgery.

Before surgery, the doctor may try to change the child's position. To do this, the woman is laid on her side and the presenting part is expected to fall into place. If this does not happen in a hospital setting, then a planned caesarean section is performed.

When the transverse position is started, regardless of the condition of the child, childbirth ends only with a caesarean section and does not wait for a spontaneous turn.

While expecting a baby, a pregnant woman lives the happiest days of her life. Awareness under the heart of a baby transforms a woman, she is already looking for contact with a child. This is how motherhood begins ... This euphoria can be broken by another visit to the doctor, who, on his own or according to the results of an ultrasound scan, comes to the conclusion that the future mother has a transverse presentation of the fetus. Why did the child take this position and how to cope with this condition?

Who is guilty?

In most cases, the baby approaches the exit head first. But sometimes it happens that it changes its position to transverse or oblique, and such a change can significantly complicate the process of childbirth. The transverse position of the fetus can happen for several reasons:

If the expectant mother has polyhydramnios, then the baby, like a fish, maneuvers in such an amount of liquid. He has the ability to make turns, changing the head presentation to the breech, and vice versa.
Incorrect positioning may occur when repeated pregnancies when the future woman in labor has flabby muscles, the anterior abdominal wall is stretched, and the uterus with the baby in it is not sufficiently fixed by its muscles. There may also be a possibility of a higher breech presentation than was seen in a previous pregnancy.
If the pregnant woman has deviations in the structure of the uterus or myoma, the child occupies the most convenient breech presentation for him, because his head is larger than the pelvic end, and the myoma nodes prevent it from being located in the bottom of the uterus.
Breech presentation sometimes signals an existing deviation in the development of the baby.
To provoke the transverse position of the fetus can be an early departure of amniotic fluid.

And what to do?

Until the 32nd week, there is no point in discussing this problem: there is room in the uterus for movements and changes in the baby's posture. But from this time on, the baby should already take the correct longitudinal position with the head down. And if there are no contraindications to gymnastics, such as placenta previa or threatened miscarriage, with the approval of the attending physician, a sweet mother can start performing simple exercises.

Lie on your side on a couch or couch, a soft bed is not welcome. Lie quietly on one side for 10 minutes, then change it to the other, stay in this state for 10 minutes too. And in this way, turn from one side to the other 3-4 times. Similar simple but effective exercises should be done 2-3 times a day. The benefit from them will appear soon - in the first week.
You can lie in a prone position with a raised pelvis for 10-15 minutes, also 2-3 times a day. The starting position is taken - pillows are placed under the legs and lower back, while the legs are located 20-30 cm above the head.
The knee-elbow position can be taken the same number of times and the same period of time as the previous exercises. To do this, you need to kneel and lean on your elbows.

In addition, water activities can also stimulate the baby to turn head down. Any set of exercises should be done on an empty stomach.
Performing all these exercises helps to remove the pelvic end of the fetus from the pelvic bones, stimulates the motor activity of the fetus, and the child will be more likely to turn around and position himself correctly. By the way, sleep on the side where the baby's head is.

How to fix this "jamb"?

With an oblique arrangement of the fetus, the long axis of the uterus intersects the longitudinal one at an acute angle. Usually pregnancy, if there are no other complications, proceeds without any features, but there is a possibility of premature birth due to prenatal rupture of amniotic fluid.

Therefore, if the doctor has established the oblique position of the fetus in the expectant mother, before the 32nd week, there is still time to “guide” the baby on the true path when it leaves the mother’s womb. The same simple gymnastics will help to do this.

Take a deep breath and carefully roll to the opposite side, lie down for five minutes.
Straighten the leg, in the first position - the left, in the second - the right, while the other leg remains in a bent state.
Take the knee covered by the hands to the side opposite to the location of the baby. Move your body forward, describing bent leg semicircle, touching the anterior abdominal wall. After that, making an elongated and deep exhalation, relax, straighten up and lower your leg.