Head presentation of the fetus. Head presentation. Is it good or bad? Why fetal malposition may occur

From this time on, his situation will not change significantly, so the diagnosis is carried out precisely at the 8th month. Fetal presentation is determined by palpating the abdomen; in case of doubt, ultrasound or radiography is used.
For normal labor it is very important that the fetus is positioned vertically.

Currently, several variants of fetal presentation are known: cephalic, transverse and pelvic. The location of the fetus in the uterus is determined by direct examination by an obstetrician-gynecologist (at longer stages of pregnancy you can feel where the fetal head is) and by ultrasound examination. Depending on the duration of pregnancy, the position of the fetus in the uterus changes significantly. If during the first 6 months the fetus is still quite small in size and has enough room for movement, then by the time of birth it occupies a stable position and its presentation can already be accurately determined. If we compare ultrasound data performed during pregnancy, we can note that in approximately 25% of women the fetus is first located in a breech presentation, which later progresses to a cephalic presentation.

Head presentation of the fetus

The child completely occupies the space of the uterus and is best adapted to its shape. In 95% of cases, the largest part of his body (torso) is located in the widest part of the uterus. This means that the baby is positioned head down, with the back most often facing to the left.

This position is considered the most comfortable for mother and baby during childbirth. It is characterized by the position of the fetus head first (the front part is directed towards the mother's back), which is the most voluminous and plastic part of the fetus, due to the unfused bones of the skull. The baby's head will be the first to pass through the woman's birth canal (this includes the cervix, vagina, external genitalia), which determines a faster course of labor. After the head has passed, the remaining torso and limbs are born without any difficulty. In this case, the child is born with his head bent, pulled into his shoulders and slightly turned to the left side. However, there are cases when a baby who is in a cephalic presentation may have his head turned to the right side, which will significantly complicate childbirth. There is also a frontal and facial position of the fetus in cephalic presentation. The causes of these head positions may be a decrease in muscle tone and weak contractions of the uterus during childbirth, close proximity of the mother's pelvic bones, the size of the fetal head does not correspond to the norm (large or small), a congenital tumor of the child's thyroid gland, as well as difficulty moving when turning the fetal head . The frontal position may be associated with anatomical changes in the structure of the mother’s uterus, with a wide pelvis, and also most often occurs in multiparous women, since the stretched muscles of the uterus cannot ensure a stable position of the fetus. When this situation is determined, the woman in labor is transferred to the operating department. Childbirth in this position of the child is possible only if the fetus is small. In most cases, a caesarean section is used to deliver the baby. The facial position of the fetus can be determined even during the first ultrasound examinations. A characteristic feature of this position is the specific position that the child takes in the womb. By carefully palpating, it is necessary to determine in which direction the chin is directed. If it is directed forward, then labor will proceed independently. During childbirth, passing through the mother's pelvic bones, the baby's head encounters resistance and tilts back, so the front part of the head appears first, not the occipital part. In the facial position, a characteristic sign of a newborn baby is the elongated lips and chin of the fetus. If the chin is turned back, during childbirth the head may be pinched by the pelvic bones, which will lead to the impossibility of further delivery. This position of the fetus is very rare, but if it is detected, a caesarean section is always performed.

Breech presentation of the fetus

In preparation for his birth, somewhere between the 32nd and 37th weeks the baby turns over, taking a vertical position with his head down - the so-called cephalic, or occipital, presentation. As a result of this rotation, the baby's head is directed downwards, exactly towards the entrance to the birth canal. The head is the heaviest part of the baby's body. When the baby is almost fully formed, he turns over head down under the influence of the natural law of gravity.

In most cases, this somersault occurs completely unnoticed, especially if the baby turns over during mother's sleep. But the change of position may be delayed if the mother experiences fear and stress, or some circumstances in her life cause her grief.

Some women, for various reasons, cannot release stress, because of this, their uterus remains tense and the baby cannot turn over. The baby simply does not have enough space to make a turn, so he remains in his original position with his head up. The baby's buttocks remain at the entrance to the cervix. This position is called “breech presentation.” Sometimes the baby makes only a partial revolution: his shoulder, arm, one or both legs remain in the lower segment of the uterus.

If no change occurs, breech birth requires important decisions to be made. There are several options: direct all efforts to help the baby roll over; give birth to a breech baby or have a caesarean section. Since not many specialists have sufficient knowledge and skills to perform breech births, in most such cases women are referred to have a caesarean section. But this is not an option that you should think about at the very beginning. Many women give birth to breech babies through the normal vaginal route with home midwives.

The child is in a vertical, but incorrect position: the buttocks are located below, and the head is above. This fetal presentation occurs due to a very small uterus or its irregular shape.

Expulsion of the fetus during labor is difficult and general anesthesia may be necessary.

Breech presentation is characterized by the passage of the fetal legs and buttocks first through the birth canal, and then the head, and difficulties may arise due to the fact that the head is the most voluminous part of the fetal body, and there is also a risk of compression of the umbilical cord between the mother’s pelvic bones and the baby’s head.

Risk factors for breech presentation

This position of the fetus most often occurs during repeated pregnancy, when the muscles of the uterus and the front of the abdomen are most stretched and poorly fix the position of the child. However, this can also happen during the first pregnancy, in the case of a low position of the uterus in the small pelvis or in case of low placenta previa (baby place) in the uterine cavity, in which it is located in its lower part; with a large amount of amniotic fluid, in which the child is more mobile and can often change its position; with a narrow pelvis, when closely spaced bones interfere with the correct positioning of the child’s head. Risk factors also include the abnormal structure of the mother’s uterus and tumor processes located in its lower part, which do not leave enough space for the head to enter the pelvis, and fetal malformations. According to the latest data, it has been possible to prove that heredity is a predisposing factor for breech presentation. It has been found that a mother who is born with this presentation has a 95% chance of having babies in the breech position. In first place among the causes of breech presentation is premature pregnancy (birth of a child starting from the 28th week of pregnancy). In this case, with premature birth, a large ratio arises between the size of the child and the uterine cavity, in which he can move freely. The shorter the gestational age at which the birth process occurs, the greater the risk of breech presentation.

With breech presentation, there are several characteristic positions for it: gluteal, leg and knee. A breech presentation can be true, in which the child is positioned with his buttocks towards the entrance to the small pelvis, and his legs, bent at the hip joints, are parallel to the body, and mixed, in which, in addition to the child’s buttocks, the legs bent at the knee joints are also directed towards the birth canal. The leg position can be complete, in which both legs are presented, slightly extended at both the hip and knee joints, and incomplete, when only one leg is presented, while the other remains in a bent position and is located much higher. The kneeling position is characterized by the fact that the child is positioned forward with his legs bent at the knee joints. In most cases, the fetus is breech. Breech presentation occurs in approximately 5% of pregnancies.

If after the second ultrasound examination a pregnant woman is diagnosed with a breech fetus, this does not mean that by the time of birth the baby will not be in the correct position. A set of exercises can help turn the fetus with its head end towards the birth canal. A woman should alternately lie on a hard surface on her left and then on her right side for 10-15 minutes several times a day. Also, the knee-elbow position and the lying position with a raised pelvis have a great effect. To do this, you need to place a cushion or pillow under the buttock area and raise your legs 20-30 cm above your head. All exercises are performed on an empty stomach for several weeks so that their effectiveness can be assessed before the final ultrasound examination. Also, after the first week from the start of exercises, the doctor can evaluate them by palpating the location of the fetal head. Pregnant women are recommended to sleep on the side where the baby's head is located. With the correct and constant implementation of all the above exercises, the pelvic part of the fetus moves away from the mother’s pelvic bones, motor activity increases, which contributes to the spontaneous turning of the child. According to reliable research data, exercises, as well as swimming, allow the child to take the correct position before childbirth in 75-96% of cases, and the mother to avoid surgical intervention. However, it should be remembered that you cannot self-medicate; in this case, you must urgently consult with the doctor monitoring this pregnancy, since there are a number of categorical contraindications to performing gymnastic exercises. These include postoperative scars on the uterus, tumor processes in it, severe systemic diseases (not combined with the reproductive system), placenta previa (in the case when it is located in the lower part of the uterus), gestosis during pregnancy (the occurrence of edema, increased blood pressure , visual impairment).

To obtain a positive result, you can use non-traditional methods of treating breech presentation in combination with physical exercises. Before combining these methods, you must consult a specialist. In most cases, acupuncture is recommended - influencing the activity of the child and the uterus by stimulating certain areas with the shallow introduction of special needles and aromatic agents. The mother's psychological influence can also contribute to the child's turning over. A pregnant woman needs to imagine a correctly positioned baby, you can persuade or ask him to turn over, look at drawings and photographs of the child in the womb. The effects of music and light are often used. Many scientists argue that the child, while in the uterine cavity, moves towards a sound or light source. According to this theory, you can place a flashlight or small lamp closer to the lower abdomen or put headphones on this area with calm music. When a positive result is achieved using these methods, it is necessary to fix the correct position of the fetus. This can be done with the help of a special prenatal bandage and exercises aimed at increasing the elasticity of the ligaments and muscles of the pelvis, as well as the correct entry of the fetal head into the pelvic area. The most effective position is sitting with your legs apart, bent at the knee joints and the soles of your feet pressed together. In this case, you need to try to bring your knees as close as possible to the floor and fix this position for 10-15 minutes several times a day. The prenatal bandage provides support for the abdomen, thereby relieving the load on the spine, which prevents or significantly reduces pain in the lumbar region, and also reduces the risk of stretch marks. Currently, the most common bandages are in the form of an elastic band that is worn over underwear. Such a bandage can be worn in any position of the body; it does not put pressure on the uterus, due to the possible change in its diameter (with an increase in the volume of the abdomen) using special “Velcro” on the sides. It is recommended to remove the bandage every 3 hours for 30 minutes. It is also possible to use bandage underwear in the form of panties with a wide support belt. The disadvantage of this type of bandage is that to maintain body hygiene, it requires frequent washing, which makes it difficult to wear it constantly.

If it is not possible to independently correct the position of the fetus, at 36-38 weeks the doctor may perform external rotation of the fetus. This procedure is performed in a hospital setting under ultrasound monitoring and constant listening to the fetal heartbeat. The purpose of this manipulation is for the doctor to gradually move the baby's head down to the birth canal. Absolute contraindications to this measure are: postoperative scars on the uterus, excess body weight (weight increase by more than 60% of the initial condition), threatened miscarriage (increased excitability, increased tone of the uterine muscles), age of the pregnant woman (over 30 years old with first pregnancy), a history of miscarriages or infertility, gestosis in the second half of pregnancy, location of the placenta in the lower part of the uterus, abnormal structure and development of the uterus, large or too small amount of amniotic fluid, entanglement of the child with the umbilical cord, close proximity of the pelvic bones, heavy internal diseases of a woman, pregnancy caused by artificial insemination. Currently, the procedure for external fetal rotation is used in isolated cases due to a large list of contraindications and possible serious complications. After this procedure, it is necessary to constantly monitor the condition of the pregnant woman and the fetus.

In cases where the measures taken are not enough, the question arises about the method of delivery. Basically, a caesarean section is performed, but in case of a pregnancy that proceeded safely and occurred naturally, if the child weighs no more than 3500 g, there are no malformations of the female genital organs and the woman has sufficient width of the pelvis, a natural birth is carried out with a breech presentation of the fetus (in the breech position). position). Such childbirth will take place in three stages. The buttocks are born first, then the torso, and lastly the head, which is the most voluminous part of the fetus. By combining data from X-ray examinations and a control prenatal ultrasound examination, an obstetrician-gynecologist can determine the method of delivery for a breech fetus. The passage of the child through the mother's birth canal in the pelvic position can be favorable, but more careful monitoring is required here, which requires the presence of a pediatric resuscitator, since birth injuries, suffocation and stillbirth of the fetus are possible. Such births are in a borderline state between normal and pathological. The frequency of natural births with a breech presentation is approximately 5%. In the initial stage of labor, the woman in labor must observe strict bed rest. It is advisable to be in a supine position, on the side of the body where the back of the fetus is located. This is done to prevent early discharge of amniotic fluid and loss of fetal parts. A pregnant woman is under the supervision of obstetricians and is being prepared for childbirth. She is given labor stimulants (oxytocin) and anesthetized. All stages of labor take place under monitoring (with constant monitoring of the fetal heartbeat). The final stage of labor remains similar to that of a normal cephalic birth. However, to prevent postpartum hemorrhage, drugs that enhance muscle contractions of the uterus (methylergometrine, oxytocin) are administered intravenously.

Presentation during multiple pregnancy (twins)

Depending on the number of fertilized eggs (female gametes) and fertilizing sperm (male gametes), both fraternal and identical twins can be located in the uterus. Fraternal (developed from two or more eggs) twins occupy separate amniotic sacs (a limited cavity in the uterus that contains the baby, surrounded by amniotic fluid) and have separate placentas. Identical (developed when several sperm enter one egg) twins can also occupy separate amniotic sacs (only in rare cases is there one for two), but they are connected by one common placenta.

The presence of two or more fetuses in the uterus leads to its significant stretching, and therefore the presentation of twins in most cases is incorrect. This is also influenced by the fact that each child must adapt not only to the passage into the pelvis, but also to the position of the other child.

During a multiple pregnancy, the woman is placed in advance in the maternity hospital, where a control ultrasound examination is performed to assess the condition of the placenta.

Twins can be positioned longitudinally. In this case, both of them can be located either in a cephalic presentation, which is the most optimal for childbirth, or it is possible that one of the children will be in a cephalic presentation and the other in a pelvic presentation. When positioned longitudinally, twins can obscure each other. It is also possible for the fetuses to have different positions in the uterus: one of them occupies a vertical and the other a horizontal position in relation to the birth canal. In rare cases, the transverse position of both twins, as well as their pelvic presentation, is noted. The baby's position may change during labor. In case of cephalic presentation of both twins, after the birth of the first child, the second child may change its position to transverse or oblique due to the increase in space in the uterine cavity. In this case, external or internal rotation of the fetus is performed to correct the position of the child. The rarest occurrence during the birth of twins is their collision (coupling), which occurs when one child is positioned in the pelvic position and the other in the cephalic position. In most cases, the birth of twins occurs through surgery (cesarean section or the use of obstetric forceps to extract the second fetus).

Transverse presentation of the fetus

The child is positioned across the entrance to the pelvis, covering it with his back. During childbirth, the shoulder is shown first. In this case, it is necessary to perform a caesarean section.

Transverse presentation is defined when the baby is positioned horizontally in relation to the woman's birth canal. There are several fetal positions. The first position is in which the child's head is turned to the left, the second - in which the head is turned to the right. If the child's back is turned forward, this is an anterior view, and if it is backward, this is a posterior view.

Most often, transverse presentation of the fetus occurs when a woman’s pelvis is too narrow, with polyhydramnios (increased amount of amniotic fluid), premature rupture of amniotic fluid, excessive fetal activity, with repeated pregnancy (the muscles of the uterus are not able to support the vertical position of the fetus), with a too large head fetus Transverse presentation of the fetus includes its oblique (shoulder) position. An ultrasound examination reveals that the head and pelvic part of the fetus are located in the lateral parts of the uterus, due to which it takes an elongated position in the transverse direction, the fundus of the uterus is below the required level. Upon examination, the baby's heartbeat can be heard only in the navel area. When labor begins, the position of the fetus can be determined by vaginal examination after the discharge of amniotic fluid. In the shoulder position, you can palpate the shoulder, collarbone and rib area (in the posterior view), as well as the scapula and spine (in the anterior view). When in a transverse position, the handle can be felt to fall out.

If one of these positions is detected, it is necessary to perform a cesarean section, since spontaneous childbirth is impossible and complications such as prolapse of the umbilical cord or small parts of the body (upper limbs) often occur. In case of early detection of this type of presentation, the obstetrician-gynecologist can perform external or internal rotation of the fetus. External fetal rotation is performed in a hospital setting. If the shoulder position is maintained, the course of natural childbirth will in most cases be complicated by the loss of small parts of the fetus or part of the umbilical cord. However, despite possible complications, delivery can occur without surgery. Most often, self-inversion occurs or the child appears with his body folded in half.

With spontaneous inversion, a child can be born in several ways. If the fetal head is located above the pelvis, then the shoulder will be born first, followed by the torso and lower limbs, and lastly the head. If the head is in the pelvic area, most often its passage will be hampered by the shoulders; in this case, the torso and lower limbs will appear first, and then the shoulders and head. When folded, the shoulder appears first, then the torso appears with the head pressed into the stomach, and then the buttocks and legs. If the fetus is in a shoulder or transverse position, spontaneous delivery can only be expected in multiparous women or with a low weight of the child. The location of the umbilical cord and small parts of the fetus (upper and lower extremities) below the larger presenting part of the child after the rupture of amniotic fluid is called their prolapse. If the integrity of the fetal bladder is preserved, but small parts are located in the lower part of the uterus near the birth canal, their presentation is established. Only a manual vaginal examination can determine the presenting part of the fetus in more detail. The prolapse of the umbilical cord can be judged by characteristic changes in the condition of the fetus and disturbances in the rhythm of its heart contractions when it is strangulated. If it is impossible to put part of the umbilical cord back and there are no necessary conditions for immediate natural childbirth, surgical intervention is performed. If part of the umbilical cord falls out during the breech presentation of the child and if there are no complications, a natural birth is performed. If one of the upper limbs falls out, the transition of the fetal head to the lower pelvic region, to the birth canal, is impossible. With this position of the child, it is necessary to move the handle behind the child's head into the uterine cavity. If for some reason this is not possible, a caesarean section is performed.

When the lower extremities of the fetus prolapse, the child’s body bends while the prolapsed leg is extended. Most often, this position of the fetus is observed in multiple pregnancies (twins) and in premature pregnancies. Also in this case, the prolapsed part of the fetus is reduced, and if the result is negative, a cesarean section is performed.

Occipital presentation of the fetus

This is the most common type of presentation - about 95%. The crown is located at the entrance to the small pelvis. During childbirth, the head will enter the birth canal with the chin pressed to the chest.

Occipital presentation of the fetus: 95% of cases

Facial presentation of the fetus

In this case, the head is completely thrown back. Childbirth often occurs with complications, sometimes resorting to caesarean section.

Frontal presentation of the fetus

In this case, a caesarean section is necessary, since the head is facing the birth canal with its large size, and childbirth through the natural birth canal is impossible.

With this type of presentation, the baby is located horizontally in the uterus. This position prevents him from going down, so a caesarean section is the only option unless the doctor tries to change the baby's position before delivery.

The baby lies across the uterus; head - below, buttocks - above. The position is called “shoulder” or transverse. Sometimes the doctor is able to change the baby's position by applying external pressure to the abdominal cavity. But this technique is not always successful and in some cases is contraindicated.

Or cephalic presentation of the fetus.

If a woman already has a child, then she has already received answers to many questions regarding pregnancy and childbirth.

But for first-time mothers who are expecting the birth of a baby for the first time, this path has yet to be covered.

For proper gestation and upcoming birth, this information is marked “particularly important.”

What does it mean

The cephalic presentation of the fetus is the desired and most common position for natural childbirth, when the baby's head is located at the entrance to the pelvis.

There are several varieties of this option:

• frontal;
• facial;
• occipital;
• anterior cephalic.

Presentation and its variants are determined using a photo ultrasound examination, and depending on this, the gynecologist determines the delivery tactics.

The occipital presentation of the fetus is considered the most ideal.

In this position, the baby moves through the birth canal with a slightly bent neck and is born with the back of the head first.

Such births, as a rule, take place without ruptures for the mother and without injuries for the baby.

The cephalic presentation of the fetus in the facial type is characterized by maximum tilting of the child's head.

This means that the baby emerges from the birth canal with the back of its head.

In this situation, based on palpation and ultrasound results, the doctor may recommend a cesarean section.

The option of natural delivery is also possible if certain conditions are met:

• the woman in labor has a wide or normal-sized pelvis;
• the fruit is medium-sized, up to 3,200 g;
• active course of the birth process;
• The baby's chin is directed in accordance with the anterior type of facial presentation.

Head frontal presentation is a 100% indication for delivery by cesarean section. This position of the fetus during childbirth is very rare, about 1-2% of the total.

The anterior cephalic, or as it is also called anterior parietal, variant of presentation is characterized by a position where the baby is forced to move forward with the fontanel.

In this case, the mother can give birth on her own, but there is a possibility of hypoxia and trauma to the fetus.

In addition to the four types of cephalic presentation, it is also taken into account which wall of the uterus, left or right, the baby’s back is turned to.

The left, most common option, is what doctors call 1st position of cephalic presentation.

If the baby is turned with his back to the right side of the uterus, then this is position 2.

And also the position of the baby relative to the vertical axis: oblique or straight.

Why a different position: reasons

If we take the total number of women giving birth as 100%, then only 3-5% are accounted for by the so-called breech presentation, which is considered incorrect.

Childbirth in this case is considered pathological and quite often occurs by caesarean section.

Incorrect positioning of the fetus at the time of birth is caused by several reasons.

This may depend on the anatomical structure of the uterus or be explained by hereditary factors.

The position of the baby directly depends on the location of the placenta and polyhydramnios during pregnancy.

Low cephalic presentation is also considered a deviation from the norm if it is diagnosed starting from the 22nd week of pregnancy.

During the normal course, the fetus begins to move downward.

At earlier stages, this can threaten premature birth or, therefore, further pregnancy occurs under the supervision of a doctor and often in a hospital setting.

If you are diagnosed with “low cephalic presentation” at home, you must adhere to several simple but mandatory rules:

• exclude all types of active recreation and physical activity. This is especially true when lifting weights;
• use ;
• not to accept ;
• lie down more and worry less.

How to determine the position: timing and diagnostic methods

You can talk about the head or pelvic position starting from the 28th week of pregnancy.

At this stage, the baby’s head can already be felt during external examination by palpation.

But to more accurately determine the position of the fetus, an ultrasound examination is performed, when everything can be examined in more detail on the monitor or in the photo.

But for about another month the baby can change position.

But starting from the 32nd week, cephalic or breech presentation can be diagnosed with a high degree of probability.

You can decide on this issue based not only on photos and ultrasound results, but by doing it yourself:

• Lie on your back;
• Bend your knees.
• Place your hand down the abdomen; with light pressure, the head will be palpable if we are talking about cephalic presentation.

Of course, details such as frontal or facial presentation of the fetus cannot be determined by touch, so the doctor will rely on ultrasound when making a diagnosis.

– longitudinal position of the fetus with the head facing the entrance to the pelvis. Depending on the presenting part of the fetal head, occipital, anterior cephalic, frontal and facial locations are distinguished. Determining fetal presentation in obstetrics is important for predicting labor. Fetal presentation is determined during examination using special obstetric techniques and ultrasound. Head presentation is the most common and desirable for spontaneous childbirth. However, in some cases (with frontal presentation, posterior type of facial presentation, etc.), surgical delivery or the application of obstetric forceps may be indicated.

General information

Head presentation of the fetus is characterized by the baby’s head facing the internal os of the cervix. With a cephalic presentation of the fetus, the largest part of the baby’s body, the head, moves first along the birth canal, allowing the shoulders, torso and legs to be born quickly and without much difficulty. Until 28-30 weeks of pregnancy, the presenting part of the fetus may change, but closer to the due date (32-35 weeks), in most women the fetus takes on a cephalic presentation. In obstetrics, a distinction is made between cephalic, pelvic and transverse presentation of the fetus. Among them, cephalic presentation occurs most often (in 90% of cases), and the absolute majority natural birth occurs precisely with this position of the fetus.

Variants of cephalic presentation of the fetus

With a cephalic presentation of the fetus, several options for the location of the head are possible: occipital, anterior cephalic, frontal and facial. Among them, the most optimal obstetrics And gynecology considers flexion occipital presentation. The leading point of advancement along the birth canal is the small fontanel.

With the occipital variant of the cephalic presentation of the fetus, during passage through the birth canal, the baby’s neck is bent in such a way that the occiput of the head appears first at birth. This is how 90-95% of all births proceed. However, with a cephalic presentation of the fetus, there are options for extensor insertion of the head, which differ from each other.

• I degree of head extension– anterocephalic (anteroparietal) presentation. In the case of anterior cephalic presentation of the fetus, the large fontanelle becomes the wire point during the expulsion period. Anterior cephalic presentation of the fetus does not exclude the possibility of spontaneous birth, however, the likelihood child birth trauma And mothers higher than with the occipital version. Childbirth is characterized by a protracted course, therefore, with such a presentation, prevention is necessary fetal hypoxia.
• II degree of head extension- frontal presentation. Frontal cephalic presentation is also characterized by the entry of the fetal head into the small pelvis by its maximum size. The conducting point through the birth canal is the forehead, lowered below the other parts of the head. With this option, natural childbirth is impossible, and therefore surgical delivery is indicated.
• III degree of head extension- facial presentation. The extreme degree of extension of the head is the facial version of the cephalic presentation of the fetus. With this option, the leading point is the chin; the head emerges from the birth canal backwards with the back of the head. In this case, the possibility of spontaneous childbirth is not excluded, provided that the woman’s pelvis or small fetus is of sufficient size. However, face presentation is in most cases considered an indication for caesarean section.

Extensor variants of cephalic presentation of the fetus account for about 1% of all cases of longitudinal positions. The reasons for various non-standard positions and presentations of the fetus may be the presence of a narrow pelvis in the pregnant woman; abnormalities in the structure of the uterus, uterine fibroids that limit the space available to the child; placenta previa, polyhydramnios; flabby abdominal wall; heredity and other factors.

Diagnosis of cephalic presentation

Fetal presentation is determined by an obstetrician-gynecologist, starting from the 28th week of pregnancy using external obstetric examination techniques. To do this, the doctor places the open palm of the right hand above the symphysis and covers the presenting part of the fetus. With a cephalic presentation of the fetus, the head is identified above the entrance to the pelvis, which is palpated as a dense round part. Head presentation of the fetus is characterized by voting (mobility) of the head in the amniotic fluid.

External examination data are clarified during vaginal examination gynecological examination. With a cephalic presentation of the fetus, the heartbeat can be heard under the woman’s navel. With help obstetric ultrasound the position, position, presentation, position of the fetus and its appearance are specified.

Birth tactics for cephalic presentation

Correct and prognostically favorable in obstetrics are considered childbirth, occurring in the anterior view of the occipital cephalic presentation of the fetus (the back of the head is facing anteriorly), which contributes to the creation of optimal relationships between the size and shape of the head, as well as the pelvis of the woman in labor.

In this case, at the entrance to the pelvis, the fetal head is bent, the chin is close to the chest. When moving through the birth canal, the small fontanelle is the leading conducting point. Bending the head somewhat reduces the presenting part of the fetus, so the head passes through the small pelvis in its smaller size. Simultaneously with the movement forward, the head makes an internal rotation, as a result of which the back of the head turns out to be facing the pubic symphysis (anteriorly), and the face is facing the sacrum (posteriorly). When the head erupts, it is extended, then the shoulders rotate internally and the head externally rotates so that the baby’s face is turned toward the mother’s thigh. Following the birth of the shoulder girdle, the baby's torso and legs appear without difficulty.

In the case of labor progressing in the posterior view of the cephalic occipital presentation of the fetus, the back of the head turns toward the sacral cavity, i.e., posteriorly. The forward advancement of the head during a posterior-occipital cephalic presentation of the fetus is delayed, and therefore there is a possibility of developing a secondary weakness of labor or fetal asphyxia. Such births are conducted expectantly; in the case of weak labor, stimulation is performed; if asphyxia develops, obstetric forceps.

The mechanism of birth with anterior cephalic presentation of the fetus in its main points coincides with the previous version. The conductive point with such a presentation of the head is the large fontanelle. The tactics of childbirth are expectant; surgical delivery is undertaken in the event of a threat to the health of the mother or fetus.

With frontal cephalic presentation of the fetus, spontaneous labor is extremely rare and takes a long time with a protracted period of expulsion. With independent childbirth, the prognosis is often unfavorable: complications in the form of deep perineal ruptures, uterine ruptures, the formation of vaginal-vesical fistulas, asphyxia and fetal death. If a frontal cephalic presentation is suspected or determined, the fetus can be rotated even before the head is inserted. If rotation is not possible, a caesarean section is indicated. In case of complicated spontaneous labor, a craniotomy is performed.

The conditions for a successful independent delivery with a facial cephalic presentation of the fetus are the normal size of the mother's pelvis, active labor, a small fetus, and an anterior view of the cephalic presentation (chin facing anteriorly). The birth is conducted expectantly, with careful monitoring of the dynamics of labor and the condition of the woman in labor, the fetal heartbeat using cardiotocography , fetal phonocardiography. In the posterior type of facial presentation, when the chin is turned posteriorly, a cesarean section is required; if the fetus is dead it is performed fruit-destroying operation.

Prevention of complications during childbirth

Pregnancy management in women at risk is associated with an abnormal course of labor. Such women should be hospitalized in a maternity hospital in advance to determine the optimal tactics for childbirth. With timely diagnosis of abnormal position or presentation of the fetus, a cesarean section is most beneficial for the mother and child.

Fetal presentation plays a vital role for the favorable course of labor. Many pregnant women know that the position of the baby in the uterus before birth should be head down. However, not everyone knows that in addition to the head down position, the type of cephalic presentation is very important. Let's consider the types of presentation of the baby upside down and the measures taken to ensure that the fetus takes the position desired for childbirth.

Head presentation of the fetus, its types, differences from other types of presentation

The location of the baby in a woman’s uterus begins to matter only after 32 weeks of gestation, when the baby is already quite large and it becomes more and more difficult for him to turn over in the stomach. Until this period, the child can spin in the womb as he pleases.

Head presentation of the fetus is the most common and natural position of the fetus in the stomach of a pregnant woman. The baby is in the womb with its head down at the entrance to the pelvis, the legs, accordingly, are located at the top of the abdomen. In 96–98% of cases, the child is in a cephalic position before labor, which is the most favorable for its good course. Other types of presentation are pathological and often childbirth with them may require surgical intervention. In addition to the favorable one, there are also such abnormal types of position of the child in the uterus before birth as: pelvic, transverse and oblique.

All types of fetal presentation except cephalic presentation are considered pathological

Variants of cephalic presentation of the fetus:

• occipital;
• anterior cephalic (parietal);
• frontal;
• facial.

The cephalic occipital presentation is preferable for the birth of a child.. The baby lies in the tummy with the head tilted towards the chest, down. The baby's face is mainly turned towards the mother's spine. Thus, the baby will go out through the narrowest point of the head - the back of the head. The occipital position of the fetus at birth is the least traumatic for the child and for the woman; childbirth usually takes place without severe damage or complications. The fetus moves along the birth canal with the back of the head forward, with the neck bent and the chin pressed to the chest.

Occipital presentation is the most favorable position of the fetus before birth

The anterocephalic or parietal position of the fetus is noted when the baby is facing the genital tract with a large fontanelle, the head is not tilted towards the chest, but is in a straight position. Going through the cervix and vagina with such a presentation will initially be crown. Delivery is possible both with the help of surgical intervention and by the woman’s own efforts. But in both situations, mandatory monitoring of the baby’s condition is necessary to avoid a lack of oxygen. Childbirth with an anterior cephalic position of the baby is often protracted and traumatic for the child or mother.

The anterior cephalic position of the fetus during childbirth can be traumatic for mother and baby

Frontal presentation of the fetus is a rare, but at the same time the most dangerous position of the child before childbirth.. Occurs in only 1–2% of pregnancies. The baby's neck straightens and the baby's forehead becomes directed towards the birth canal. The fetus, in the event of birth, will have to pass through the genitals at the widest point of the head. The birth of a baby in a natural way with this presentation is unacceptable.

With frontal presentation, delivery is always performed through surgery.

Facial presentation is observed even less frequently than frontal presentation - in only 0.3% of all pregnancies. With this position, the baby's head is strongly tilted back and the back of the head is almost pressed to the back. In the case of childbirth, the baby moves along the birth canal face forward, and the nose and chin become the leading point. Childbirth can be either natural or through surgery. In each case, an individual decision is made regarding the type of birth, depending on many factors: the parameters of the woman’s pelvis, the weight of the child, the intensity of contractions. Despite all the circumstances of pregnancy, the birth of a baby naturally in the frontal position is almost as dangerous and traumatic as in the frontal position. Injuries to the child's spine are often observed. Often presentation changes to facial from frontal at the time of birth. Less commonly, facial position is diagnosed by ultrasound some time before birth. This type of pathology most often affects multiparous women.

Frontal presentation of the fetus is a 100% indication for cesarean section

Causes of pathological types of cephalic presentation on the part of the mother and fetus

Causes of pathological presentation of the fetus on the part of the woman:

• narrow pelvis of a pregnant woman;
• too weak tone of the uterus, irregular compression of its sides;
• excess amniotic fluid;
• second or more births;
• multiple pregnancy;
• uterine fibroids;
• saddle or bicornuate uterus;
• the presence of a septum in the body of the uterus.

Causes of pathological position on the part of the fetus:

• tumor of the baby’s neck or thyroid gland;
• too small, or vice versa, very large head, which is associated with diseases.

Diagnosis of cephalic presentation

A specialist can manually assess the position of the child after 22 weeks of an interesting position. However, before the 32nd week of pregnancy, the baby may change its position several more times. After 32–35 weeks, the baby is most often breech, which will persist until delivery.

In 95% of pregnancies after 35 weeks, the position of the baby in the uterus remains unchanged.

In order to understand the presentation of the baby, the obstetrician-gynecologist, with an open palm, tries to feel the baby’s head in the lower abdomen (the junction of the lateral pelvic bones). When the baby is positioned head down, it is palpated and determined to be a dense, rounded part. In addition, the doctor uses a technique called voting. If the palpable part of the fetus is lightly moved a couple of times, the head wanders (oscillates) in the amniotic fluid. The baby's heart, when positioned head down, usually beats just below the mother's navel, which the doctor can also find out using a fetal doppler. The gynecologist can clarify the type of position of the baby using a vaginal examination.

If there are any doubts about the position of the baby in the womb, it is advisable for the pregnant woman to undergo another ultrasound.

Mommy can assess the location of her baby on her own. To do this, she should lie on her back with her legs bent at the knees. Using the fingers of one hand, try to gently feel the head in the lower abdomen. If this succeeds, the position is in the head position. It is impossible to find out the type of head position at home.

Using an external examination, the doctor can determine fetal presentation

Exercises to correct abnormal types of baby presentation

If, after thirty-two weeks, a pregnant woman is found to have an abnormal position of the baby, doctors may recommend performing useful exercises that will encourage the fetus to assume a normal position for childbirth. However, it is worth remembering that sometimes there are individual characteristics of the female body or child that can prevent the baby from turning into the correct position, despite the quality of the exercises performed by the woman.

There are also restrictions on performing gymnastics by a pregnant woman:

• risk of untimely birth;
• placenta previa.

If there are no restrictions, a woman can try doing simple exercises:

1. Lie on your side on a hard surface. Lie down for 12–15 minutes on one side, then turn over to the opposite side and lie down for the same amount of time. You should roll over from one side to the other at least three times in one approach. It is worth performing these manipulations two to three times a day. The effectiveness of simple actions is often high and the result appears already in the first 5–7 days.
2. Lie on your back, place blankets under your legs and lower back so that your legs are 25–30 cm higher than your head. You need to lie in this position for 20–25 minutes, 1–2 times a day.
3. Take a knee-elbow position on the floor and stay in this position for 20–25 minutes. The exercise should be performed 3-4 times a day.
4. Exercise “Cat”, for which you initially also need to take a knee-elbow position. While in the starting position, bend your back up in the lumbar region, then straighten your back without bending down. The exercise must be performed 15–20 times in one approach, 2–3 times a day. “Kitty” is useful for all pregnant women who have no contraindications; when performing this exercise, the uterus is saturated with oxygen.
5. Stay in a standing position or slightly leaning forward for longer than usual.
6. Try to sleep on the side where your baby's head is.
7. Swim on your stomach and back.

   Swimming helps turn the fetus head down

8. Starting position: standing, feet shoulder-width apart, hands on the belt. Perform slow bends forward and backward. Inhale while standing, exhale while bending over. It is recommended to perform 10–20 smooth bends in one approach.
9. The starting position is the same. Perform smooth bends to the side. As you inhale, be in a horizontal position and raise your arms up; as you exhale, lower your arms and tilt to one side. It is worth performing 10 bends in each direction at a time.

When performing any of the exercises, a pregnant woman should not experience discomfort, severe physical exertion or pain. To achieve the best effect, it is recommended to perform gymnastics no earlier than 2-3 hours after eating. Movements help increase the tone of the uterus and stimulate the baby's motor activity.

People say that you can help your baby roll over using a headphone with music or a light source placed on the lower abdomen. They say that the baby, even in the womb, begins to pick up sounds and changes in lighting and, out of curiosity, can turn towards an external stimulus.

If the mother’s efforts were not in vain and the child, with the help of physical exercises, nevertheless took the necessary position, it is worth helping him remain in a natural presentation. First of all, for this you need to wear a bandage. The bandage should be put on while lying down and worn for at least half a day. It also makes sense to do a couple of simple exercises:

• sit on the floor, bend your knees and bring your feet together. Press your knees to the floor as much as possible and sit in this position for 5-15 minutes;
• sit on a chair, press your feet to the floor. Slowly raise your bent legs up 20–30 cm, and then lower them to the starting position. It is recommended to perform 20–30 repetitions in one approach.

It also happens that the baby independently turns over into a natural position for childbirth in the last weeks of pregnancy. Still, nature takes its toll and there is no need to panic ahead of time.

That's what happened to my friend. After 32 weeks, she was informed that the baby was in a breech presentation. She began to do physical exercises to make the child turn over, but they did not bring results. And a week later, after the girl stopped doing gymnastics, at the next ultrasound she was pleased that the fetus had turned head down.

External obstetric inversion

Another way to turn the baby into the desired presentation is an external obstetric inversion. It is usually performed after the 35th week of pregnancy by experienced specialists strictly in a hospital setting. The manipulation is also carried out under the control of ultrasound and CTG.

Before starting the inversion procedure, the doctor monitors the position of the fetus using ultrasound and performs CTG, so the doctor has a good idea of ​​what is happening inside. After this, using gentle hand movements on the pregnant woman’s belly, the doctor tries to turn the baby head down. Typically the manipulation lasts from several seconds to several minutes. After the revolution, the condition of the fetus is again assessed using an ultrasound machine and CTG. Then the woman goes home.

Some women are afraid of performing an external rotation, assuming that the doctor’s actions may injure the child. But that's not true. The fetus in the womb is in a state of hydro-weightlessness and cannot be injured by the experienced actions of a doctor.

Obstetric fetal inversion does have small risks, which are discussed with the patient before the manipulation, but the risk from external inversion is very small and is not comparable to the danger of giving birth to a child in an incorrect presentation or cesarean section. All over the world, there is no knowledge of the real complications that the procedure of obstetric fetal inversion would bring.

At approximately 35–40%, external rotation cannot be performed. This is mainly due to the presence of contraindications to this manipulation. Less often, there are cases when the fruit itself could not be turned over. It depends on the stage of pregnancy. The higher the gestational age, the more difficult it is to successfully perform an external obstetric rotation of the baby.

Video: external obstetric inversion

Features of childbirth with facial, frontal and anterior cephalic types of presentation

The birth of a child in the facial, frontal and anterior cephalic (parietal) position is pathological. In the face presentation, the fetal head enters the small pelvis with the largest size of 32–33 cm, the leading part is the chin. In a presentation with the forehead forward, the largest size of the head passing through the birth canal is 39–41 cm, and the leading part is the eyebrow. With anterior cephalic presentation, the maximum circumference of the head passing through the genitals is 34–35 cm, and the leading point is the crown.

In many cases, during labor, the type of abnormal presentation may change. Thus, the parietal position, when the head is tilted forward, passes into the occipital position, and when extended, into the frontal position.

The anterior cephalic position of the baby is often accompanied by untimely rupture of amniotic fluid. The decision regarding the type and strategy of childbirth is made individually in each case; independent childbirth and caesarean section are possible. A woman will be able to give birth on her own if the fetus is small and the head can pass through the genital tract with the crown. During normal childbirth, the initial periods of birth last longer than with occipital presentation, and the likelihood of trauma to the woman’s genital organs, as well as the likelihood of trauma to the child and its hypoxia, increases. There are cases when the baby’s head enters the pelvis and after this the woman in labor experiences weakness in labor. In such a situation, specialists remove the fetus using obstetric forceps or a vacuum extractor (a device that pulls the baby out of the genitals using rarefied air).

During prolonged labor and weak labor, obstetricians-gynecologists use a vacuum extractor to extract the baby.

A small pelvis of a woman in labor, a large head of the baby, weak contractions, post-term pregnancy - serve as indications for the use of an operative method of delivery.

Particularly dangerous for childbirth is frontal presentation. The baby's head lies at the entrance to the genital tract at its largest size. Therefore, independent childbirth in this position of the child is practically impossible, and if it takes place, it is with severe damage to the child and mother. A woman may experience a rupture of the perineum or uterus. Untimely discharge of amniotic fluid is observed, which can lead to oxygen starvation or infection of the fetus. The duration of labor increases. The only possibility of independent birth is to correct the position of the fetus to the parietal or facial position, but it will still not be possible to avoid damage to the child.

Due to the danger of serious consequences of natural childbirth, in almost 100% of cases, childbirth with the frontal position of the fetus is carried out using surgery. The main thing is to have time to carry out surgical intervention before the head enters the pelvis. If the head has entered the small pelvis and remains in a static state for a long time, signs of fetal hypoxia are noticed - specialists usually resort to the help of obstetric forceps. If the forceps do not help and the fetus cannot be extracted, it is necessary to perform an operation that destroys the fetus in order to save the life of at least the woman in labor.

With a facial presentation of the fetus, prenatal rupture of amniotic fluid and oxygen starvation of the fetus may also occur, and umbilical cord prolapse may occur. The duration of birth increases by almost one and a half times when compared with childbirth in a favorable position. A significant factor is keeping the fetus in the posterior position, otherwise a transition to the frontal position is possible and independent childbirth will become impossible. If the type of presentation has changed to frontal, an immediate cesarean section is required, or, if it is too late and the head is stuck, specialists perform a fetal-destroying operation.

If the birth goes according to plan, the child’s skull needs to adapt to the birth canal and change its shape, which is why a birth tumor is formed. The parietal bones may also overlap each other. In both situations, the baby’s head takes on a normal shape for some time after birth.

In 92–95% of births with the fetus in the facial position, they occur naturally; in other situations, a cesarean section is necessary.

Measures to prevent abnormal fetal positions

In fact, there are no special specific measures to prevent the risks of malpresentation of the fetus. Everything is natural, and the correct position of the child in the womb is inherent in nature; you just need to ensure the normal course of pregnancy throughout its entire period.

It is advisable for a pregnant woman to maintain a favorable psychological mood, eat a nutritious and varied diet, and observe a work and rest schedule. You shouldn't overeat either, especially in the last weeks of pregnancy. After all, a large and post-term fetus can be a risk factor for malpresentation. You should also strictly follow your doctor’s recommendations and take vitamins or medications as prescribed by specialists. If necessary, it is possible to perform special gymnastic exercises suggested by the obstetrician-gynecologist.

Communicate more with your baby, ask him to take the correct position in his tummy - this will help both you and the baby tune in to a positive wave before giving birth.