Obstetrics and gynecology. Transverse and oblique position of the fetus (the most important)

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Obstetrics and gynecology. Transverse and oblique position of the fetus (the most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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19. Transverse and oblique position of the fetus

Causes of the transverse and oblique position fruits are varied.

1. Excessive fetal mobility - with polyhydramnios, sagging muscles of the anterior abdominal wall in multiparous.

2. Limited fetal mobility - with oligohydramnios, multiple pregnancy, large fetus, anomalies in the structure of the uterus, the presence of uterine fibroids, increased uterine tone, with the threat of termination of pregnancy.

3. The presence of obstacles to the insertion of the head - placenta previa, the presence of uterine fibroids in the lower segment, with a narrow pelvis.

4. Congenital malformations of the fetus: hydrocephalus, anencephaly.

Diagnostics. The diagnosis is made on the basis of a visual examination: the transverse oval or oblique shape of the abdomen and the low position of the uterine fundus are determined.

Large parts (head, pelvic end) are determined by palpation in the lateral sections of the uterus. With the help of auscultatory examination, the fetal heartbeat is heard in the umbilical region.

With vaginal examination, the presenting part of the fetus cannot be determined, while great importance is given to the ultrasound method. From the armpit, you can determine where the fetal head is located.

Course of pregnancy and childbirth. During pregnancy, if the fetus is not positioned correctly, the most common complications may be premature rupture of amniotic fluid due to the lack of an internal seal, as well as premature birth. With placenta previa, bleeding is possible.

A long anhydrous interval lasting 12 hours or more contributes to the infection of the ovum, uterus and the spread of infection to the peritoneal area. Intensive discharge of amniotic fluid in the first stage of labor limits the mobility of the fetus, may be accompanied by prolapse of the umbilical cord or the handle of the fetus, and it is also possible to drive one of the shoulders into the small pelvis. This state is called neglected transverse position of the fetus. If labor activity continues and the fetus does not move along the birth canal, the lower segment first overgrows, and then the uterus ruptures.

Management of pregnancy and childbirth. During pregnancy up to 34-35 weeks, the position of the fetus (transverse or oblique) is called unstable, because during this period the fetus is very mobile. The position of the fetus may change and become longitudinal. In this case, the pregnant woman must be thoroughly examined to determine the possible causes of abnormal fetal positions. They can cause complications in the further course of pregnancy and delivery. With a transverse position of the fetus, pregnant women are asked to lie on their side in the same position as much as possible, and with an oblique position - on the side of the underlying large part of the fetus. After 35 weeks of pregnancy, the fetus takes a more stable position. If the position remains incorrect, the pregnant woman is hospitalized to find out its cause and determine tactics for managing pregnancy and delivery.

The caesarean section is the optimal method of delivery in the transverse or oblique position of the fetus.

Author: Ivanov A.I.

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