The fact that such a pelvic presentation of the fetus, or CCI is probably heard by many, but what exactly is meant? In medical practice, there are many cases, some of them occur more often, while others are quite rare. Pregnancy here is no exception - how many unusual births were accepted by obstetricians, that it’s just right to compose a novel, in several volumes.
But the topic of our article concerns precisely the situation of the child on the eve of childbirth. We will touch on what it should be and what consequences its incorrect position threatens. And also we will analyze the features of the downside down position, which can be done in this case.
Pelvic Presentation Overview
Pregnancy is a complex physiological process that cannot be predicted. Up to a certain point in time, the baby is free in the womb, and he can swim as he wants. However, as it develops, it grows, and places become less and less. In this regard, he occupies a certain position and remains in this state until the very birth.
In some cases, a child under 35 weeks of age can change its position in the uterus several times, which in medical practice is called unstable. However, at a later date, he takes a certain position, and in most cases his head is directed downward. This is called head presentation. But sometimes he can take the position with his legs down, which, in turn, is called pelvic (or foot) presentation, which is undesirable. Below for clarity, there is a photo of the pelvic presentation.
Specialists in the field of obstetrics and gynecology consider this situation of the child as a pathology, since this complicates the course of not only the pregnancy itself, but also the birth itself. Often this becomes one of the main causes of deviations in child development.
There is a theory according to which there is a relationship between the development of the vestibular apparatus of the child and his position in the uterus. Since this organ of equilibrium in the early stages of pregnancy is still only at the developmental stage, pathology cannot be diagnosed. It is possible to identify it in a child only after his birth.
Before the onset of 33-34 weeks, the child can move actively and unhindered. In this case, the pelvic position is detected in 35% of pregnant women. As for the prenatal period, a similar kind of pathology occurs in 4% of pregnant women.
Types of pathology
What is characteristic, like almost every disease, pelvic presentation has several types, each of which is further subdivided into subspecies. Gluteal presentation includes the following:
- In its pure form - of all cases of pelvic or leg presentation, this subspecies is observed in 75% of pregnant women. Only the buttocks of the child are directed to the small pelvis of the woman , while his legs are located along the body.
- Mixed pathology - here the legs of the fetus are bent and, together with the buttocks, are directed to the exit of the uterus. This pose occurs in 20-24% of cases.
Foot presentation has one more subspecies:
- Full - both legs of the fetus are facing the area of the female pelvis.
- Incomplete - in this case, only one leg is in the wrong position.
- Knee - such a subspecies is the record holder in the number of recorded cases - only 0.3%. Here the knees of the child are already turned to the pelvis.
As many experts note, pelvic presentation of the fetus at 32 weeks of gestation is considered the most dangerous, since it can provoke the loss of the umbilical cord or limbs of the child. Asphyxia during childbirth is also not ruled out. If the size of the pelvis of a woman is impressive in size, then with simple gluteal presentation during the birth, complications will not arise.
Causes of the uncharacteristic position of the fetus
Often, doctors are not able to find out for what reason the child takes an undesirable position before childbirth. Nevertheless, some factors can be distinguished. From the point of view of modern medicine, they include a genetic predisposition. In other words, if the expectant mother herself was born in this position, then her children can be born in the same way. At the same time, this theory has so far been little studied, although many obstetricians have recently adhered to it too.
It is very difficult to establish the exact cause of the pelvic presentation of the child. Almost always there is one or two circumstances leading to this. The exact position the child takes depends on many factors, both in relation to the fetus and its mother. Let us first consider the so-called maternal causes, and then touch on some features of the development of the fetus.
Problems with the uterus
Among the main causes of incorrect presentation of the child in the womb are deviations in the development of the genital organ. The characteristic ones include the saddle uterus, the two-horned uterus and the doubling of the genital organ. In some cases, such pathologists are detected during pregnancy.
Uterine fibroids are not uncommon. In particular, we are talking about the large size of a benign tumor, which, purely on a mechanical level, creates an obstacle to turning the child upside down. No less serious danger is represented by myomatous nodes that grow into the uterine cavity.
Another reason for the pelvic presentation of the child is a decrease in the tone of the uterus and its contractility. This condition is characteristic of those women who have already given birth, more than once, and in their history there have been cases of abortion or curettage. Those women who have had a cesarean section (CS) or myomectomy have scars. As a result, contractility of the middle muscle membrane of the uterine wall decreases, and it is more difficult for a child to take a “comfortable” posture.
Placenta previa also plays an important role. By this is meant the overlap of the internal pharynx by the placenta, which can be full or partial. Under normal conditions, the pharynx should be free, and the placenta should be located at least 7 cm from the internal pharynx. Its overlap creates a restriction on the stretching of the lower part of the uterus. The child also has few opportunities for the necessary coup.
Umbilical cord
The cause of the pelvic presentation of the fetus may be the length of the umbilical cord. And if it is short - less than 40 cm, then purely mechanically this also creates problems for the movement of the fetus in the uterine cavity. But if its length is within normal limits, cases of spontaneous entanglement of the umbilical cord are not ruled out. Often this can happen during pregnancy from the 23rd to the 24th week. In this case, the child cannot perform a coup due to the mechanical tension of the umbilical cord loop.
Amniotic fluid
In some cases, the cause of the pelvic position of the fetus may be polyhydramnios or oligohydramnios.
With polyhydramnios, due to an increase in the amount of amniotic fluid, prerequisites are created for a multiple change in the position of the fetus in the cavity of the genital organ. During the entire period of pregnancy, the child risks taking a pose upside down. But, in addition to this, there is another equally dangerous risk: the umbilical cord can wrap itself not only around the child’s body, but also the neck.
With oligohydramnios, the amount of amniotic fluid, on the contrary, is reduced, which also interferes with the free movement of the fetus in the uterine cavity and leads to pelvic presentation. He simply does not have the opportunity to take the necessary and only correct position - head down.
Here you can consider one interesting case when the appearance of not one baby, but several is expected. It is a multiple pregnancy. With twins, almost always one child is positioned as needed (the head is pointing down), while the other has the pelvis turned down. The same goes for triplets.
Again, this is due to the limited space in the uterine cavity. With the birth of the first baby, the birth canal expands, as a result of which there are no problems with the promotion of the second child.
Bone structure
With anatomical narrowing of the pelvis or deformation of the bones of a woman, it is also quite difficult for the fetus to take the desired position. Such a feature in the anatomy of a woman can occur due to injuries or a disease. Often it provokes rickets, bone tuberculosis or severe scoliosis.
Some features of fetal development
The main difficulty with pelvic presentation is cesarean section, only in some cases can you do without it. But more about this later, but for now, as promised, we will touch on those features of the intrauterine development of the child, because of which he cannot take the right position. First of all, this applies to fetal malformations, and they must have a pronounced character.
For example, there is an increase in the thyroid gland or cases of hydrocephalus, when the child's head exceeds the permissible size. Fortunately, such an anomaly is quite rare, and it will not be difficult to detect it using ultrasound. And this study, as you know, is highly reliable. And if a similar or any other case with a pronounced severity is diagnosed, a decision is made to terminate the pregnancy in connection with medical indications.
If the fetus is small, then it can freely “flounder” in the womb, as he pleases. Usually this can indicate a delay in fetal development.
Possible consequences
What complications can an unwanted position of a child lead to? Maybe everything is not as bad as it seems, and childbirth with pelvic presentation will go smoothly? Here it’s worth immediately clarifying that the child’s pose, with his legs pointing down, poses a serious danger, and not one. In most cases, it is the presentation of the legs that provokes the threat of premature birth. In addition, gestosis or fetoplacental insufficiency may develop.
As a result, this negatively affects the formation of many body systems, including the nervous and endocrine. Also, such conditions often cause a decrease in the amount of amniotic fluid, fetal hypoxia, and impaired development.
Only this is far from being limited to the following cases can occur before delivery with a pelvic presentation of the fetus:
- Toward the end of the gestation period, the medulla oblongata lags behind in development, the pituitary gland is disturbed.
- In the testes or ovaries, depending on the gender of the child, hemorrhage can begin. In some cases, the tissues of the body swell, as a result of which the germ cells die. As a result, this leads to azoospermia (severe male infertility), hypogonadism (testicular insufficiency due to a decrease in the level of sex hormones), and other pathologies.
- The intake of the necessary “life-giving” gas to the fetus, up to oxygen starvation, is significantly limited.
- The heart begins to work in a rapid mode.
- As a particularly difficult case is the development of cerebral palsy.
However, all this can threaten the fetus even in the womb. But if the risk of preterm birth has passed, then after the appearance of the baby it becomes very difficult for him to adapt to the environment. Many reviews of pelvic presentation confirm this. Antistress resistance is markedly reduced.
Nevertheless, each pregnant woman must take into account that foot presentation of the fetus for up to 34-35 weeks is not yet a pathology.
Signs of pelvic pathology
It is quite difficult to independently determine the type of CCI, nevertheless there is the only reliable sign - these are tremors that are felt only in the lower abdomen, while in other departments they are less pronounced or even absent. Another sign that can be used to judge CCIs is the baby’s heartbeat. With a head presentation, it is clearly heard below the umbilicus, while in the opposite position of the fetus, the work of the heart is felt at the same level with the navel or above it.
As practice shows, many pregnant women do not even suspect CCI, only during diagnostic tests revealed pelvic presentation of the fetus at week 32 or another term. In addition, as is now clear, the abnormal position of the child negatively affects him. Therefore, it is necessary to regularly attend a antenatal clinic and not to refuse the necessary examination.
CCI Diagnosis
To establish the exact position of the child in the uterine cavity, several methods are used:
- external examination (palpation of the abdomen);
- vaginal examination;
- conducting ultrasound.
During an external examination, the doctor feels the stomach of the future mother to determine the displacement of the baby's head relative to the bottom of the uterus. She in this case is above the norm. Other signs of CCI are also revealed. However, in some cases, palpation of the abdomen will not give a result. This applies to those women who have a more complete physique or well-developed abdominal muscles. It also includes a double pregnancy, increased uterine tone.
During the study of the vagina, you can find a soft and large formation directly at the bottom of the genital organ, which are the buttocks of the child.
Ultimately, you can verify the accuracy of the diagnosis and the need for cesarean with pelvic presentation using ultrasound. In addition to gluteal previa, this study will reveal other signs:
- Amniotic fluid reduction.
- The nature of the attachment of the placenta.
- Offset head position.
In some cases, the doctor may prescribe an additional examination such as Doppler ultrasound and CGT. This will establish the functional state of the child.
What to do to expectant mother?
What does a woman have to do if it is discovered that her child has taken an undesirable position, and there is little left before childbirth? Is there really no way out ?! Do not despair! As you know, the child independently takes the necessary position, preparing for childbirth, which usually happens with the onset of the 5th month of pregnancy.
But if during the planned examination at a later date (more than 35 weeks) he is still with his legs down, measures must be taken. Just do not panic, because stress does not benefit either the baby or the mother herself. In addition, while there is still time.
In addition to regular visits to the gynecologist and other necessary examinations for pelvic presentation of the fetus, what else can I do? The daily regimen should be observed. In particular, you need a full and restful sleep, during the day you need more rest, avoid stressful situations. As for nutrition, it is necessary to adhere to a fractional diet. That is, to eat food in small portions, but often throughout the day.
Medical support
The characteristics of the CCI are such that, with the uncharacteristic position of the child in the womb, you need to closely monitor the course of pregnancy. With the arrival of 38-39 weeks, she will be offered hospitalization in the clinic in order to determine the date and method of delivery. The survey itself consists of several planned points:
- The first step is to study the medical history of the woman and her past pregnancies, if any.
- The general condition of the expectant mother is examined, not only physical, but also emotional.
- With pelvic presentation of the fetus in the late weeks of pregnancy, its more accurate period is specified on the basis of the obtained ultrasound data and the date of the last menstruation.
- The nature of the pelvic pathology (gluteal or foot presentation), the degree of readiness of the cervix for childbirth, the state of the placenta and the fetal bladder are determined.
- The sizes of a woman's pelvis are determined.
- The state of development of the child is assessed. That is, it turns out its weight, the amount of amniotic fluid, there are any deviations, etc.
- The gender of the child and the degree of extension of the head are also determined. Typically, boys are most difficult to tolerate birth stress.
Based on the data obtained during these studies, one or another method of delivery is chosen.
Effective technique
What else can help in a situation of pelvic presentation? How to turn a child so that there are no dangerous consequences?
To do this, there is a whole range of exercises:
- "Bridge". For this exercise, you need to choose a flat surface - a bed, a sofa, but still the floor is better. It will be necessary to lie down, after which put 2 or 3 pillows under the lower back, while the pelvis will be 20-30 cm above the head. You need to stay in this position for 10-15 minutes.Do the exercise 2-3 times a day before meals. In this case, the baby's head begins to rest against the bottom of the uterus, as a result of which he has a feeling of discomfort, and he begins to turn to eliminate it.
- Breath.You should take a starting position, legs apart at shoulder width, hands should be lowered. On inspiration, raise your hands, palms down, to shoulder level. At the same time, you need to climb on your toes, slightly bending the lower back forward. After that, you can slowly lower. Repeat 4 times per set.
- No less effective gymnastics with pelvic presentation called "Turn". For this exercise you need a solid surface, again, help out the floor. You need to take a lying position and turn on that side, towards which the back of the child is facing. Bend and press your legs to yourself and lie down in this way for 5 minutes. After this, take a deep breath, exhale and turn to the other side through the back. Also lie down for 5 minutes and inhale, exhale. Breathing should be free and even. Depending on the position of the fetus, it is necessary to straighten the leg that is below (with the transverse) or the one that is above (with the pelvic). Now, at each breath, it should be pressed to the stomach, and on the exhale, straighten. Movement should be performed slowly and within 10 minutes.
- "Bridge 2". Again, take a lying position, with your feet resting on the floor, hands should be along the body. Taking a breath, raise the pelvis up, linger for a few seconds, while exhaling lower it. After that, on the next breath, you should tighten the muscles of the perineum, and when you exhale, relax. Repeat this complex several times.
All these exercises with pelvic presentation of the fetus must be performed in the exact order in which they are given above. In this case, the muscles will smoothly be included in the work, which will avoid a sharp overload of the body. In the case when the child turned as needed, you should continue to perform only the last exercise as a preventive measure until the birth. According to many experts, the effectiveness of this method is 75%.
CCI features
In those cases when the situation could not be corrected at the 38th week of pregnancy, the woman is sent to a hospital and, depending on the situation, the optimal method of delivery is selected. This can be a natural birth, which every mother aspires to, or surgical intervention (cesarean section).
Both methods differ in their readings. The reasons for cesarean with pelvic presentation can serve:
- Presentation of the foot or buttock (mixed) nature, given that this is the first birth.
- The mass of the fetus is less than 2 kg or more than 3.5 kg.
- Low placenta location.
- Enlarged veins in the genital area.
- Anatomical contraction of the pelvis.
- The presence of gestosis.
- Uterine fibroids or other abnormalities in its development.
- There is a scar on the genital organ.
- Originous women 30 years and older.
- ECO.
Natural birth can pass without complications if:
- The dimensions of the pelvis allow the child to freely pass through the birth canal.
- The woman and her child are in satisfactory condition.
- The body of a woman is completely ready for childbirth.
- Only buttock presentation.
In the case when the choice of the future mother fell on natural childbirth with pelvic presentation, a woman needs special training. For this, the administration of sedatives and restorative drugs, including antispasmodics, is prescribed. In this case, the doctor must monitor the course of drug therapy! The cervix also needs preparation. This is done using special injections and gels that are injected into the vagina. But if the cervix is still closed, then an operation is performed.
The incorrect position of the child in the uterine cavity is not a sentence - a woman can give birth, according to natural laws. However, with the existing threat, both in relation to the mother and the child, there is nothing left but to resort to the COP.
In conclusion
Pelvic pathology is the case of pregnancy when a lot depends on the actions of not only the woman herself, but also the medical staff. The task of obstetrician-gynecologists is the vigilant and constant monitoring of the patient, the appointment of useful and special exercises. The result of such joint actions will be the birth of a healthy child.
Well, and most importantly - do not panic if the doctor has made a disappointing diagnosis - "pelvic presentation." What to do in this case, the expert will tell. Also, each expectant mother should read useful information not only about the topic of this article, but also about how the pregnancy proceeds in general. No wonder there is one good saying: forewarned - means armed!