Pelvic Presentation

Breech presentation

One fine day (namely, at approximately 28 weeks of pregnancy), during the next visit to the antenatal clinic, the doctor will try to determine which part of the fetus can be felt in the lower segment of the uterus - that is, what is the presentation of the fetus. The presenting part of the fetus is precisely the part that will pave the way through the birth canal and be the first to emerge into the world. The baby’s head is the largest part of the body in diameter, so it is with its birth that the main difficulties of childbirth are associated: after the appearance of the head, the birth of the baby’s body, arms and legs is easy and almost imperceptible. Therefore, the most favorable position in the uterus is considered to be a longitudinal (vertical) position with the head down - this is the so-called cephalic presentation.

However, occasionally the child may occupy a transverse position in the uterus (the shoulder is present), and it happens that the buttocks or legs of the fetus are palpated in the lower segment of the uterus. In the latter case, they talk about breech presentation, which will serve as the topic of our discussion.

Breech presentation is determined in 3-5% of pregnancies; Most often, pure breech presentations occur (67%), less often - mixed breech (20%) and leg presentations (13%).

Causes of breech presentation:

1. Decreased tone and excitability of the uterus, which leads to a decrease in its ability to correct the position of the fetus through muscle contractions.

2. Increased fetal mobility in polyhydramnios and premature pregnancy.

3. Oligohydramnios and abnormal development of the uterus, limiting fetal mobility.

4. Factors that prevent the position of the head at the entrance to the pelvis: narrow pelvis, placenta previa, tumors in the lower segment of the uterus, fetal malformations.

Why is breech presentation considered pathological?

1. Childbirth with breech presentation is often accompanied by complications: birth injuries, fetal asphyxia.

2. More often it is necessary to resort to surgical delivery.

Diagnosis of breech presentation:

1. The doctor palpates a soft, irregularly shaped part of the fetus above the entrance to the small pelvis, the head in the fundus of the uterus.

2. Ultrasound to determine the type of presentation, position of the legs and head of the fetus.

3. Pelviometry - measuring the size of the pelvis.

4. If necessary, amnioscopy and Doppler.

Pregnancy management:

1. From 32 weeks, exercises are recommended to transfer breech presentation to cephalic presentation.

2. If the exercises are ineffective, try external rotation on the head at 34-37 weeks.

3. Before giving birth, the question of the method of delivery is decided - natural birth or cesarean section.

Thus, breech presentation requires special attention from the doctor and implementation of recommendations to prevent possible complications during childbirth.