Timing of caesarean section for breech presentation. Indications for caesarean section for types of atypical fetal presentation

Breech presentation is quite often diagnosed in utero in children up to 32-34 weeks. And later, most of them occupy the correct position in the uterus - head down. This position is considered the most physiological and safe for childbirth.

Cesarean section for breech presentation, emergency or planned surgery is often performed. But there must be additional relative indications for it, in addition to the incorrect position of the child in the uterus. They are usually determined 1-3 weeks before the expected date of birth.

Thus, a planned caesarean section for breech presentation is performed in the following cases:

the presence of uterine fibroids in the isthmus area, the lower part of the uterus, which can lead to problems with cervical dilatation;
the baby’s legs are at the bottom (a special type of presentation);
male child (due to hypothermia of the scrotum during childbirth, the child may begin to make breathing movements earlier than birth, resulting in asphyxia);
large fetal weight (approximately more than 4 kg);
gestosis;
fetoplacental insufficiency, confirmed by impaired blood flow recorded during Doppler ultrasound;
anatomically narrow pelvis;
venous insufficiency in the pelvic area.

How many weeks a caesarean section is performed for breech presentation depends on the clinical situation. It may happen that a woman goes into labor much earlier than her expected due date, for example at 35 weeks. In this case, the tactics of how a caesarean section occurs with a breech presentation remains unchanged, however, the surgical intervention itself is called and is emergency, not planned. Such an operation is always more risky than a planned one, since the woman is not prepared for it. Perhaps there is an exacerbation of some chronic disease or an infectious process that can lead to complications. And psychologically, the woman is not ready for such a resolution of the situation, which can affect lactation in the future.

The timing of a cesarean section for a breech fetus, if it is a planned operation, is usually as close as possible to the expected date on which natural labor should begin. The well-being of the expectant mother and child also plays a role. If everything is in order, when is a caesarean section performed during breech presentation? At 39-40 weeks, sometimes directly on the so-called PDR day, if it falls on the operating room, is not a holiday, etc.

How long does it take for a doctor to realize that the baby is lying incorrectly and what can be done about this so as not to lead to surgical delivery? Although breech presentation is not always an indication for cesarean section, you can and should know about the position of the baby from about 25 weeks of pregnancy. At this stage, the doctor can already feel the location of the baby’s body parts in the uterus. And an ultrasound can clearly see how the baby lies from about 15 weeks of pregnancy. Seriously though this information you can have enough of these early stages do not perceive. After all, the child then often changes his position. And a sufficient amount contributes to this amniotic fluid. But over time there are fewer of them, and the weight of the fetus increases, and accordingly, there are fewer and fewer opportunities for a revolution.

Before deciding the breech presentation of the fetus in in this case gives a chance for a natural birth or cesarean is preferable, the woman should make attempts to turn the baby. To do this, very simple and safe exercises are performed. For example, turning from one side to the other in a lying position, standing in a cat pose (on all fours), etc.

There is a medical technique called external inversion. But it is quite risky and is carried out exclusively in hospital settings. Meaning: the doctor, using his hands, right in the uterus, turns the fetus into a cephalic presentation. Sometimes such manipulation leads to placental abruption and discharge of amniotic fluid. Before you decide to do this, you need to carefully weigh the pros and cons. Perhaps a caesarean section will be much less dangerous for the health of the woman and child, taking into account all the possibilities of modern medicine?

17.10.2019 08:07:00 6 ways to slow down aging At a young age, few people think about aging - the skin can quickly recover, harmful effects have little influence. But time makes its own adjustments, but with the help of these tips you can slow down the aging process of the body.
17.10.2019 07:06:00 Don't Eat These Vegetables If You Want to Lose Weight Vegetables are low in calories, but at the same time they fill the stomach and saturate well. Ideal for losing weight, isn't it? If only there were some vegetables that interfere with getting rid of extra pounds. Alas, even in this barrel of honey there was a fly in the ointment.
16.10.2019 18:58:00 -50 kg in 6 months: how Jessica Simpson lost weight Within six months, Jessica Simpson managed to lose 50 kilograms. Her trainer explains how she lost weight so quickly without going to the gym every day.

Breech presentation is when the baby sits on his bottom with his legs up, or sits as if squatting. This happens often, there is no tragedy here, there is no need to be afraid of this diagnosis.

It is absolutely natural that the child gets tired of lying in his mother’s tummy in one position all the time, and he changes his positions. The expectant mother feels it and can even see it in ultrasound images. First, the child lies head down, then turns over, and you can already see him in a “sitting” state or lying on his side. This continues until the 33rd week of pregnancy. The child is still small, his size allows him to move in the amniotic sac completely freely, he has room for maneuvers. Doctors are concerned about children who do not want to roll over into the correct cephalic presentation after 33 weeks. Then we have to decide on a caesarean section for a breech presentation of the fetus.

The entire pregnancy with a breech presentation, starting from the 33rd week, is aimed at persuading the baby to roll over into a cephalic presentation. If by the 37th week it was not possible to transfer the wayward baby to a cephalic presentation, the woman is prepared for surgery - a planned caesarean section for a breech presentation of the fetus.

It must be said that surgery for breech presentation is not the only solution. Everything very much depends on the general course of pregnancy, the well-being of the woman and the child. In any case, two weeks before the planned birth of the child, if the child is in a breech presentation, the doctor will admit you to the hospital in order to calmly examine you and the child and hold a consultation at which it will be decided how you will give birth.

Indications for caesarean section for breech presentation of the fetus

At a consultation of doctors, decisions on methods of childbirth are made based on factors such as:

Age of the woman in labor (if the age of the primigravida is more than 35 years, a cesarean section is performed).
Women's health. They take into account: the history of previous pregnancies and births, the presence of edema, problems with the heart and blood pressure.
Gender of the child. Breech boys are born only by caesarean section. This is done to avoid injury to the scrotum.
The size of the mother's pelvis. Narrow pelvis = caesarean section.
Child's weight. Ideal weight child from 2500 to 3500 grams.
Elasticity, softness of the cervix.
What kind of breech presentation does the baby have? There are pure and mixed breech and leg presentation. Leg presentation of the fetus is the most dangerous, that is, a caesarean section is always performed to avoid the baby’s arm or leg falling out during childbirth.

Fear of caesarean section for breech fetus

There is no need to be afraid of a caesarean section if the fetus is breech - the operation takes place quite quickly - from 40 to 60 minutes - and, as a rule, the mother is conscious. General anesthesia for this type of abdominal surgery is used quite rarely; epidural anesthesia is more often used, i.e. immobilizes only the lower part of the body, but none harmful substances do not enter the patient’s bloodstream, since the anesthesiologist injects anesthesia directly into the lumbar spine inside the spinal canal. And immediately after birth, the mother sees her newborn baby.

Sometimes doctors' advice allows a woman to give birth naturally, but due to problems with labor directly during the birth process, the doctor may change the decision in favor of surgical intervention to save the mother and child.

Don't be alarmed by breech presentation. An experienced doctor, right? decision, competent and calm behavior of a woman are the main components of successful childbirth in any presentation.

Breech presentation is when the baby sits on his bottom with his legs up, or sits as if squatting. This happens often, there is no tragedy here, there is no need to be afraid of this diagnosis.

Indications for caesarean section for breech presentation of the fetus

At a consultation of doctors, decisions on methods of childbirth are made based on factors such as:

Age of the woman in labor (if the age of the primigravida is more than 35 years, a cesarean section is performed).
Women's health. They take into account: the history of previous pregnancies and births, the presence of edema, problems with the heart and blood pressure.
Gender of the child. Breech boys are born only by caesarean section. This is done to avoid injury to the scrotum.
The size of the mother's pelvis. Narrow pelvis = caesarean section.
Child's weight. The ideal weight of a child is from 2500 to 3500 grams.
Elasticity, softness of the cervix.
What kind of breech presentation does the baby have? There are pure and mixed breech and leg presentation. Leg presentation of the fetus is the most dangerous, that is, a caesarean section is always performed to avoid the baby’s arm or leg falling out during childbirth.

Fear of caesarean section for breech fetus

There is no need to be afraid of a caesarean section if the fetus is breech - the operation takes place quite quickly - from 40 to 60 minutes - and, as a rule, the mother is conscious. General anesthesia for this type of abdominal surgery is used quite rarely; epidural anesthesia is more often used, i.e. They immobilize only the lower part of the body, but no harmful substances enter the patient’s blood, since the anesthesiologist injects anesthesia directly into the lumbar spine inside the spinal canal. And immediately after birth, the mother sees her newborn baby.

Sometimes the advice of doctors allows a woman to give birth naturally, but due to problems with labor directly during the birth process, the doctor may change the decision in favor of surgical intervention to save the mother and child.

Don't be alarmed by breech presentation. An experienced doctor, the right decision, competent and calm behavior of a woman are the main components of a successful birth in any presentation.

Breech presentation is the position of the fetus in the womb in which the baby's buttocks or legs are located in the lower part of the uterus. Lately, babies stubbornly refuse to lie down in the “correct” head position before they are born. They prefer to “sit on their butts” and look at the world from their belly, not upside down. But doctors are urgently trying to turn the curious stubborn man into a natural position. After all, this is exactly how Mother Nature intended for a successful birth. Otherwise, some difficulties may arise during childbirth.

Until the 32nd week, the baby floats freely in the womb, and only towards the end of pregnancy should he assume a cephalic presentation. The reason for the incorrect position of the fetus may be the high activity of the baby, or various anomalies in the development of the uterus, etc. By the end of pregnancy, a woman should try to “turn over” her little one in every possible way. Today there are many different techniques and exercises. However, even if all methods were unsuccessful, there is no need to worry. One way or another, you will give birth to your baby - there is no escape.

There have always been stubborn babies in the womb. Our grandmothers learned about breech presentation during the birth itself, and nothing happened - they gave birth. Then various benefits appeared and breech presentation began to be considered a pathology, and childbirth itself was allowed exclusively by cesarean section. Fortunately, the fashion for caesarean sections is passing, and every woman has the right and opportunity to have one. No, don’t think that we are categorically against cesarean section. No one doubts the advantages of this method of delivery, but it should be used only in extremely justified cases.

It is far from the main indicator for a cesarean section, although it has its own characteristics during natural delivery.

Definitely, if at 37-38 weeks of pregnancy the baby has not turned over, then you will have to be hospitalized in an obstetric hospital 2 weeks before the expected day of birth. It is here and only now that the question of the method of delivery will be finally resolved. Get ready for the fact that you will be examined in full, by many specialists and in every possible way.

These are the main criteria by which they will evaluate the possibility of giving birth to a baby independently or surgically.

Age. Although it is customary in our time to give birth to children at any age (there are practically no medical contraindications), doctors say that all children should be born before the age of 35. And if you are 35 or older, you are pregnant for the first time, and the baby is sitting in your stomach on your butt, then most likely you will be “cased”. There may be several reasons for this: the presence of chronic diseases, for example, is almost always an indication for a cesarean section; the course of late pregnancy can be complicated by edema, high blood pressure and other complications. The risk of natural delivery with a breech fetus increases several times. It is unlikely that you and your doctor will want to take risks in this case.
The course of pregnancy. If this pregnancy proceeded with many complications, then it is likely that a cesarean section would be prescribed, regardless of the presentation of the fetus. Severe gestosis, placental insufficiency, hyperextension of the head, and if breech presentation is added to all this, then surgery is definitely needed. They also do a cesarean section if the first baby is in an “incorrect” presentation. When choosing the delivery of an existing pregnancy, previous pregnancies are also taken into account. The final decision is influenced by the presence of abortions and the outcome of previous births. For a successful natural delivery, the most favorable picture is when the birth is the second, and the previous ones had a positive outcome vaginally.
State of health of the reproductive organs. For a favorable natural delivery, the condition of the cervix is important. During an obstetric examination, her maturity is assessed. The cervix, ready for childbirth, is soft, located in the center of the small pelvis, shortened to 2 centimeters. If there is a scar on the uterus from a previous cesarean section, then in case of breech presentation, repeated surgical intervention is necessary, because with natural childbirth the risk of uterine rupture at the seam will increase. Indications for caesarean section are also developmental anomalies and tumors of the uterus.
Pelvic dimensions. An anatomically narrow pelvis, even with a “normal” fetal position, is an indicator for a cesarean section. In case of breech presentation, on the eve of the upcoming birth, the size of the mother's bony pelvis is assessed using X-ray pelviometry. This research method makes it possible to accurately determine the size and shape of the small pelvis.
Fetus. If your little one sits on his butt and weighs more than 3.5 kg, then you won’t be able to give birth to him on your own. A large fetus with a breech presentation is a direct indication for surgery. The most favorable for natural birth is the body weight of the fetus from two to three and a half kilograms. Also, when choosing a method of delivery, the condition of the fetus is also taken into account. Signs of chronic hypoxia and lack of oxygen can aggravate protracted labor naturally.
Breech presentation of the fetus. There are several types of this fetal position. Pure gluteal (the baby’s legs are extended upward and pressed to the body, and the buttocks are adjacent to the entrance to the small pelvis), mixed gluteal (the buttocks and feet of the fetus are present) and leg. Leg presentation is considered the most unfavorable during natural childbirth. In this case, the following are possible: loss of the baby’s arms or legs, umbilical cord loops, suffocation (asphyxia).
Head position. Surgical delivery is indicated in case of excessive extension of the head, since during vaginal birth, during the passage of the head, serious complications can arise: brain injuries, cervical spine and other birth injuries.

Caesarean section is also prescribed if there is no effect of labor induction. Well, the persistent desire of a pregnant woman to give birth “under anesthesia” plays almost the main role when choosing a method of delivery of a “sessile” fetus.

Course of labor during breech presentation

If, according to all indications, you can successfully give birth to your baby on your own, then your main task is to prepare yourself psychologically for a difficult birth, gain strength, patience and stock up on knowledge about the course of childbirth with a breech presentation.

As with any natural birth, you will experience contractions, pushing, and the delivery of the placenta. However, with breech presentation at each stage there are some nuances that both the woman in labor and, of course, the medical staff should take into account.

Cervical dilatation

At this stage of labor, the woman in labor is supposed to lie on the side where the back of the fetus is facing. Otherwise, there is a high probability of complications: labor anomalies, premature rupture of amniotic fluid, prolapse of fetal limbs and umbilical cord loops, fetal asphyxia, protracted labor. During labor, doctors evaluate the baby's heart activity and uterine contractions. You may be given painkillers and antispasmodics. However, many doctors oppose such methods and adhere to the natural course of childbirth (“no hands”). During this period, it is also possible to prevent the development of hypoxia in the fetus.

Expulsion of the fetus

With a breech presentation, the baby is born in this “order”: birth to the navel, birth from the navel to the lower edge of the angle of the shoulder blades, birth of the shoulder girdle and arms, birth of the head. At each stage, specialists monitor the condition of the fetus and the woman in labor. It is important to follow your doctor's instructions to avoid possible consequences. Usually, when cutting through the buttocks, the doctor performs a dissection of the perineum. This is done in order to reduce the inevitable ruptures at birth of the head and thereby reduce the likelihood birth injuries. The incision is most often made from the center of the perineum to the side.

Obstetric care may be needed after the birth of the fetus up to the level of the navel, because during this period the head presses the umbilical cord. Labor should end within 10 minutes, and if this does not happen, the fetus may die from suffocation. The consequences of oxygen starvation are very unpleasant.

With weak attempts, the woman in labor is given an intravenous drip, which stimulates uterine contractions. To prevent cervical spasms, antispasmodics (papaverine, no-shpu) are also administered.

Postpartum period

The birth of the placenta during a breech birth is no different from a birth with a “normal” fetal position. During this period Special attention pay attention to the pulse, blood pressure, the state of the mother’s bladder, monitor the amount bleeding from the uterus. The likelihood of early postpartum bleeding is quite high, so for prevention, drugs are administered that contract the walls of the uterus.

Recently, more and more doctors insist on childbirth without any intervention. Even with this type of birth, they refuse to “push out” the baby by using stimulant drugs. Birth should occur by forward movement, and not by pulling, they say.

Usually, “buttock” children are no different from their peers. After birth, such babies require consultation with a neurologist. Nervous system disorders and hip dysplasia are possible. With timely diagnosis and treatment, these problems can be eliminated.

No matter how your baby sits in the belly, don’t worry about childbirth. After all, your confidence and positivity are the basis for a successful birth. Good luck!

Especially for- Tanya Kivezhdiy

On later During pregnancy, expectant mothers often think about the upcoming birth. But for some of them, doctors recommend a cesarean section for various reasons. For example, it is often used if problems are expected to occur during natural childbirth. For example, a woman has an insufficiently wide pelvis, while

Another reason to prescribe an operation may be a previous surgical intervention if the suture fails, that is, the threat of placenta previa may also become a reason for doctors to insist on the need for delivery through cesarean section.

Options are possible, but recently surgical intervention has become more common, especially if the child is male.

The problem is that when passing through the birth canal there is a high risk of damage to the testicles, which can subsequently negatively affect testosterone levels. Other injuries, including fatal ones, are also possible. But you shouldn’t be scared right away - these cases are extremely rare.

How does it happen that the fetus is not positioned correctly in the uterus? Of course, during pregnancy the baby changes its position several times, but as it grows, it tends to move because the center of gravity is shifted. Sometimes this doesn't happen. As a rule, this is due to serious anomalies in the development of the uterus, oligohydramnios or polyhydramnios, hypertonicity, pathologies of fetal development, etc.

There are several different positions, and not every one is a reason to perform a caesarean section. With a leg-type breech presentation, when the fetus rests its feet on the cervix, this is not even discussed. Until about 32 weeks the chance of change is not that small as the baby still has plenty of room to roll over, but later this is unlikely to happen.

Until this critical time future mom can do special exercises, which, according to gynecologists, help the baby take the right position.

There are 2 more types of positions - gluteal and mixed. in case of breech presentation, these types are not always indicated, but if doctors suggest surgery, it is better to agree. And there are two reasons for this: firstly, quite often in such cases the umbilical cord can be pinched between the child’s head and the birth canal, which can cause hypoxia. In addition, if the baby's head is thrown back, he may suffer a spinal injury during childbirth.

That is why a caesarean section for breech presentation is the best option.

There is no need to be afraid of this - the operation takes place quite quickly, and, as a rule, the woman in labor is conscious. General anesthesia for caesarean section is used quite rarely; epidural or a combination of both is often used.

Of course, some women are quite unpleasant to realize the fact that childbirth will not take place. naturally, and with the help of doctors, but it is better to think about your health and the condition of the baby. Planned surgery is always better than emergency surgery. Doctors have the opportunity to discuss everything several more times and make an informed decision about whether a caesarean section is necessary. How long is it scheduled to take place? Usually this is the 37-38th week, since it is better not to let the contractions begin so that the operation does not become an emergency.

Now medicine has reached such a level that almost any woman can become a mother. And even if during pregnancy there are serious problems, in most cases, doctors will be able to help give birth to a healthy baby.