Obstetrics and gynecology. Childbirth with an extension presentation of the fetal head (the most important)

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Obstetrics and gynecology. Childbirth with an extension presentation of the fetal head (the most important)

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18. Childbirth with extensor presentation of the fetal head

There are the following extensor presentations of the fetal head: anterior head, frontal and facial (the parietal region, forehead or face of the fetus, respectively, are facing the entrance to the small pelvis). The main causes of extensor presentations include reduced uterine tone, its uncoordinated contractions, underdeveloped abdominals, narrow pelvis, decreased muscle tone of the pelvic floor, too small or, conversely, large fetal sizes, and lateral displacement of the uterus.

Anterior presentation of the fetus (first degree of extension). In this case, the large fontanel is a wire point, the head with a straight size passes the plane of the small pelvis.

frontal presentation characterized by the fact that the wire point is the forehead. The head passes through all the planes of the pelvis with a large oblique size, it is 13-13,5 cm.

Facial presentation of the fetus is the third degree of extension. With this type of presentation, the wire point is the chin. The head passes the birth canal with a vertical size, which is 9,5-10 cm).

extensor presentation include five main stages of the birth mechanism.

The first moment is the extension of the head.

The second point is the internal rotation of the head with the formation of a rear view.

The third moment is the flexion of the fetal head after the formation of a fixation point at the lower edge of the pubic symphysis.

The fourth moment in frontal and frontal presentation is the extension of the head after fixing the back of the head at the top of the coccyx.

The fourth moment (with facial presentation) and the fifth moment (with frontal and frontal presentations) include the internal rotation of the shoulders and the external rotation of the head.

With extensor cephalic presentations, other anomalies of insertion of the head are also possible: high straight standing of the head, low (deep) transverse standing of the head, asynclitism.

The diagnosis of anterocephalic presentation of the fetus is carried out using data from a vaginal examination. Childbirth occurs through the natural birth canal, their management is expectant.

With frontal presentation, the fetal heartbeat is better heard from the side of the breast. During an external obstetric examination, on one side of the presenting part of the fetus, a sharp protrusion (chin) is probed, on the other, the angle between the back and the back of the head. The diagnosis is determined by vaginal examination. At the same time, the frontal suture, the anterior edge of the large fontanel, the superciliary arches with eye sockets, and the nose of the fetus are determined. Childbirth in a natural way is possible only with a small size of the fetus.

With facial presentation, the chin, superciliary arches, and the upper part of the orbit are palpated. With breech presentation, the coccyx, sacrum, ischial tubercles are determined.

Author: Ivanov A.I.

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