Closer to the eighth month of pregnancy, most babies turn their heads upside down, thus preparing for childbirth. But if your child has not done this, then in 90% of cases this means that he is preparing to come out of the womb forward with his buttocks or legs. This is called breech presentation. If this is found before 35 weeks, then you can try to help the baby to take the correct position on your own. Sometimes from 37 weeks, you may be offered obstetric coup. Childbirth in which the child is in breech presentation(i.e. booty or kicks down) require more skill from midwives and are more likely to have complications. But this does not mean that you cannot give birth yourself.

The first thing you can do is help your baby roll over. And help you with this

1. Conversations. Do not laugh. But your attitude, your mood, and your words greatly affect your baby.


2. Swimming. If there are no contraindications from your doctor, start visiting the pool! Most often, a sedentary lifestyle, and is the reason that the baby is stuck, as it were, and cannot roll over. Besides, water is a good relaxant. Aqua gymnastics and aqua aerobics, to cheer you up, relieve tension from the spine and abdominal muscles. And your baby will be helped to roll over


3. Coup. It is very important for the mother to lie down and turn over from side to side. Sleeping and lying in the same position can cause breech presentation. Just your little one, make yourself comfortable too. Therefore, the first exercise:

Lie on a firm, level surface (sofa, couch, floor) on your side. Lie down like this for 10 minutes, roll over over your back on the other side, and lie down like this for another 10 minutes. It is good if you manage to do the exercise at least 2-3 times. It is best done before meals.

1. Kitty. One of the most recommended exercises. Get on all fours and slowly swing your hips. Bend over as you inhale, and as you exhale, bend your back like a cat, and lower your head down.


2. Incline. Lie near the wall, put a pillow under the back, so that the pelvis is a little higher than the head, and rest your bent legs against the wall ... Try to relax and lie like this for 5-10 minutes


3. Sit on the floor and bring your feet together. Try to press your knees to the floor. Soak in this position for 10-20 minutes. Repeat the exercise 3 times a day.


4. Yes fitball hello! Do not be lazy, buy yourself a ball for pregnant women. Then he will be useful to you more than once. The best exercise on it is
   
   
   • Bend your knees, lay on the ball, lie on your back, raise and lower your pelvis. Repeat the exercise 10 times.
   
   
   • Bend your knees and place them on the ball. Pump them slowly from side to side. Repeat the exercise 10 times
   
   
   • Sit on the ball with your feet shoulder-width apart. Begin to make light circular movements with your hips.
   
   

Do not be discouraged if you have done everything in order for your baby to turn over, and he stubbornly sits on the bottom. But sometimes the child accepts this position because it is most convenient for him to be in it - the length of the umbilical cord and the location of the placenta make this very position convenient for the child. In this case, trying to turn the baby over is useless.

I would also like to tell you about the obstetric coup. In our country, the external rotation of the fetus is very rarely recommended, and no one dares to do the internal one at all, since the method itself is considered outdated and unreliable. There is a risk that the child from the head, after turning, will go to the transverse presentation - and from there he will be almost 100% cesarean.
Decide unambiguously future mom and her doctor.

Obstetric turn is an operation with the help of which it is possible to change the position of the fetus, unfavorable for the course of labor, to a favorable one, and, always, only longitudinal. There are the following ways of obstetric rotation: outward turn on the head, less often on the pelvic end; inner turn with full opening of the uterine pharynx - a classic, or timely, turn.
External rotation of the fetus is performed by the doctor only by external methods through the abdominal wall without any influence from the vagina. Indications: transverse and oblique fetal position, breech presentation of the fetus. Conditions for carrying out: good mobility of the fetus (when the waters have departed, the turn is not shown); normal size of the pelvis (true conjugate is not less than 8 cm); lack of indications for the rapid end of labor (fetal asphyxia, premature placental abruption, etc.).

There are also contraindications.

Please note that not all women can be affected by this procedure! If you carry twins or your pregnancy is complicated by bleeding or oligohydramnios, this manipulation is contraindicated for you! And, of course, this procedure is not performed for those women who, in any case, will give birth by cesarean section - for example, with placental presentation, bearing triplets, or having a history of two or more cesarean sections or operations on the uterus. Severe complications, although relatively rare, can occur. For example, obstetric rotation of the fetus can lead to separation (detachment) of the placenta from the wall of the uterus, which will force the doctor to decide on an emergency caesarean section. The procedure can also lead to a slowing of the baby's heart rate, a condition that requires immediate delivery if it does not go away on its own within a short period of time. For these reasons, the physician must perform this procedure only in a hospital with an operating room, intensive care unit and medical staff that may be needed for a caesarean section in case of any complications.

Technics obstetric coup.

The classic internal turn is performed only by the doctor. When carrying out an internal obstetric turn, one hand is inserted into the uterus, the other is helped through the abdominal wall of the woman in labor. Shown is the classic internal rotation with the transverse position of the fetus, as well as with dangerous for the mother presenting (for example, frontal) and head insertions (for example, posterior-parietal). With the classic turn, you can turn the fetus from a transverse position (sometimes longitudinal) to the head and to the leg. Rotation to the crown is currently of no practical importance. Conditions for turning: full opening of the uterine pharynx, full fetal mobility. The contraindication to internal rotation is the neglected lateral position of the fetus.
Today, doctors rarely risk the health of the woman in labor and the baby. Therefore, the Caesarean is preferred to the internal coup.

Easy pregnancy and childbirth!

This is an operation with the help of which it is possible to change the position of the fetus, unfavorable for the course of labor, to a favorable one, and always only longitudinal. There are the following methods of obstetric rotation: external rotation to the head, less often to the pelvic end; an internal turn with full opening of the uterine os is a classic, or timely, turn.

External rotation of the fetus is performed by the doctor only by external methods through without any influence from the vagina. Indications: transverse and oblique fetal position, breech presentation of the fetus. Conditions for carrying out: good mobility of the fetus (when the waters have departed, the turn is not shown); normal size of the pelvis (true conjugate is not less than 8 cm); lack of indications for the rapid end of labor (, premature detachment, etc.).

Technics. The outer turn, especially in multiparous, can be done without anesthesia. In oblique fetal positions, it is sometimes sufficient to lay the woman in labor on the side towards which the presenting part is deflected. For example, with the left oblique position of the fetus (head to the left), the woman is placed on her left side. In this position, the bottom of the uterus, together with the buttocks of the fetus, deviates to the left, and the head - in the opposite direction, to the entrance to.

With a clearly expressed lateral position of the fetus, special external techniques are required for rotation. A woman in labor, 30 minutes before the operation, is injected subcutaneously with 1 ml of a 1% solution (for some relaxation of the uterine muscles so that further manipulations do not cause unnecessary disturbances). The woman in labor lies on a couch (preferably on a firm one) on her back, with her legs slightly bent and drawn to her stomach. The obstetrician sitting on the side of the couch puts both hands on the woman in labor so that one hand lies on the head, grabbing it from above, and the other on the pelvic end of the fetus, covering its lower buttock (Fig. 1). Having clasped in this way, with one hand they press on the head of the fetus towards the entrance to the pelvis, and with the other they push the pelvic end upward, to the bottom of the uterus. All these manipulations are done persistently, but extremely carefully, they are permissible only during a pause, at the moment of complete relaxation of the uterus; with the onset of a contraction, the obstetrician's hand remains in place, holding the fetus in an occupied position.

Rice. one... External rotation to the head with the transverse position of the fetus (anterior view).
Rice. 2... General rules for external preventive rotation (along the arrows) in breech presentation: displacement of the buttocks towards the back, back towards the head, head towards the entrance to the pelvis.
Rice. 3... The overlying leg is captured (rear view of the transverse position).

External turn on the head with breech presentation, the so-called preventive turn, is done at 34-36 weeks in a hospital by a doctor. General rules for preventive turn - see fig. 2. After turning, it is necessary to systematically observe the pregnant woman. If the cephalic presentation is again replaced by the pelvic presentation, the rotation is immediately repeated.

To prevent breech presentation and correct it in the cephalic presentation, the following method is proposed. A pregnant woman (in terms of 29 to 40 weeks) is prescribed classes: lying on the bed (couch), she should alternately turn on one side or the other, staying on each of them for 10 minutes. Exercises are repeated 3-4 times (on average, each lesson takes 60-80 minutes.), A busy person is carried out 3 times a day before meals. After several sessions (usually in the first 7 days), the fetus turns to the head. After the installation of the head, in order to prevent recurrence of breech presentation, the pregnant woman is recommended to lie on her side, corresponding to the position of the fetus, and on her back, and also wear a fixation. A pregnant woman should see a doctor at least once a week. In case of relapse, additional classes are carried out.

Classic inner twist produces. In emergency cases, if it is impossible to call a doctor, a classic internal turn can be performed. When carrying out an internal obstetric turn, one hand is inserted into the uterus, the other is helped through the abdominal wall of the woman in labor. Shown is the classic internal rotation with the transverse position of the fetus, as well as with dangerous for the mother presenting (for example, frontal) and head insertions (for example, posterior-parietal). With the classic turn, you can turn the fetus from a transverse position (sometimes longitudinal) to the head and to the leg. Rotation to the crown is currently of no practical importance. Conditions for turning: full opening of the uterine pharynx, full fetal mobility. The contraindication to internal rotation is the neglected lateral position of the fetus.

The technique of the classic internal rotation on the leg in transverse positions. Three stages should be distinguished: 1) the introduction of the hand, 2) finding and grasping the leg, and 3) the actual rotation of the fetus. In the transverse position of the fetus, it is recommended to insert the hand corresponding to the pelvic end of the fetus, counting the obstetrician's side.

In the anterior view of the transverse position (the back is anterior), the underlying fetal leg should be grasped (when the overlying leg is grasped, the posterior view can easily be obtained, which is unprofitable for childbirth); with rear views of the transverse position, grasp the overlying leg (Fig. 3), since it is easier to transfer the rear view to the front. When looking for the fetal leg, two methods are recommended: “short” - the hand is held directly to the fetal leg and “long” - the hand is moved along the back of the fetus to the buttocks, then along, to the corresponding leg. Always grab one leg with the whole hand (Fig. 4) or with two fingers (Fig. 5). When finding the leg with a hand lying on the abdominal wall ("outer" hand), help the hand inserted into the uterus ("inner" hand). The “outer” hand rests on the pelvic end of the fetus, bringing it down to the entrance to the pelvis towards the “inner” hand.

As soon as the fetal leg is found and captured, it is necessary to immediately transfer the "outer" hand from the pelvic end to the head and push it to the bottom of the uterus (Fig. 6). If this is not done, leave the hand in the same position and press it on the pelvic end, an infringement of the head may occur - a complication that threatens with complete failure to turn.

Rice. 4... The leg is gripped by the whole hand. Rice. 5... The leg is gripped by two fingers. Rice. 6... The leg is grasped by the "inner" hand, the "outer" hand is moved from the pelvic end to the head and pushes it to the bottom of the uterus.

Rules for turning the fetus (turning itself): traction (attraction) is performed outside the contraction; traction is done downward, towards (with traction on oneself, and especially upward, the symphysis will interfere); do traction until the knee comes out of the genital slit. When the leg is brought out to the knee and the fetus has taken a longitudinal position, the rotation is complete.

Further, if there are no contraindications, childbirth can be left to the forces of the body and conducted in the same way as with incomplete foot presentation. Currently, most obstetricians adhere to a different tactic: in the interests of the fetus, after the turn made, they immediately perform the operation of removing the fetus by the pelvic end (see).

Internal classical rotation of the fetus on the pedicle in the cephalic presentation is done according to the same rules as in the transverse position of the fetus.

Indications: the need to urgently complete childbirth. A hand is inserted into the uterus as deeply as possible (to the elbow), corresponding to the small parts of the fetus, counting the side of the obstetrician. When holding the hand into the uterus, it is necessary to first push the head to the side and, what is especially important, do not forget to timely transfer the “outer” hand from the pelvic end to the head end, after the leg is captured. heads are especially disadvantageous in these cases.

In obstetric head to pedicle swivel, it is easy to mix the stem with the handle. To avoid this, it is necessary to insert the hand deeper, and then, when grasping the leg, pay attention to the calcaneal tubercle, which serves as the difference between the leg and the handle.

Complications during obstetric turn and help with them. 1. Loss of the handle,. The dropped part is not set back, as the filled part usually falls out again. A loop should be placed on the dropped handle so that in the future it cannot be thrown back behind the head. 2. The obstetric turn fails because the traction is done incorrectly (towards oneself or up, not down). 3. The obstetric turn is done incorrectly - during the fight, whereas it must be done outside the fight. 4. Infringement of the head (the “outer” hand was not transferred after the leg was grasped from the pelvic end to the head end). First of all, you must carefully try to push the head away. In case of failure, the second leg should be reduced (to create more space for yourself in the uterine cavity) and again try to push the head away. If this also fails, it is necessary to perforate the head. 5. Crossing of the legs: the leg resting on the symphysis, crossing with the relegated leg, interferes with the rotation of the fetus. It is also necessary to reduce the second leg.

OBSTETRIC TURN- obstetric operation, with the help of which it is possible to change the unfavorable, in a given obstetric situation, for the course of labor, the position or presentation of the fetus to a favorable one. Obstetric rotation is carried out by manual techniques (see. Obstetric manual techniques).

Operations by obstetric rotation include: external prophylactic obstetric rotation, external-internal classical (combined) obstetric rotation with full opening of the external cervical os and external-internal (combined) obstetric rotation with incomplete opening of the uterine pharynx, the so-called Braxton Gix rotation.

There are four options for Obstetric pivot: pedicle pivot, leg pivot, buttock pivot, and head pivot. The combined rotation, as a rule, is performed on the leg. Rotation to the head is performed only with external obstetric rotation

General indications

General indications: transverse or oblique position of the fetus; loss of small parts and the umbilical cord with a cephalic presentation. A number of authors cite some other indications for the production of obstetric rotation, namely: unfavorable insertion of the fetal head (posterior parietal, facial chin posteriorly, frontal insertion) and maternal diseases requiring immediate delivery, in particular heart defects, eclampsia. However, at present, most obstetricians believe that with such complications it is more expedient to produce C-section(cm.).

External obstetric turn

External obstetric turn is performed in the absence of the effect of prenatal correction of anomalies in the position and presentation of the fetus by the method physical exercise proposed by I. I. Grishchenko, A. E. Shuleshova and I. F. Dikan.

External obstetric head rotation produce taking into account the position of the fetus according to the method of B.A. Arkhangelsky or without taking into account the position, taking into account only the ease of movement of the fetus - according to Wiegand. According to most obstetricians, clarification of the type and position of the fetus is one of the prerequisites for external obstetric rotation.

Indications: transverse or oblique position of the fetus, breech presentation. Conditions: pregnancy 35-36 weeks, good mobility of the fetus, compliance of the abdominal wall, normal size of the pelvis or the absence of significant narrowing of it, favorable condition of the mother and fetus.

Contraindications: a history of premature birth and stillbirth, postoperative scars on the uterus, toxicosis and bleeding in this pregnancy, anomalies in the development and tumor of the uterus, narrowing of the pelvis (second degree and below), oligohydramnios, polyhydramnios, large fetus, multiple pregnancies.

External (prophylactic) rotation according to Wiegand with the transverse and oblique position of the fetus. The pregnant woman's bladder is emptied and placed on a hard couch on her back with her legs bent at the knees. The obstetrician places both hands flat on the belly of the pregnant woman so that one hand wraps around the head of the fetus, the other around the buttocks (Fig. 1, 1). Simultaneous action on the head and buttocks, guided exclusively by the ease of movement, without taking into account the position of the fetus, the latter is gradually transferred to a longitudinal position. The head is pushed back to the entrance to the small pelvis, and the buttocks - to the bottom of the uterus.

Outside (preventive) turn along Arkhangelskoye with the transverse and oblique position of the fetus. A pregnant woman is injected under the skin with 1 ml of a 1% solution of promedol, the bladder is emptied, placed on a hard couch, and offered to bend the legs. The doctor sits on the right, facing the pregnant woman, precisely determines the position of the fetus, after which he clasps the head with one hand from above, the other - the pelvic end of the fetus from below. In the anterior view of the transverse position of the fetus, when its back is facing the bottom of the uterus, with careful movements, the head is shifted to the entrance to the small pelvis, the pelvic end of the fetus - to the bottom of the uterus (Fig. 1, 2). In the case when the back of the fetus is facing the entrance to the small pelvis, the rotation is performed by 270 °, for this, the buttocks are first shifted to the entrance to the small pelvis, and the head - to the bottom of the uterus. Then, from the breech presentation, the fetus is transferred to the head presentation.

The general rule for external rotation according to Arkhangelsk for all types and positions (with oblique and transverse positions) of the fetus is the displacement of the buttocks towards the back, the back - towards the head, the head - towards the abdominal wall of the fetus.

When performing these techniques, the fetus after turning is in the anterior view. Arkhangelsky believes that with this technique, the fetus, while maintaining the correct articulation and shape of the ovoid, remains in the flexion position, which is most favorable for its rotation in the uterine cavity.

External prophylactic rotation of the fetus on the head with breech presentation. An unfavorable prognosis in breech presentation for the mother and fetus was the basis for the use of preventive correction of the pelvic presentation during pregnancy by external rotation to the head.

The conditions and contraindications for turning from the breech presentation to the head are the same as for turning in the transverse position.

A pregnant woman is emptied of the intestines, immediately before the operation - the bladder and put her on a soft couch on her back. The doctor sits down to her right. Determines in detail the position and type of the fruit.

Rotation technique: very carefully manipulating both hands simultaneously, move the buttocks away from the entrance to the small pelvis to the bottom of the uterus, towards the back of the fetus, and the head towards the entrance to the pelvis, towards the abdominal wall of the fetus (Fig. 1, 5).

After the operation of the external rotation, the possibility of relapse is not excluded, therefore, it is necessary to fix the longitudinal position of the fetus. To this end, Arkhangelsky proposed a special bandage in the form of a tape 10 cm wide, which is fixed on the belly of the pregnant woman at the level of the navel or slightly below it; this contributes to an increase in the vertical and a decrease in the horizontal diameter of the uterus. The bandage should not be removed for 1-2 weeks to exclude the possibility of the fetus moving to a lateral position.

Holding the longitudinal position of the fetus after external rotation on the head can be done using two rollers rolled from sheets placed on both sides of the fetus, followed by bandaging the abdomen.

Outside-inside turn

External-internal classic (combined) rotation of the fetus on the pedicle. Indications: transverse position of the fetus, prolapse of the umbilical cord and small parts in cephalic presentations, complications and diseases that threaten the condition of the mother and the fetus. Unfavorable head insertions (posterior parietal, frontal, frontal chin posterior) do not serve as an indication for obstetric pedicle rotation.

Conditions: full disclosure of the external os of the cervix, the fetal bladder is intact or water has just been poured out, the mobility of the fetus in the uterine cavity is completely preserved, the correspondence between the size of the fetus and the size of the pelvis.

Contraindications: neglected transverse position of the fetus, discrepancy between the size of the mother's pelvis and the head of the fetus, threatening, begun and completed rupture of the uterus.

The bladder should be emptied prior to surgery. The operation is performed under anesthesia on the operating table or on the Rakhmanov bed. It consists of the following points: 1) the introduction of the hand; 2) finding the leg; 3) gripping the leg; 4) the turn itself.

1. Introduction of the hand. The right hand is usually inserted into the uterine cavity. Some obstetricians recommend inserting the arm of the same position. So, at the first position of the transverse position (head to the left) and the first position of the cephalic presentation (back to the left), the left hand is introduced, at the second position, the right hand.

Rice. 2. External-internal (combined) obstetric rotation of the fetus on the pedicle: 1 and 2 - insertion of the hand into the birth canal, the "external" hand on the area of ​​the uterine fundus (2); 3 - grabbing the front leg with a cephalic presentation; 4 - the leg is gripped by the whole hand; 5 - the leg is captured by two fingers; 6 - bringing down the legs through the vagina, the "outer" hand pushes the fetal head up; 7 - the turn is over, the leg is brought out to the knee; 8-10 - according to Boyarkin: 8 - the head is captured by the hand, the “outer” hand is at the fundus of the uterus, 9 - the head is abducted to the fundus of the uterus, 10 is the capture and lowering of the leg; 11-13 - with incomplete opening of the uterine pharynx according to Braxton Hicks: 11 - the head is pushed to the side of the back, the "outer" hand brings the pelvic end closer to the entrance to the pelvis, 12 and 13 - the leg is grasped with two fingers and lowered

After thorough disinfection of the external genital organs and hands of the obstetrician, the genital slit is pushed apart with the "outer" hand; the hand chosen for turning ("inner") is lubricated with vaseline oil, the hand is folded in a cone, inserted into the vagina and advanced to the uterine pharynx (the back of the hand should be facing the sacrum). As soon as the ends of the fingers have reached the throat, the “outer” hand is transferred to the fundus of the uterus (Fig. 2, 1 and 2). After that, the fetal bladder is opened and the hand is inserted into the uterus; with a cephalic presentation, before the introduction of the hand into the uterus, the head is pushed towards the back.

2. Finding the leg. When turning from the longitudinal position, one should find and grab the fetal leg facing the anterior wall of the uterus (Fig. 2, 3). In transverse positions of the fetus, the choice of the leg depends on the type: in the anterior view, the underlying leg is captured, in the posterior view, the overlying one, since it is easier to transfer the posterior view to the anterior one.

To find the legs, they grope the side of the fetus and slide their hand from the armpit to the pelvic end and further along the thigh to the lower leg and grab the leg. During the search for the legs with the "outer" hand, move the pelvic end of the fetus downward, towards the "inner" hand.

3. The gripping of the leg is carried out in two ways: a) the shin is grasped with the whole hand - with four fingers, the shin is wrapped in front, thumb located along the calf muscles, its end reaches the popliteal fossa (Fig. 2, 4); b) with the index and middle fingers, they grasp the fetal leg in the ankle area (Fig. 2, 5), the thumb supports the foot.

4. Actually the rotation of the fetus. After capturing the leg, the “outer” hand is transferred from the pelvic end of the fetus to the head and pushed up to the bottom of the uterus; at this time, the leg is brought down with the "inner" hand, bringing it out through the vagina (Fig. 2, 6).

The turn is considered complete after the leg is brought out of the genital slit to the knee (Fig. 2, 7). Immediately after turning, the fetus is removed (see Childbirth).

External-internal (combined) obstetric turn according to S. Ya. Boyarkin. The insertion of the hand into the uterine cavity and rupture of the fetal bladder are performed as described above in the classic obstetric twist. The "outer" hand fixes the fundus of the uterus and helps bring down the buttocks. At the same time, the "inner" hand is directed to the head of the fetus, captures it and with smooth movements takes it to the bottom of the uterus (Fig. 2, 8 and 9). In this way, the actual turn takes place. As soon as it is produced, the “inner” hand is held along the body, along the side of the fetus or its back, and then along the buttocks, thigh and lower leg, grab and bring down the leg (Fig. 2, 10). With this method of lowering the leg, it is easily possible to grab it and cannot be mistaken for the handle, since the latter, during the abduction of the head, rose up to the bottom of the uterus. However, most obstetricians prefer the classic method as it is less traumatic for the fetus.

External-internal (combined) leg rotation according to Braxton Hicks. Indications: partial placenta previa and a dead or non-viable premature fetus, transverse (oblique) positions of the fetus with early outpouring of water and a dead premature fetus.

Conditions: opening of the external cervical os by at least 4-6 cm, fetal mobility, absence of significant narrowing of the pelvis, lack of indications for immediate delivery.

Contraindications: live full-term fetus, full placenta previa.

The technique of the operation consists of three points: inserting a hand into the vagina and two fingers into the uterine cavity, finding and grasping the leg, and actually turning.

The operation is performed on a Rakhmanov bed or on an operating table under anesthesia.

Having parted the labia with one hand, the brush with the other, folded conically, is inserted into the vagina in the same way as when turning with full disclosure of the external os of the cervix. The index and middle fingers are inserted into it. If the fetal bladder is intact, the membranes are torn apart by the forceps who took it. If the rotation is performed with a cephalic presentation, then with the fingers the head is pushed towards the back. At the same time, the "outer" hand is pressed on the fundus of the uterus and the pelvic end of the fetus is brought closer to the "inner" hand (Fig. 2, 11). With the transverse position of the fetus, the "outer" hand produces pressure on the lateral surface of the uterus, where the pelvic end is located. With two fingers, they grab any leg above the ankle, pull it down (Fig. 2, 12 and 13) into the pharynx, then into the vagina and, finally, bring the leg out of the genital slit. At the same time, the "outer" hand is moved to the head, pushing it up. The rotation is considered complete when the fetal leg is brought out of the genital fissure to the popliteal fossa, and the head is at the fundus of the uterus. In the future, childbirth is expected; a weight of 200-400 g is suspended from the leg (see Childbirth). After turning the fetus on the stem according to Braxton Hicks, it is impossible to extract the fetus. This can lead to significant bleeding due to rupture of the cervix and the lower segment of the uterus, especially with placenta previa, and in some cases it can be fatal.

Possible complications

During the production of an external obstetric turn, the following complications are possible:

1. The onset of fetal asphyxia. The operation should be stopped. Treat intrauterine fetal asphyxia.

2. Premature detachment of the normally located placenta. Obstetric treatment should be stopped, carefully monitor the condition of the pregnant woman and the fetus. With an increase in the phenomena - an urgent cesarean section.

3. The appearance of signs of uterine rupture. The manipulation should be stopped. When a diagnosis of rupture of the uterus is established, urgent gastrointestinal surgery is indicated.

When performing external-internal (combined) rotation of the fetus, complications are also possible:

1. When opening the fetal bladder, the umbilical cord loop may fall out. With this complication, the turn is continued, trying not to press the umbilical cord. Following the turn (with full opening of the pharynx), the fetus is immediately removed.

2. The introduction of the hand into the uterine cavity is prevented by the spasm of the internal pharynx. This complication can also occur after the hand is inserted into the uterus. In this case, it is necessary to leave the hand in the uterus without movement, deepen the anesthesia and inject 1 ml of a 0.1% solution of atropine sulfate under the woman's skin. If these measures do not help and the spasm continues, the obstetrician should withdraw the hand from the uterus and abandon further attempts to rotate.

3. The handle is removed instead of the leg. In this case, a loop of gauze bandage is put on the dropped handle. The assistant moves the handle with a loop towards the head, and the obstetrician re-enters the hand into the uterus, searches for and grabs the leg and makes a turn.

4. The turn is not made due to insufficient fetal mobility. In this case, all manipulations are stopped in order to avoid rupture of the uterus and childbirth is carried out in the future, depending on the characteristics of their course.

5. The most dangerous complication during the production of obstetric turn is the rupture of the uterus (see. Childbirth), which usually occurs when the operation is performed with insufficient mobility of the fetus or its extraction is performed with incomplete opening of the external os of the cervix. Prevention of this serious complication must consist in the exact observance of the conditions necessary for the production of the rotation operation.

Bibliography:

Bodyazhina V.I. and Zhmakin K.N. Obstetrics, M., 1970; Gritsenko II and Shuleshov AE Prenatal corrections of incorrect positions and pelvic presentation of the fetus, Kiev, 1968; Zhordania I. F. Textbook of obstetrics, M., 1964; A multivolume guide to obstetrics and gynecology, ed. L. G. Persianinov, vol. 6, book. 1, p. 73, M., 1961; Yakovlev I.I. Emergency care for obstetric pathology, L., 1971.

G. M. Savelyeva.

By the 36th week of pregnancy, the child takes the position that will remain until the moment of delivery. The part of the baby's body that will face the mother's pelvic cavity is called the presenting one. In 97% of cases, this is the head, and the most favorable of the head is the occipital presentation, when the chin of the fetus is close to the chest. But in 2.5% of pregnancies, breech presentation or, even less often, transverse or oblique position may persist. In such cases, in order to avoid a cesarean section, they resort to obstetric rotation of the fetus.

External rotation of the fetus: indications and contraindications

With the pelvic position of the baby before delivery, an external obstetric rotation of the fetus can be performed. This is a series of manipulations, which is recognized by obstetricians around the world, to reduce the frequency of delivery by caesarean section.

Previously, with insufficient development of technical means, it was difficult to control the efficiency and safety of manipulation. Currently, everything is carried out under the control of ultrasound and CTG, so the risk of complications is much lower than after a caesarean section.

The procedure is performed at 35-36 weeks. The probability of maintaining a cephalic presentation after it reaches 60%. When performing in more late dates efficiency is much lower. The prerequisites are:

• good fetal mobility;
• pliable abdominal wall;
• the pelvis of a pregnant woman is of normal size;
• general good condition of the mother and fetus.

It is not necessary to perform an obstetric twist in breech presentation if a cesarean delivery is planned. Manipulation is contraindicated in the following cases:

• a history of premature birth or antenatal death;
• operated uterus;
• pregnancy was complicated by toxicosis, gestosis or bleeding;
• multiple pregnancy;
• lack of water and polyhydramnios;
• large fruit;
• anomalies in the development of the uterus,.

Technique for performing obstetric rotation

The obstetric turn is performed in a hospital setting, where it is possible, if there is evidence, to transfer a woman to a delivery unit or to deploy an operating room.

• Before the start, an ultrasound scan is required to determine the position of the fetus, the amount of water and the location of the placenta, and CTG to assess the condition of the fetus.
• The woman is given an enema, is asked to empty her bladder, or urine is released with a catheter.
• Tocolytics are necessarily introduced, which will prevent the development of uterine tone.
• The pregnant woman takes a position on her back on the couch.
• The doctor is located nearby, facing the pregnant woman. He places one hand at the pelvic end, and the other on the head of the fetus.
• The upward shift of the pelvis is carried out very carefully, at the same time pressure is exerted on the head. The fetus rotates towards its abdominal wall.

Obstetric rotation of the fetus can have consequences in the form of a relapse of the breech presentation. To avoid this, it is recommended to apply a bandage at or slightly below the navel. It can be a 10 cm elastic tape. It will give the uterus a more elongated vertical shape. If the brace is removed, the child can take a lateral position.

Many fear injury to the fetus when turning. If there are no contraindications, the procedure is completely safe. The child cannot get injured, all manipulations are softened by amniotic fluid.

If, during the manipulation, a deterioration in the condition of the mother or child is noticed, it is immediately stopped. The second attempt is carried out only on condition of complete well-being.

After turning, ultrasound is done again, CTG is recorded to assess the child's condition. After 1-2 days, it is recommended to come again for examination and assessment of the condition of the fetus. If everything went well, then childbirth can go through the natural birth canal. Otherwise, a caesarean section will be offered.

Obstetric rotation can be complicated by twisting or squeezing of the umbilical cord and the development of fetal hypoxia. Continuous observation allows you to monitor the condition of the child and take the necessary measures. Sometimes water can leave or labor can develop. This is not critical, since the manipulation is performed at 36 weeks, when there is no longer any risk to the fetus.

Rotation of the fetus in childbirth: indications and technique

Diagnostic errors can lead to the development of the lateral position of the fetus during labor. Performing obstetric rotation of the fetus on the leg will help to correct the situation.

The transverse position is not the only indication, except for it, manipulation is carried out in cases of loss of small parts of the body and the umbilical cord during presentation of the head. By themselves, incorrect head insertions (posterior parietal, frontal, facial) are not recognized as indications for manipulation.

This type of assistance is carried out with the opening of the throat by 10 cm and the preserved mobility of the fetal head and the whole fetal bladder. If a neglected lateral position has developed, the procedure is not resorted to. The head of the fetus must correspond to the size of the mother's pelvis, otherwise everything loses its meaning. When the rupture of the uterus begins, the turn is not carried out.

In modern conditions, the course of the operation is monitored using ultrasound and a CTG apparatus.

• The woman in labor is given anesthesia, and urine is released through a catheter.
• The external genitals are thoroughly disinfected.
• The hand is smeared with petroleum jelly.
• The doctor usually inserts the right hand into the vagina, but some practice matching the position of the fetus: if the head is turned to the left, then the hand is left, if to the right - the same name.
• When the uterine pharynx is reached, the other hand is placed on the abdomen. Water breaks open and penetration into the uterine cavity occurs.
• To search, the legs are groped by the side of the child, moved from the armpit to the non-correction of the buttocks. At the same time, with the outer hand, the hand is holding the pelvis of the fetus and slowly shifting it towards.
• The fetal leg is grasped by the shin, grasping it with four fingers, and placing the large one under the knee. Alternative option: they grip the foot, holding it from below with the thumb.
• The outer hand is transferred to the head area, the inner hand is pulled and the leg is lowered into the vagina. Immediately thereafter, the fruit is removed.

During the procedure, complications may arise in the form of loss of the umbilical cord loops. The action continues neatly, trying not to squeeze her. If by mistake the handle is captured and withdrawn, then it is taken to the side with the help of a loop from the bandage, re-enter the birth canal, find the leg and turn it.

Failure to comply with all mandatory conditions to perform a turn, rupture of the uterus is possible. To avoid it, you need to follow all the instructions exactly.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

Breech presentation is a fairly common pathological phenomenon in which the child is positioned with the legs or buttocks down. Why is this happening? Shortly before birth (usually starting from 32 weeks gestation), the fetus takes a certain position, contributing to an easy course of labor. In 90% of cases, we are talking about a cephalic presentation, when the child is in the body with the head down, just above the bosom. This means that this particular part of the body, the largest in a newborn, will be born first. It is with its release that the most unpleasant sensations and the most difficulties are associated. The passage through the birth canal of the rest of the body (shoulders, trunk, limbs) is usually almost not felt.

However, in some cases, the fetus is located with the pelvis down. This can be determined when visiting the doctor leading the pregnancy by visual examination and palpation. Also, the longitudinal location of the fetus in the uterus is easily diagnosed by ultrasound. It makes sense to fix such a position from about 32 weeks of pregnancy, since for more early dates the fetus is constantly moving and can change position repeatedly. The forecast of the situation is possible from the 28th week.

Correcting the situation before childbirth

Diagnosing a breech presentation is not the final judgment. At the stage of 32-34 weeks, you can perform special exercises that can provoke the fetus to turn over. This is the tilt of the pelvis, carried out on an empty stomach, specific exercises performed in the knee-elbow position. In the latter case, the pelvis should be above the level of the head. It is recommended to stay in this position for no more than 20 minutes several times a day.

It is also possible to use the force of gravity. Swimming in the pool helps pretty well. Here the pressure decreases, making it much easier for the fetus to turn over on its own.

The effectiveness of the described methods with their regular use varies in the range of 65 - 75%. However, we must not forget that there are contraindications for the above-mentioned gymnastics:

• narrow pelvis;
• the risk of premature birth;
• fetal malformation;
• unsuccessful pregnancy that ended in a miscarriage in the past;
• too much or too little amniotic fluid;
• pathology of the development of the uterus;
• multiple pregnancy;
• placenta previa;
• preeclampsia;
• a number of concomitant diseases in which such loads are contraindicated.

In the past few years, the use of acupuncture and homeopathic treatments has become more widespread. Sometimes suggestion, the use of light, special music helps. However, the degree of effectiveness of these methods has not been fixed by science.

Obstetric coup: pros and cons

With a breech presentation of a child from 36 or 37 weeks of pregnancy, an obstetric coup is allowed. We are talking about the implementation of a certain manipulation, in which the doctor can force the child to take the desired position (head down) by mechanical action. Performed exclusively in medical institution, in the absence of contraindications, under strict supervision. During the process itself, control is performed by ultrasonic equipment. Pain relief is usually not required.

Before performing an obstetric coup, appropriate preparation is required. A pregnant woman should not eat anything since the evening before (empty intestines are important), emptying Bladder occurs immediately before the start of the procedure itself. Also, the expectant mother is injected with special drugs that help to relax the internal muscles and the uterus. This is intended to facilitate the coup process.

The procedure can take 2 to 3 hours. In total, no more than 3 attempts are made.

The degree of effectiveness does not exceed 60%, the fetus may not succumb to manipulation. The child is also able to soon take up the previous position after the coup. It is for the latter reason that many countries have begun to abandon the practice of obstetric coup.

What you need to know

There are contraindications to this procedure:

• lack of water, in this case, any effects of this kind can damage the fetus;
• extensor position of the head in a child;
• multiple pregnancy;
• the presence of contraindications in a pregnant woman to drugs that promote relaxation;
• individual features of the structure or development of the fetus or uterus.

In most of the cases listed above, an obstetric coup is not possible. Therefore, if the child has not changed position (which is checked by ultrasound, including control - at preoperative ultrasound), a cesarean section is prescribed.

Caesarean section with breech presentation of the fetus

A cesarean section in breech presentation is recommended to minimize the risks to the baby. It is especially often prescribed if the pregnant woman's pelvis is too narrow, and the baby's head is large. Also, doctors pay great attention to exactly how the fetus lies, what type of pelvic proposal is in question. In male infants, such an operation is intended to help prevent problems with the genitals. The latter can be damaged during natural childbirth.

Surgical delivery is also indicated if the position of the fetus is complicated by other nuances.

Attention! Foot presentation is considered especially dangerous, in this case there is a high likelihood of asphyxia and too severe injury to the newborn.

In some cases, there is even a threat of death of the baby. To avoid such situations, doctors prescribe a cesarean section.

Types of breech presentation

The wrong position of the fetus can be different, which affects the decision about how exactly the delivery will proceed. The gluteal variant is considered classic. In this case, the child rests against the mother's pelvis with the buttocks. Moreover, the legs can be either bent at the knee joint or extended along the body. When bent, the presentation is called mixed. It is determined strictly according to the ultrasound indications. A visual medical examination is not enough here.

A more complex and rare case is the foot presentation (the legs are facing the entrance). It can be complete, here we are talking about both legs, or incomplete, when one is bent and the other is extended. In some cases, presentation is knee, the fetus is facing the birth canal with knees bent at the joints. Sometimes the child is turned sideways, obliquely. In the latter case, surgical delivery is recommended.

What is the danger of childbirth with a similar presentation

The generic process with breech presentation, even in the absence of additional negative factors, will be complicated. The reason is simple: the newborn's bottom is smaller than the head. And the fetus will begin to press with less force on the bottom of the uterus, which causes weaker contractions. This leads to a delay in labor, the appearance of a specific weakness. That is fraught with excessive blood loss, fetal asphyxia, and other unpleasant consequences.

During childbirth, the baby's head may tilt back, which is fraught with injury to the newborn (neck or skull). The birth process becomes difficult, slows down. There is also a high likelihood of pinching the umbilical cord between the fetal head and the birth canal.

This causes a weakening of blood flow to the body of the newborn, sometimes hypoxia develops. Boys are at particular risk. During delivery with gluteal adherence, considerable pressure is exerted on the scrotum. Squeezing may cause injury to this part of the body. That is why, when breech presentation of male infants in Europe, it is strongly recommended to perform a cesarean section.

What else you need to know about the management of pregnancy and childbirth in this situation

Despite the obvious risk, natural delivery is quite possible if the woman feels well, no clinical pathology of the uterus or fetal developmental abnormalities was found. The baby's low weight also contributes to normal course childbirth.

Therefore, it cannot be said unequivocally that wrong location the fetus is a "judgment." However, for the best resolution of the situation, a pregnant woman needs special medical supervision. A week or two before the estimated due date future mother can be saved. After all, the indicated presentation is fraught with premature birth... This risk cannot be ignored.