Births with breech presentation are fraught with many dangers. Because of this, the preparation of such pregnant women for the delivery process is carried out in advance. Let us consider this phenomenon in more detail, we will outline the peculiarities of conducting ancestral care, possible complications of the process of the baby's appearance.
Biomechanism of labor with pelvic presentation
Before the preparation for delivery, physicians carry out a control study for a few days to check whether the position of the fetus has changed. With the onset of the birth process, the woman goes to the delivery room. The very mechanism of labor in pelvic presentation is as follows:
- Inserting the baby's little glutes into the mother's small pelvis and moving along the birth canal. The process begins with the fact that the gluteal line is the insertion of the torso of the baby. Then his pelvic end passes into the cavity of the small pelvis. In the process of fights, the buttocks sink lower, and deeper enter the small pelvis. One buttock then falls below the other. It acts directly as a wiring point, like a small fontanel in the head preposition.
- Inner turn. There is a rotation of the buttocks. At the same time, the anterior one approaches the lone articulation, the posterior one is directed to the sacrum.
- Cutting and eruption of the buttocks. It occurs after the fixation of the anterior buttock of the infant by the iliac region. So the pelvic end is born. In this case, the spine makes a strong lateral bend. With a mixed form of breech presentation, one or two legs come out.
- Birth of the shoulder girdle. Internal rotation occurs almost simultaneously with the bending of the head. The humeral girdle is born as well as with the head previa - the transverse dimension is inserted into the pelvis of the parturient woman.
- The birth of the head. Occurs in a bent position. The suboccipitary fossa is fixed by the arc of the lateral bone. After this, the chin, the face of the baby, his forehead, crown and the back of the head are gradually born.
How does breech delivery begin?
The precursors of labor in pelvic presentation do not differ from those that precede the generic process in the headache. To such obstetricians include:
- the departure of the cork ;
- regular contractions;
- outflow of amniotic fluid.
However, there are some features of the immediate onset of the birth process. So the process of exile can begin when there is no complete opening of the uterus. This is due to the smaller size of the pelvic end, in comparison with the head one. Because of this, in the first period of childbirth a woman is forced to comply with bed rest. This prevents the development of complications of the delivery process.
How are births in the pelvic presentation?
The course of labor in pelvic presentation is completely controlled by obstetricians. The main principle in the conduct of the birth allowance is to maintain the correct position of the baby. The legs should be stretched along the trunk. Fruit handles press them to the chest. First the baby is born to the navel, then to the edge of the lower line of the scapula. Only after this, the hands, the shoulder belt come out and the head is born.
The main points of labor in pelvic presentation are:
- the prevention of loss of legs;
- assistance with the need to remove the handles and head (to prevent asphyxiation);
- the implementation of episiotomy (for rapid birth of the head).
Pelvic presentation - a caesarean or natural birth?
With this type of arrangement of the baby in the mother's womb, like a pelvic presentation of the fetus, the birth or cesarean is determined solely by the doctors. In this case, doctors speak for natural childbirth. But not always this type of delivery is permissible. Among the indications for cesarean section with pelvic presentation, it is worth noting:
- the bearing of the male fetus;
- premature onset of the birth process;
- foot prawning;
- a narrow pelvis of the woman in childbirth;
- risk of strong extension of the head during labor;
- large or on the contrary - a small fruit (less than 2.5 kg or more 4);
- presence of umbilical cord entanglement;
- chronic hypoxia;
- presence of other complications.
Are natural births possible with pelvic presentation?
The obstetricians answer this question in the affirmative. Natural births with pelvic presentation are performed with the glutealateral and purely gluteal arrangement of the fetus. In this case, doctors take into account some features of gestation, which allow for classic births:
- absence of umbilical cord entanglement ;
- small-sized fruit;
- normal size of the pelvis;
- timely opening of the cervix;
- term pregnancy.
Conducting births for Tsovyanov with pelvic presentations
Considering the peculiarities of labor in pelvic presentation, it is worth noting that often with such a delivery obstetricians use Tsovyanov's manual. The purpose of this is to observe the normal arrangement of parts of the body in the process of childbirth. So during the expulsion of the baby it is necessary to ensure that the legs are always straightened and pressed against the body (thorax).
At the same time, keep the baby's arms crossed while holding the legs. This prevents tipping. The feet are placed at the level of the face, which preserves the bent position of the head. In this position, the fetal body acquires a conical shape. The maximum volume is reached at shoulder level (42 cm in diameter). After the birth of the shoulders, the appearance of the head occurs without difficulty. This is how the delivery is performed with pelvic presentation.
Complications of breech delivery
The correct choice of tactics and the observance of the sequence of delivery grant excludes the development of complications. However, this does not always happen. Among possible violations, doctors call the following consequences of labor in the pelvic presentation:
- premature discharge of the amniotic fluid;
- loss of parts of the body and umbilical cord;
- primary weakness of labor activity;
- fetal death (with prolonged compression of the umbilical cord to the pelvic wall for more than 10 minutes);
- aspiration with amniotic fluid;
- unbending, pinpring.
Pelvic presentation - premature delivery
Births with pelvic presentation of the fetus often begin before the prescribed time. This is due to the excessive pressure of the gluteal part of the trunk on the cervix. Given this fact, women with stable pelvic presentation are hospitalized at 38-39 weeks. Pregnant carefully prepare for the process, follow the opening of the cervix and the fetus. This helps to avoid the development of complications in the process of delivery.