Pelvic presentation of the fetus is a fairly common diagnosis, which is usually given to a woman at 20-22 weeks of pregnancy. It is in 90% of cases that the fetus is placed with its head down, and its back turns to the left side. Thus, he occupies the correct position, which is also called head presentation. This position is the most convenient and, most importantly, safe for childbirth. But in some cases, the baby may take a completely different position, which will significantly complicate the upcoming birth.
The content of the article:
Pelvic presentation of the fetus: what is that?
Classification of pelvic presentation of the fetus
Features of the course of pregnancy with pelvic presentation of the fetus
Management of pregnancy and childbirth with pelvic presentation of the fetus
Causes of pelvic presentation of the fetus
Diagnosis of pelvic presentation of the fetus
Complications of childbirth with pelvic presentation of the fetus and their prevention
Pelvic presentation of the fetus
Pelvic presentation of the fetus: what is that?
If you are interested in what a pelvic presentation of the fetus is, then note that this diagnosis implies a variant of the location of the fetus in the uterus, in which its pelvic end is located at the entrance to the small pelvis of a woman. It is worth noting that childbirth in this case is considered pathological, since there is a danger of various complications. But at the same time, it is worth noting the low frequency of childbirth with pelvic presentation of the fetus, since they occur in 3-5% of cases. It is also worth saying that the main danger during these births is perinatal fetal mortality.
Often, a diagnosis is made to a woman no earlier than 22 weeks of pregnancy, since before this period the baby can occupy various positions. In the period from 32 to 34 weeks, it is still possible to correct the situation using, for example, special gymnastics. If no methods helped and the child still took the wrong position, a caesarean section is prescribed. At the same time, the risk of complications in this case is significantly lower than in natural childbirth.
Classification of pelvic presentation of the fetus
Depending on what position the baby took, there are several types of pelvic presentation of the fetus. The gluteal variant means the position of the fetus in which its legs are bent at the hip joints, and the knees are straightened and pressed against the abdomen. Quite often there is such a pathology in women who give birth for the first time. The frequency of cases is 50-70%. When the fetus is in the leg position, both thighs or one are unbent, and the leg is just at the exit from the uterus. It occurs in 10-30% of cases mainly during the second and subsequent childbirth. Mixed presentation of the fetus, when both the hips and legs are bent, is very rare — in 5-10% of cases.
Features of the course of pregnancy with pelvic presentation of the fetus
Many women are concerned about the question of what pelvic presentation of the fetus means and why it is considered a pathology. It is worth noting that in some cases, even with this diagnosis, childbirth can pass without problems and the child will be born healthy. But at the same time, experts note that the risk of complications as a result of this pathology is significantly higher. To avoid problems, doctors are much more likely to resort to surgical methods of childbirth if a woman has a pelvic presentation of the fetus.
The most common complications that can occur during childbirth include: weakness of labor activity, premature discharge of amniotic fluid, fetal intrauterine hypoxia, extension and infringement of the fetal head. That is why it is important to diagnose this pathology correctly and in time and try to correct it.
Management of pregnancy and childbirth with pelvic presentation of the fetus
Since doctors understand the dangers of pelvic presentation of the fetus, they usually carefully monitor the health of the woman and the position of the baby. If this pathology is detected before the 28th week of pregnancy, there should be no cause for concern. Doctors will only have to observe the woman. But if I detect pathology in the period from 29 to 30 weeks, then specialists select tactics to correct it. Both traditional and non-traditional methods can be used for this purpose. The latter include: aromatherapy, acupuncture, homeopathy, swimming, light and sound effects.
Corrective gymnastics is considered one of the most popular and effective traditional methods of correcting pelvic presentation of the fetus. It is worth noting that it shows its effectiveness in more than 75% of cases. But at the same time, in some cases, it absolutely cannot be prescribed. Such cases, first of all, include gestosis, abnormalities of fetal and uterine development, placenta previa. If the pelvic presentation of the fetus persists up to 35-37 weeks of pregnancy, doctors can try to perform an external rotation of the fetus on the head, developed by B.L. Arkhangelsky. This method has shown its effectiveness, which reaches 87%. This procedure should be performed exclusively by a highly qualified doctor. This should be done only in a hospital setting, so that, if necessary, a caesarean section can be performed, as well as all the necessary assistance to the baby and mother. After the fruit has been turned over, it must be secured. For this purpose, various exercises and a bandage are usually used, which help to fix the fetus in a position favorable for childbirth. It is also worth noting that even in the case of an unsuccessful termination of the procedure, childbirth is still possible in a natural way.
Causes of pelvic presentation of the fetus
There are also fetal pathology factors: congenital anomalies of fetal development, multiple pregnancy, vestibular disorders and prematurity. Placental factors also affect the position occupied by the baby. These include placenta previa. The reason may be a lot- or vice versa, lack of water, due to which the fetus moves easily and freely, which is why its head is not fixed in the pelvic floor of a woman. But the opposite situation may also arise, when a child simply does not have the opportunity to move actively if he is entwined with an umbilical cord.
A child who will soon be born already has an instinct for self-preservation. Therefore, in case of any threat, he takes the most comfortable position for himself. In addition to all of the above reasons, it is also worth mentioning the genetic one separately. There is an opinion that women who were born in breech presentation have a high risk that their baby will also take the wrong position before giving birth.
Diagnosis of pelvic presentation of the fetus
Of course, many women are interested in what are the signs of pelvic presentation of the fetus. The fact is that a woman who has been diagnosed with pelvic presentation of the fetus may not notice signs of pathology. No pain or discharge indicates that the baby has taken the wrong position. In this regard, we can say that only a doctor can detect pathology. For this purpose, methods of external obstetric and vaginal examinations are most often used.
During an external examination, the doctor determines a large, soft and sedentary part adjacent to the entrance to the pelvis. At the same time, the hard, round and movable part, which is the head of the fetus, is easily determined in the bottom of the uterus. There is also a higher standing of the uterine floor, which does not correspond at all to the term of pregnancy. As for the heartbeat, it is listened to at the level with the navel or slightly above it.
Vaginal examination shows a soft and voluminous part with a breech presentation, on which the sacrum, coccyx and inguinal fold can be determined. In the case of mixed or leg presentation, the doctor easily determines the fetal feet. It is also worth noting that the pathology can be diagnosed quite easily with the help of ultrasound. This method even allows you to determine the type of pelvic presentation of the fetus. During the diagnosis, the position of the head and the degree of its extension are also evaluated. By the way, excessive extension of the head can cause complications during childbirth, such as injuries to the cerebellum, cervical spinal cord and other injuries.
Complications of childbirth with pelvic presentation of the fetus and their prevention
If a woman was diagnosed with pelvic presentation of the fetus and during pregnancy doctors failed to correct this pathology, childbirth is still possible in two ways: natural and by caesarean section. The choice of a certain method of delivery depends on some factors. These may include factors such as: the age of a pregnant woman, anamnesis data, pregnancy period, pelvic dimensions, diseases, type of pelvic presentation, gender and fetal weight.
As mentioned above, childbirth can take place naturally. This is possible only if the gestation period is no more than 37 weeks. The weight of the fetus should not exceed 2500 grams, and the size of the mother’s pelvis should be normal. At the same time, a girl should be born, not a boy, and the presentation should be buttock or mixed. Otherwise, it is necessary to do a cesarean section. It is also worth choosing the latter option if the birth is premature, the baby’s weight is less than 2500 grams or more than 3500 grams, he is male, and the pelvic presentation is leg.
Sometimes, already during natural childbirth, the doctor may decide to perform a cesarean section. Usually this decision is made in the following emergency cases: weak labor, fetal hypoxia, placental abruption, discoordination of labor, loss of legs, handles or umbilical cord. Pelvic presentation of the fetus, childbirth in which is most often by caesarean section, can cause various complications. At the same time, it is worth emphasizing that this pathology does not affect the course of pregnancy in any way. On the contrary, problems can arise exclusively during childbirth.
