Pregnancy is a dynamic process that ultimately ends in delivery. The course of this largely responsible and global stage influences not only the course, but also the tactics of labor management. One of the most important parameters in this case is the position of the child in the uterine cavity. In some cases, you can meet the oblique presentation of the fetus.
At the same time, many confuse two concepts that seem to be similar to each other: position and presentation. However, there is a difference:
- The position is determined by the location of the child relative to the axis of the uterus.
- Presentation depends on how exactly the fetus is rotated in relation to the “exit” (throat of the neck) of the genital organ.
The position can be longitudinal (the axes of the fetus and the uterus coincide), transverse (the axes mentioned are perpendicular to each other) and oblique (the axes of the uterus and the baby form a right angle). The only correct position for the child is longitudinal. It is considered the norm and is most often found in obstetric practice.
As for the oblique and lateral position or presentation, this is already a pathological condition that creates insurmountable obstacles to the course of childbirth in a natural way. But what can cause oblique presentation of the fetus at 37 weeks of pregnancy?
Types of presentation of the child in the cavity of the genital organ
As we now know, the position of the child can be either longitudinal, or peppered, or oblique. As for the types of presentation, here everything is determined by the part with which the child is turned (head or pelvis).
Both the presentation and the position of the fetus in the cavity of the genital organ can vary throughout the gestation period. However, with the onset of the 33rd week, the child takes a stable position. By the end of the gestation period, the fruit is quite large, and it is more difficult to spin every day, since there is less free space for such maneuvers. The situation can reach oblique presentation of the fetus at 30 weeks of gestation.
Starting from the 34th week, the child is preparing to go out. Women at this time feel the contractions, which are preliminary or training in nature, while the child begins to sink lower. The last ultrasound shows the final presentation of the fetus.
Head down
According to statistics, this is the most common form of presentation (up to 95% of all cases). Moreover, the position of the fetus itself is longitudinal.
As already noted, each type of presentation is divided into several subspecies depending on the level of extension of the head:
- forehead;
- occipital;
- facial.
- frontal.
Let's consider each of them in more detail.
Forehead
This situation is complicated by the fact that the head passes through the small pelvis with the largest dimensions. This makes the birth process difficult. Nevertheless, there have been cases when, during delivery, the fetus changed the position of the head in order to facilitate the way of birth. This type of presentation can be considered as an indication for cesarean section.
The same applies to oblique head presentation of the fetus. However, this moment is purely individual. Each case should be considered separately, since other aspects must be taken into account.
Occipital
As for the occipital presentation, then this situation is considered the norm. In this case, a woman is able to give birth on her own and without outside interference. This is the most convenient way of birth for a child and his mother. The baby moves along the birth canal with the back of the head, while his face is turned to the woman's back. In another way, this is called anterior occipital presentation. Here, as a leading point, which appears the very first, acts a small fontanel.
There is also posterior occipital presentation, but such births occur in extremely rare cases (no more than 10%). Here the face of the child is facing in the opposite back. Moreover, during the course of childbirth, the baby turns to take a more comfortable position. But despite this, the oblique presentation of the fetus at 32 weeks ends.
Frontal
Like oblique presentation of the fetus at 32 weeks of gestation, this is another rare case (0.05%). This presentation is characterized by an average degree of extension of the head. At the same time, passing the baby through the birth canal is not so difficult — it is completely impossible! Therefore, this is another medical indication for cesarean section.
Facial
In this case, the maximum degree of extension of the head is observed, which is also extremely rare, 0.25% of all birth cases. From a technical point of view, such birth can take place naturally. However, due to the peculiarities of such a presentation, this threatens to cause injuries, not only to the child, but also to his mother.
For this reason, when a facial presentation is detected, a cesarean section is prescribed. This is the only way to avoid unreasonably high risk. True, he is present during surgery.
Pelvis and legs out
But not only oblique presentation of the fetus at 35 weeks of gestation is undesirable. This case also does not bode well. Otherwise, this position of the child is called the buttock. Here, the ass is already facing the way out of the birth canal. In this case, there are also several ways to have a baby:
This type of presentation in obstetric practice also happens quite rarely, no more than 5%. Often, when it is discovered, gynecologists give valuable recommendations or begin to carry out those manipulations themselves that allow you to turn the baby over.
With pelvic presentation, childbirth is considered pathological, since it can be accompanied by various complications:
- acute fetal hypoxia;
- birth injuries;
- weak labor;
- trauma to the birth canal;
- squeezing the umbilical cord between the bones of the pelvis and the head of the child, which usually ends in his death.
If childbirth with oblique pelvic presentation of the fetus proceeds naturally, then almost always there is a certain difficulty associated with the removal of the head of the child. After all, first appears the pelvic part, which is noticeably smaller in size than the head.
In the case of leg presentation, the obstetrician faces an important task: to prevent the legs from falling out until the baby takes a “squatting” position and begins to pass along the birth canal forward with the buttocks.
In any case, the birth of a child with pelvic presentation is more difficult. Therefore, women can experience severe pain, and in this connection, under certain circumstances, doctors may decide in favor of a caesarean section.
Across or oblique?
Both oblique and transverse presentation of the fetus is a direct medical indication for a caesarean section. In this case, giving birth to a baby is simply impossible.
Earlier in obstetric practice, special manipulations were made that allow you to turn the child by the limbs. However, now this approach is under the strictest ban, because the implementation of this procedure threatens to cause substantial harm not only to the child, but also to his mother.
The only case when such manipulations are allowed for is the birth of twins. That is, when the first child has already been born, and the second one has taken an unsuitable position (in an oblique or transverse direction with respect to the genital organ).
Causes
Oblique presentation of the fetus in the uterine cavity can be due to a variety of reasons. They can be conditionally divided into two groups:
- structural features of the female body;
- genital diseases.
The features of the anatomical structure include a large or small amount of amniotic fluid, as well as a weakened state of the muscle fibers of the uterine wall. In addition, pregnancy with twins and other aspects should be included here.
The number of various diseases and pathologies also varies widely. The most common cases are an increased tone of the genital organ, the threat of a miscarriage, a narrow form of the pelvis.
Diagnostics
Diagnostic measures that are carried out in order to determine the position of the child in the uterine cavity are complex. It is possible to identify the wrong position of the uterus with the onset of the 30-32th week of pregnancy. To do this, a number of necessary procedures are carried out:
- visual external inspection;
- visual internal inspection;
- palpation;
- Ultrasound
During an external visual examination, you can determine in which pose the child is. The article contains photos of the oblique presentation of the fetus, so you can visualize the picture. Under normal conditions, the genital organ has an oval-elongated shape. The incorrect position of the fetus will be noticeable already visually: in this case, the abdomen will appear oblique-stretched (oblique presentation) or transverse-stretched (transverse presentation). Due to the incorrect position of the child, the uterus becomes spherical, and not oval, as it should be. In addition, the bottom of the uterus in this case is not high enough.
Internal visual inspection is relevant when the water has already departed and the uterine pharynx is opened by a few centimeters. In this case, a vaginal examination should be carried out with a high degree of accuracy, since there is a risk of falling out of the handle or leg, which is undesirable.
When performing palpation, it is also possible to determine in which position the baby is. If the abdomen in the upper part is soft and inactive, and the bottom is dense, rounded and mobile, this indicates the longitudinal position of the child. If the emptiness of the uterine fundus is felt from above and below, the head and buttocks are felt in the sides, the baby’s position is not the most suitable. In the case of oblique presentation, the head is located in the iliac region.
Ultrasound can determine the position of the child in the cavity of the genital organ with 100% accuracy. The resulting image is a kind of photo of the oblique pelvic presentation of the fetus, only without bright colors.
Generic activity
Directly oblique presentation of the child in the uterine cavity is the rarest case (1% of the entire pregnancy pool). This position can be determined by the 32nd week of the term. However, until the very birth, there remains the possibility that the child will still independently change his position.
Childbirth with such a pathological presentation is considered quite difficult. They are in extremely rare cases carried out naturally. The main problem is the early discharge of amniotic fluid. There is also a risk of premature birth. If childbirth will take place naturally, then both mother and baby can get injured.
If in the last weeks of pregnancy the baby continues to maintain an incorrect position, the woman is usually hospitalized. In stationary conditions, doctors conduct the necessary additional examinations. In addition, tactics of optimal labor activity should be developed. Often with oblique presentation, a cesarean section is made as the only true and safe way for a child to be born.
Undesirable consequences
With oblique presentation of the fetus, favorable natural childbirth is unlikely. That is why, in most cases, doctors insist on the operation. The oblique position of the child in most cases is accompanied by various complications:
- The loss of parts of the child with the rapid discharge of amniotic fluid. If the umbilical cord is pinched, serious circulatory failure can occur and childbirth, usually ending in a fatal outcome for the child.
- Oxygen deficiency of the baby in the acute stage.
- Premature discharge of amniotic fluid. This happens due to the lack of pressure on the entrance to the small pelvis.
- Female genital infection. At the end of childbirth, as a rule, the necessary therapy is required.
- Injury to the child during its passage through the birth canal.
If a number of problems arise, only a highly qualified obstetrician-gynecologist with extensive experience in conducting such childbirth can cope with the situation.
Special exercises
It is worth noting that the photo of the oblique presentation of the fetus should not intimidate expectant mothers.
As noted, such a presentation is extremely rare, so the problem can be reversible. There are a large number of exercises that help the child turn in order to accept the only true presentation.
At the same time, it is impossible to show initiative in any case, since there are certain contraindications:
- myoma;
- placental presentation;
- previous pregnancy ended with cesarean section;
- the woman’s presence of a whole bunch of various diseases.
As obstetric practice shows, in 50% of cases, women managed to change the presentation of the child through exercises. Also, there are cases when the baby independently changed his position a couple of days before delivery. So, even if surgery is prescribed, women should not panic, because the baby needs a happy mother. It is worth remembering that childbirth in this way in most cases proceeds without complications, the baby is born healthy.
Expert Advice
But what can a woman do with oblique presentation of the fetus in the uterine cavity? Experts recommend lying alternately on each side for 10 minutes with a repeat of 3-4 times a day. Another exercise that should be performed at least 3 times during the day will also be useful. A woman needs to lie with her pelvis raised 20-30 cm above her head for 10-15 minutes.
Good results can give a knee-elbow pose. It must be done with the same frequency as the other exercises considered.