Obstetrics and gynecology. Childbirth with a breech presentation of the fetus (the most important)

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Obstetrics and gynecology. Childbirth with a breech presentation of the fetus (the most important)

Lecture notes, cheat sheets

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17. Childbirth with breech presentation of the fetus

Distinguish:

1) pure breech presentation, when the buttocks are facing the entrance to the pelvis, and the legs are bent at the hip joints, unbent at the knee joints and extended along the body;

2) mixed breech presentation, when both (or one) legs are presented, bent at the hip and knee joints, crossed with each other and unbent at the ankle joints;

3) foot presentation, if the legs of the fetus are facing the entrance to the pelvis, and a full foot presentation is distinguished if both legs are presented, and incomplete if one leg is presented.

Recognition of breech presentations is based on the ability to palpate the head from the buttocks. The buttocks are less dense, less rounded, have less volume and do not ballot. The diagnosis of breech presentation is easier to make if a dense, rounded, movable head can be found in the bottom of the uterus. After the outflow of water and in the presence of labor, the fetus begins to move along the birth canal of the mother. In the biomechanism of childbirth with breech presentation, six points are distinguished.

First moment. In this case, the buttocks make an internal rotation when moving from the wide part of the pelvic cavity to the narrow one. At the outlet of the pelvis, the diameter of the buttocks is set in a straight size, and the anterior buttock fits under the pubic arch. In accordance with the longitudinal axis of the pelvis, some lateral flexion of the fetal torso is observed.

Second moment consists in lateral flexion of the lumbar region of the fetus. Under the influence of contractions, the fetus makes a forward movement. In this case, lateral flexion of the fetal spine occurs. From the genital gap, the posterior buttock is shown first, and then the anterior one. At this moment, the shoulders of the fetus enter the entrance to the pelvis in the same oblique size as the diameter of the buttocks.

Third point. The internal rotation of the shoulders and the associated external rotation of the body ends at the exit from the pelvis and is characterized by the fact that the shoulders are installed in a straight size. The front shoulder fits under the pubic arch, and the back one is located at the tailbone.

Fourth moment - this is the lateral flexion of the cervicothoracic spine of the fetus. It ends with the birth of the shoulder girdle and handles.

Fifth moment - internal rotation of the head. The head enters one of the oblique dimensions of the entrance to the pelvis with its small oblique size (9,5 cm), depending on the position of the fetus and its type, but this oblique size is always opposite to that into which the shoulders of the fetus enter.

Sixth point. Bending of the head involves the gradual eruption of the head from the birth canal (the mouth is born first, then the nose, forehead and crown of the fetus).

Conducting childbirth in breech presentation

Childbirth with a breech presentation stands on the verge between physiological and pathological. All pregnant women with breech presentation are hospitalized 2 weeks before the expected date of delivery. In the first period, a woman is observed. During the period of exile from the moment of eruption of the buttocks, there is a danger of fetal hypoxia. After eruption of the buttocks, an obstetric (manual) allowance is provided according to Tsovyanov or in the classical way.

Author: Ivanov A.I.

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