28 weeks pelvic. Breech presentation of the fetus: natural birth or cesarean? This and other important questions. What to do with normal or low uterine tone

During pregnancy, at about 28 weeks of gestation, before your doctor antenatal clinic The task arises in determining that part of the fetus that can be felt in the lower region of the uterus. This is called the presenting part of the fetus, and it is this part that, after passing through the birth canal, first appears in our world.

The most successful option is considered to be a longitudinal position with the head down, also known as cephalic presentation. This is due to the fact that the head is the largest part of the baby’s body in diameter and the main problems during childbirth are associated with its passage. After its release, the birth of the baby's legs, arms, and torso is easy and not so painful.

Unfortunately, this situation does not always arise, and there are cases when the fetus in the uterus is presented shoulder-shaped, that is, located transversely, or even rests against the lower part of the uterus with its legs or buttocks. I would like to dwell in more detail on the second case, the so-called breech presentation of the fetus.

It is worth considering that before the 36th week the position of the fetus may change, so determining the breech presentation of the fetus at 28 weeks of pregnancy cannot be a final diagnosis. In addition, today many techniques and special exercises have been developed aimed at changing the child’s position in a more favorable direction.

Doctors distinguish between the buttock, leg and knee, and pelvic presentation of the fetus. In turn, the breech is divided into pure breech presentation and mixed. In the first case, the child’s buttocks are present in the lower part of the uterus, and his legs are extended towards the body, while they are straightened at the knees and bent in the pelvic area. In the second case, the buttocks are located at the entrance to the pelvis along with the legs, which are bent at the knees and hip joints.

Leg presentation can be complete or incomplete. In a situation of full leg presentation, both legs are facing the entrance to the pelvis, slightly extended at the knee and hip joints. If it is incomplete, only one leg is presented, which is extended at the joints, and the second lies higher and bent in the pelvic area. The last type of breech presentation of the fetus is knee, characterized by the location of the child’s bent knees in the lower part of the uterus.

As a rule, breech presentation is found in 3-5% of pregnant women, with the most common being a purely breech presentation (about 67% of cases), less often mixed breech (20%) and leg (13%) can be found.

Causes of the problem

What causes breech presentation of the fetus? In most cases, breech presentation appears as a result of a decrease in the excitability and tone of the uterus. This reduces its ability to contract to change and adjust the position of the fetus in the uterine space. According to experts, the most serious factors in the development of breech presentation of the fetus include:

Various anomalies in fetal development and oligohydramnios, which reduce fetal mobility;
The presence of increased mobility in the situation of premature pregnancy and polyhydramnios;
Factors that prevent the fetus from positioning itself in the correct position, such as placenta previa, narrow pelvis, tumors of the lower uterine region and some defects in fetal maturation.

Why is breech presentation a pathology?

This is explained by the fact that childbirth in a situation of breech presentation of the fetus is accompanied by various kinds of complications (fetal asphyxia, birth injuries) much more often than in cases of cephalic presentation. In addition, in the case of breech presentation of the fetus, there is often a need for surgical intervention. As a rule, this is planned in advance, especially if the fetus is breech for 38 weeks or more.

Determination of breech presentation of the fetus occurs during an examination by an obstetrician-gynecologist, and is subsequently confirmed during an ultrasound scan. In most cases, diagnosing this pathology does not cause serious difficulties, but in cases of increased uterine tone, multiple pregnancies, obesity and severe muscle tension in the anterior abdominal wall, minor problems may arise.

During the examination, the specialist feels a large round part of the fetus above the entrance to the pelvis, which has a soft consistency and flows into the body of the fetus. In the lower part of the uterus, as a rule, the baby’s head can be felt, and the high position of the uterine fundus is noted. The heartbeat of the examined fetus is usually heard in the area of the mother's navel and slightly above.

In turn, ultrasound, in addition to presentation, makes it possible to identify abnormalities in the development of the fetus, its size, and also determine the location of the placenta. If a breech presentation of the fetus is detected, its appearance, the degree of extension of the head, the location of the fetal legs and the umbilical cord are determined. In addition, Doppler ultrasound (ultrasound of blood flow) is performed, which allows you to examine the uteroplacental blood flow and identify the presence of umbilical cord pathology.

In some cases, doctors use amnioscopy to study the condition of the fetus with this type of presentation. It involves observing the fetus and the surrounding waters through the membranes by inserting a special tube into the cervix. Due to the risk of damage to the membranes and loss of amniotic fluid, this technique is used exclusively for diagnosing conditions that threaten the fetus (post-term pregnancy, hypoxia, etc.).

Each expectant mother, regardless of the type of presentation, undergoes measurement of the size of the pelvis - pelviometry. Typically, a standard external measurement to identify possible pathologies is not enough, therefore computed tomographic pelviometry and X-ray pelviometry are additionally used. The use of these methods allows you to more accurately determine the type of breech presentation of the fetus and diagnose it.

Management of pregnancy with breech presentation of the fetus

The course of pregnancy in the presence of breech presentation in most cases is similar to that with cephalic presentation. Upon reaching 32 weeks, antenatal clinic specialists should suggest using a number of exercises to transfer breech presentation to cephalic presentation. The most common exercises are the following:

It is necessary to lie on a sofa with a flat surface on the side where the fetal head is displaced. Lie on this side for 3-10 minutes, after which spend the same time on the other side. This exercise should be performed 2-3 times daily. In this case, it is advisable to sleep on the side towards which the baby’s head is shifted.
Take a position lying on your back, after placing a pillow under your lower back to raise your pelvis 20-30 cm above the level of your head. This position must be maintained for 5-15 minutes. This exercise allows the baby's head to rest against the fundus of the uterus under the influence of gravity, while the fetus itself often turns into a cephalic presentation. It must be performed on an empty stomach 2 times a day.

According to doctors, the effectiveness of such a complex is approximately 75%. Special exercises are performed as prescribed by the doctor who is managing the pregnancy and determining the breech presentation of the fetus at 33 weeks, plus or minus 1-2 weeks. However, there are a number of contraindications for using exercises of this kind. These include placenta previa, uterine tumors, scars on the uterus from previous operations, late toxicosis and complex extragenital diseases.

If there is no result from performing gymnastic exercises, it is recommended to carry out a preventive external rotation on the head. This procedure is performed between the thirty-third and thirty-seventh weeks in an obstetric hospital under the supervision of an ultrasound machine. Before rotating the fetus, the patient is given special agents to relax the uterus.

This procedure is not suitable for everyone, and there are a number of contraindications:

obesity;
age at first birth over 30 years;
scars on the uterus;
risk of miscarriage;
toxicosis;
too narrow pelvis;
polyhydramnios or oligohydramnios;
placenta previa;
severe extragenital diseases;
umbilical cord entanglement;
pregnancy as a result of the use of reproductive technologies.

In conclusion, I would like to say that for modern medicine, breech presentation is not a serious problem and the baby is born healthy. So don’t be upset about this and darken the most happy days– days of waiting for your miracle!

For the correct course of the process of bearing a child, a period such as the 28th week of pregnancy is very important. The position of the fetus can be either cephalic or pelvic. Usually by this time the baby’s eyes have already opened, very often they are blue at first.

The final color of the baby’s iris will only be established within a few months. During this period, grooves appear on the child's brain, and his weight continues to increase. The child’s weight can reach up to a little over a kilogram, and his height is about twenty-five centimeters. Also, this period of pregnancy is characterized by a constant increase in the child’s weight, as his body gains muscle and fat mass.

A fairly common case at this time is breech presentation of the fetus; 28 weeks is not the end of pregnancy; very often the child later turns on his own or with the help of doctors. Since the baby's body is still in the process of growth, there is still enough space in the stomach for it to unfold correctly.

The good news is that if for some reason the baby is born at this time, then he is already quite viable, and modern medicine will help cope with this task.

During this period, a woman has a lot of worries related not only to the growth of her abdomen, but also to constant visits to the antenatal clinic and tests. The position of the fetus at 28 weeks is not final, but the average height of the uterus is about eight centimeters. Typically, expectant mothers by this time gain from seven to eleven kilograms, depending on their constitution and features of their build.

All expectant mothers should know that from the 28th week it is necessary to see a doctor managing the pregnancy every ten to fourteen days. In this way, it is possible to prevent the vast majority of problems that arise, which can pose a danger both to the development of the child and to the health of the mother herself. Also during this period, you need to do a whole lot of tests, including a test for the presence of antibodies when negative Rh factor. At this time, it is very useful to begin to study issues related to pregnancy and the birth process itself, so that in the end it does not become a surprise.

The position of the baby at 28 weeks can have only two options. The first of them is called cephalic presentation and is characterized by the presentation of the baby's head to the cervix. Breech presentation The fetus is determined by the presentation of the baby's legs to the cervix. If during both the first and second trimesters of pregnancy the expectant mother was given exactly this diagnosis, then this is not at all a reason for concern, according to doctors. Before this period, the baby’s small size allows him to constantly change position in the stomach, so the position may change several more times.

An interesting medical fact is that in almost a third of pregnant women, up to the thirtieth week, the child takes conditionally incorrect position while in a breech position. The position of the baby can be determined by ultrasound examination or by manual examination.

As the baby increases in size, he begins to occupy a fairly stable position in the stomach. Thus, by the time of birth itself, the child usually takes a preferred position; only three or four babies out of a hundred are born in a breech position.

You can try to change the breech position of the fetus; the following exercises are recommended for this.

You need to lie down on a fairly hard bed or other surface and lie on your right side for about ten minutes, then roll over onto your left side. You need to repeat the exercise about four times, doing the entire complex two to three times a day. Results will quickly appear within seven days.

For the next exercise you need to choose comfortable position by placing a pillow under the legs or lower back, and the pelvis must be raised. It is necessary that the legs are slightly higher than the head, approximately twenty-five centimeters. You need to lie in this position for ten to fifteen minutes, also two or three times a day.

You can also change the baby's position using the knee-elbow position. To do this, you need to carefully get on your knees and elbows and stand like that for about twenty minutes, two or three times every day.

Doctors recommend doing the entire set of exercises only on an empty stomach, and not with a full stomach. If a woman feels that she needs rest, then the exercises can be postponed for a while. The complex is designed to help the baby get the opportunity to return to correct position by stimulating his movements; in this case, the child’s pelvis gradually moves away from the mother’s pelvis.

In addition, women who have encountered a similar problem recommend sleeping on the side next to which the baby’s head is located.

Among the recommended physical activity To correct the situation when the baby is in a breech position, swimming is also done. It helps the baby roll over to the recommended position upside down. According to medical data, with daily exercise, the probability of returning the child to cephalic presentation ranges from seventy-five to ninety-six percent. But before you start doing these exercises, you should definitely consult your doctor, as there may be individual medical contraindications. These include some diseases of the mother or pathologies in the development of the child and the course of pregnancy.

But besides that, there are other methods. Everyone knows how strong the emotional connection between mother and child is, so you can try to ask him to roll over, while explaining exactly how he should lie. In most cases this helps. Although medicine is still not able to explain this fact.

Well, to consolidate the results obtained, you can start wearing a special bandage, which you can purchase at a pharmacy or in a store for expectant mothers. The bandage is much easier to put on when the woman is lying down, and it must be used throughout the day.

During its development, the baby, found in its mother’s tummy, turns over several times. And after 22-23 weeks of pregnancy, the baby, as a rule, assumes a head-down position - and this is the position of the fetus that is considered optimal for subsequent births. The fetal head is the largest part of its body in diameter, and therefore it is with its passage during delivery that the greatest difficulties are associated. After the baby’s head passes through the birth canal, the rest of his body “by inertia” follows almost unnoticeably. If the baby is positioned vertically in the mother’s tummy, that is, head down, in most cases this position does not bring any difficulties. But it also happens that the fetus takes a transverse position in the womb: legs or buttocks down. In this case, we are talking about breech presentation during pregnancy, which is diagnosed, as a rule, by the 28th week during the next visit to the antenatal clinic. It should also be mentioned that breech presentation discovered at this time will not necessarily persist until delivery - the baby can change position up to 36 weeks. In addition, there are a number of measures that can help “turn over” the fetus, thereby giving it a cephalic position.

Causes of breech presentation of the fetus

Breech presentation of the fetus during pregnancy can be caused by several factors. Doctors call one of the main reasons a decrease in the tone and excitability of the uterus. Also called causes of breech presentation are abnormalities in the development of the uterus, placenta previa, and some fetal malformations. Breech presentation can be breech, leg, mixed, knee - each of them can be easily diagnosed by a doctor during a routine examination, after which ultrasound confirmation will be necessary. Breech presentation is considered not a completely normal position for both the baby and the mother - although it does not pose any direct major threats.

Although natural childbirth with a breech presentation of the fetus is possible, it is still often indicated for delivery C-section. If childbirth proceeds and naturally However, constant and intensive monitoring by a doctor is necessary - breech birth is much more often accompanied by complications.

Signs of breech presentation of the fetus

Physically, if there is a breech presentation of the fetus, the woman does not feel this pathology in any way. She is not bothered by any pain symptoms or feelings of discomfort, which can clearly signal the “wrong” position of the baby in the uterus.

Breech presentation can only be determined through examination. Thus, with breech presentation, experts note a higher position of the uterine fundus above the pubis, which does not correspond to the gestational age. The fetal heartbeat can be heard more clearly in the area of the navel or slightly above it on the right or left (depending on the position of the fetus).

Also, signs of a breech presentation of the fetus are revealed during a vaginal examination. For example, with a breech presentation, the soft volumetric part, the inguinal fold, the coccyx and the sacrum are palpated. With adjacent breech and foot presentation, you can identify the baby's feet with a calcaneal tubercle and short toes (different from the fingers) located in the same line. To clarify the diagnosis, however, ultrasound will also be used.

Exercises for breech presentation of the fetus

You can “give” the baby a head position in the tummy with the help of special gymnastic exercises. They can be used starting from 32-34 weeks of pregnancy - after consultation with your doctor. Gymnastic exercises involve turning the expectant mother in a lying position from one side to the other: 3-4 times approximately every 7-10 minutes. This exercise is performed 2-3 times a day. You can also carry out an exercise that involves lifting the pelvis: lying on your back, you should place some kind of cushion under your lower back (you can use ordinary pillows) so that the pelvis is 20-30 centimeters higher than your head. You need to stay in this position for 5 to 15 minutes, but no more. The exercise is performed 2-3 times a day on an empty stomach. Contraindications for performing such gymnastics are scars on the uterus from any operations, late toxicosis. Offers his methods for breech presentation and alternative medicine, for example, acupuncture, homeopathy, .

If the above methods did not bring desired results, the expectant mother may be offered external fetal rotation. This procedure is carried out at approximately 34-37 weeks of pregnancy, always in a hospital setting with monitor, ultrasound monitoring and the use of special drugs that relax the uterus. A successful external revolution will make it possible to subsequently carry out childbirth naturally, but since this procedure is quite difficult, and also has many contraindications (scar on the uterus, obesity, the age of the primigravida over 30 years, gestosis), it is not suitable for every pregnant woman and is performed quite rare.

Childbirth with breech presentation

If breech presentation could not be eliminated by any of the methods, this should not become a reason for frustration. In this case, the pregnant woman will be advised to go to the obstetric hospital earlier: here, after all the necessary examinations, the method of delivery will be chosen.

Without any serious contraindications, childbirth can occur naturally - under the constant supervision of a doctor. If it is not possible, a caesarean section will be required. Indications for a caesarean section in breech presentation include (more than 3.5 kilograms), the presence of a scar on the uterus, a narrow pelvis in a pregnant woman, placenta previa, presentation in the leg or mixed position.

Especially for- Tatyana Argamakova

Week 28 is the time when the baby will be born very soon. This article will talk about the features of fetal development at this stage.

Anatomical features

By the 28th week of pregnancy, the baby is already quite well developed. Most of the fetal body systems are already functioning.

The size of the baby also changes. Every day the child weighs more and more. It is important to note that this period is characterized by a more intense gain in body weight with a relatively slow increase in height.

To assess how well the baby is developing in the mother's womb, doctors resort to conducting a special ultrasound examination. Experts call it fetometry. This medical term is deciphered quite simply: in Latin “fetus” means “offspring”, and “metrio” is interpreted as “I measure”. Thus, by fetometry, doctors mean a research method in which the main parameters of the fetal body are determined.

The most important informative criteria include the baby’s height and weight. However, there are other medical parameters intrauterine development, which can be determined by a specialist performing fetometry. The normal values of some determined parameters of the fetal body are presented in the table below.

After fetometry, the specialist who conducted this examination issues a conclusion to the pregnant woman. In it, he indicates all the obtained values of the studied parameters of the fetal body.

It is important to note that the study conclusion is not a diagnosis. It must be interpreted by the attending physician who monitors the course of pregnancy.

How does the baby develop?

The fetal nervous system undergoes a number of changes. The structure of the cerebral cortex changes every day. Every day the number of convolutions in the fetus increases. This feature leads to the baby’s behavior becoming more orderly. The fetus also increases the number of movements it makes.

Interestingly, at 28 weeks of pregnancy the baby already begins to have dreams. The baby’s entire sleep can be divided into several stages that successively replace each other. A dream consists of shallow and deep sleep. During the shallow sleep stage, a child's eyes are usually slightly open. During deep sleep, his eyelids are already completely closed.

A change in the structure of the cerebral cortex leads to the appearance of quite a lot of different nerve impulses in it. At 28 weeks, these are no longer just response impulses to irritations coming from the external environment. Some scientists believe that at this time the fetus even develops its character.

The active development of the cerebral cortex and sensory organs contributes to the fact that the fetus already has its own sensations. So, the baby can detect taste, react to bright light and too loud sounds. The fetus may also have a reaction to inhalation by the mother. unpleasant odors. It has been scientifically noted that at 28 weeks of pregnancy the child develops the ability to respond to painful stimuli.

Interesting changes occur in the bodies of boys. In some boys, the testicles begin to descend into the scrotum, but this process is quite individual, and the descent of the testicles from the scrotum is not always abdominal cavity into the scrotum occurs during pregnancy. However, experts believe that best period for this process is the time of intrauterine development.

Girls already have a certain set of eggs, which are located in the ovaries. Without a sufficient number of full-fledged female reproductive cells, a woman’s reproductive function is impossible in the future. That is why doctors note that the female reproductive system is formed during the period of intrauterine development.

A baby who is in an aquatic environment can swallow amniotic fluid. This process is very important and necessary for the full development of digestion in a child. Scientists have found that a fetus can swallow about 500 ml of amniotic fluid per day.

In the process of swallowing liquid, the pectoral muscles play an active role. Its active development is necessary so that after birth the baby can take his first independent breath in his life. After ingestion amniotic fluid The baby usually hiccups. This reaction is quite common and physiological.

Doctors note that a baby born at 28 weeks of pregnancy is already viable, but nursing it will require special conditions and the necessary medical equipment. Only with such careful care can the baby be ready for further independent life.

What does it look like?

By the 28th week, the baby, who “lives” in the mother’s belly, is already quite well developed. So, the child already has mobility in many joints, he actively moves his arms and legs, and can bend his small fingers. Every day the baby looks more and more like a small child. His body proportions change and his facial features change. Hair is actively growing on the baby's body. At 27-28 weeks of pregnancy, a special pigment begins to appear in them, which determines the color of the hair.

The baby can even blink now. His eyes are covered from the outside with eyelids, so the child is able to open and close his eyes. The baby also develops swallowing and sucking reflexes.

Movements

The baby's motor activity at this stage of pregnancy is quite high. The fetus can knock its arms and legs on the walls of the uterus, causing its mother to experience specific sensations. A woman feels that her baby is pushing or kicking her stomach.

The more active a child is, the more intense his motor activity. Calm babies, as doctors note, push and turn over in the womb significantly less than restless children.

A variety of different factors influence a baby’s motor activity. Hypoxia can lead to increased active movements. This condition is characterized by insufficient oxygen supply to the child’s body; in this case, the respiratory function of the fetus is disrupted, which leads to increased motor activity.

Stress and strong negative experiences of the mother have an extremely adverse effect on the baby. During pregnancy, not only a physiological, but also a psycho-emotional connection is formed between a woman and her child. Negative life events that a woman experiences during this time have an adverse effect on the fetus. If the baby pushes hard, this may be caused by discomfort experienced by the fetus.

If physical activity increases, the expectant mother should definitely consult with her doctor. The doctor must determine possible reason any violations that have arisen and draw up a plan to improve the general condition of both the pregnant woman and her baby.

More recently, a special breech presentation of a child was not considered a serious pathology in obstetric practice. But today the opinion of experts regarding this issue has changed. This is due to the likelihood of complications of labor and a fairly large percentage of congenital abnormalities in the development of the baby.

Definition and types

The normal longitudinal position of the fetus is diagnosed at the 25th week of pregnancy. Compared to the rest of the body, the baby's head has the largest diameter at birth. Therefore, doctors associate the greatest difficulties with its passage during childbirth.

There are cases when the baby takes not a vertical, but a transverse position in the mother’s womb: his buttocks or legs are lowered down, which is most often diagnosed at the 26th week of pregnancy.

The following types of pelvic position of the baby are distinguished:

The breech position is the most common type, in which the baby’s buttocks are adjacent to the entrance, the legs are bent to the tummy, the baby’s head and arms are pressed tightly to the chest.
Mixed or heterogeneous position, a characteristic of such a presentation: the baby’s buttocks and feet are adjacent to the entrance.
Leg position – in which the feet of both legs or one leg are adjacent to the entrance.
Kneeling position - the baby in the womb seems to be on its knees. This type is observed quite rarely in medical practice.

Throughout pregnancy, the baby constantly turns over and thereby changes its position. As a result, the vertical position of the fetus may change at week 20, and at week 29 the doctor will discover the pelvic position. Conversely, with a breech presentation of the fetus at 20 weeks, it is difficult to make a final conclusion that this position will remain until the birth process begins.

Reasons

Every woman in labor should know the dangers of breech presentation of the fetus. Indeed, during the process of childbirth, sudden serious complications can arise that adversely affect the health of the baby and his mother. These include: suffocation of the baby, rupture of the birth canal in the mother, spinal damage or intracranial injuries in the baby. In order to avoid undesirable consequences, you need to try to help the baby with a breech presentation at 35 weeks of pregnancy change his position.

Causes of breech presentation of the fetus:

decreased uterine tone;
various anomalies of the female reproductive organs discovered during diagnosis;
excessive and insufficient accumulation of amniotic fluid;
specific deviations in child development;
features of the placenta.

Most often, with a breech presentation of the fetus at 37 weeks of pregnancy, a cesarean section is indicated. But sometimes natural childbirth is possible, requiring minute-by-minute monitoring by a doctor.

Signs

The expectant mother does not feel the particularly unusual position of the baby in her womb. When the fetus is breech during pregnancy, the pregnant woman does not experience any pain or other discomfort. But this fact cannot mean that the problem does not exist at all.

Signs of breech presentation:

At 34 weeks of pregnancy, there is a more noticeable protrusion of the uterus above the pubis.
With a breech presentation of the fetus at 30 weeks, the baby’s heartbeat can be heard more clearly at the mother’s navel, as well as slightly to the left or right of it.
With a breech presentation of the fetus at 33 weeks, an unusual position of the child is felt when examining the vagina: his tailbone is palpated in a diagnosed breech presentation, the tubercle of the heel and smaller fingers (not as long as on the arms) in the foot position.

Special gymnastics

In practice, if a breech presentation of the fetus is diagnosed at 21 weeks of pregnancy, this position of the child is not necessarily maintained until birth. For example, a change in fetal position may be observed at 34 weeks. Breech presentation of the fetus at 32 weeks can be changed by doing the necessary gymnastic elements.

Recommended gymnastics for breech presentation of the fetus includes the following actions:

The breech presentation of the fetus at 31 weeks can be changed if the pregnant woman makes 10 turns or rolls in a supine position from one side to the other. You need to do the exercise three times a day.
At 31 weeks of pregnancy, a woman is recommended to perform this simple task: lying on her back, place a small pillow under her lower back. The back should be raised by approximately 20–30 cm. Remain in the given position for 3 to 12 minutes. Perform the exercise three times a day on an empty stomach.

A woman can begin performing these exercises with a breech presentation of the fetus from 31–34 weeks after the permission of the attending physician. Possible contraindications may include scars on the uterus after undergoing surgical interventions, special position of the placenta, toxicosis in the later stages.

Other ways to change position

In addition to special gymnastics expectant mother may wear a bandage, which can also affect the change in the position of the baby in the womb. In addition, there is an opinion that with this pathology it is useful to sleep on the left side.

If the exercises do not bring significant results and the longitudinal position of the fetus is not diagnosed, the attending physician may recommend a specially developed procedure for external rotation of the baby. It can be carried out under ultrasound monitoring of the fetus at 36 weeks in a hospital setting. During the procedure, special substances are used that relax the uterine tone.