Breech presentation in ultrasound
Causes, Complications, Turning & Delivery
Overview
Types of breech positions during pregnancy.What is a breech baby?
A breech baby, or breech birth, is when your baby’s feet or buttocks are positioned to come out of your vagina first. Your baby’s head is up closest to your chest and its bottom is closest to your vagina. Most babies will naturally move so their head is positioned to come out of the vagina first during birth. Breech is common in early pregnancy and most babies will move to a head-first position by 36 weeks of pregnancy. This head-first position is called vertex presentation and is the safest position for birth.
How common is a breech baby?
There is a small chance that your baby will not move into a head-first position before 37 weeks of pregnancy. Breech babies account for about 3% to 4% of all full-term pregnancies.
What are the types of breech position a baby can be in?
There are several fetal positions your baby may present in. Ideally, your baby is positioned head-down, facing your back, with their chin tucked to their chest.
Breech babies can be in a few different positions:
- Frank breech: The baby’s buttocks are aimed at the vaginal canal with its legs sticking straight up in front of their body and the feet near their head.
- Complete breech: The baby’s buttocks are pointing downward and both the hips and the knees are flexed (folded under themselves).
- Footling breech: One or both of the baby’s feet point downward and will deliver before the rest of their body.
- Transverse lie: This is a form of breech presentation where your baby is positioned horizontally across your uterus instead of vertically. This would make their shoulder enter the vagina first.
How does a breech baby affect pregnancy?
Your pregnancy is usually not affected. Most breech babies are born healthy, although there is a slightly elevated risk for certain birth defects.
Your baby’s movements may feel a little different. You will feel your baby’s kicks lower in your belly. You may feel a hard lump closer to your ribs. This is your baby’s head.
If you planned a vaginal delivery, a breech baby could change these plans. When your baby is breech, a vaginal delivery can be complicated and dangerous. Your healthcare provider may feel comfortable attempting a vaginal breech delivery, but in most cases, they will recommend a Cesarean birth (C-section).
How does a breech baby affect delivery?
If your baby presents in a breech position after 36 weeks of pregnancy, your birthing plan will likely change. It's usually unsafe for a breech baby to be born vaginally due to risks of injury. In most cases, a planned C-section is the safest way to deliver your baby. Some healthcare providers may be comfortable with a vaginal breech birth. In some cases, turning your baby to a head-down position while they are still inside your uterus is an option. Your baby is then born head first.
Symptoms and Causes
How can you tell if your baby is breech?
You may be able to tell if your baby is breech, especially if you have had past pregnancies where your baby was head-first. The places where you feel lumps and kicks might indicate that your baby is breech. Let your healthcare provider know where you feel movement. They will feel your belly or do an ultrasound to confirm that your baby is breech.
What causes a baby to be breech?
It’s not always known why a baby is breech. Some factors that may contribute to this position are:
- You are expecting multiples (twins or more). This makes it harder for each baby to get into the right position.
- There is too much or too little amniotic fluid.
- The uterus is not normal in shape or has abnormal growths such as fibroids. Most of the time, the uterus is shaped like an upside-down pear. If it's shaped differently, there might not be enough room for a full-grown baby to move into position.
- The placenta covers all or part of the cervix (a condition called placenta previa).
- The baby is preterm. This means they are less than 37 weeks gestation and may not have turned to a head-first position.
- Your baby has a birth defect that causes them to not turn head-down.
Diagnosis and Tests
How is a breech baby diagnosed?
Your healthcare provider may be able to tell which way your baby is facing by placing their hands at certain places on your abdomen. By feeling where the baby’s head, back and buttocks are, it’s usually possible to find out what part of the baby is positioned to come out of the vagina first. An ultrasound may be used to confirm the baby’s position.
When is a breech baby diagnosed?
Almost all babies are breech at some point. As your pregnancy progresses, your baby will naturally move to a head-down position — probably between 32 and 36 weeks. Your healthcare provider will feel your belly and determine where your baby is positioned.
This will happen during most of your appointments in the third trimester. After 37 weeks, a breech baby usually does not turn on their own. Your healthcare provider will discuss delivery options with you.
Management and Treatment
What are the options for treating a breech baby?
If your baby is breech at 37 weeks of pregnancy, your healthcare provider may:
- Try turning your baby in your uterus into the head-first position.
- Plan a C-section birth.
- Plan a vaginal breech birth.
What are some complications of having a breech baby?
The complications of having a breech baby usually do not occur until it's time to deliver. Some breech babies can be safely delivered through the vagina.
The risks of attempting a vaginal breech birth are:
- Injuries to your baby’s legs or arms such as dislocated or broken bones.
- Umbilical cord problems. The umbilical cord can be flattened or twisted during delivery. This can cause nerve or brain damage due to a lack of oxygen.
Will my doctor try to flip my baby if it's breech?
If your baby is breech, your healthcare provider may consider turning your baby so that you can have a vaginal delivery. In some cases, trying to turn your baby may not be safe or the risks outweigh the benefits.
Flipping your baby may not be safe if you have any of the following:
- Bleeding from your vagina.
- Placenta previa. This is when your placenta covers all or part of your cervix.
- A nonreactive nonstress test.
- An abnormally small baby.
- Low level of amniotic fluid.
- Low or high fetal heart rate.
- Premature rupture of the membranes.
- Twins or multiples.
The most common method used to turn a breech baby is called external cephalic version (ECV). It's performed by your healthcare provider around 37 weeks of pregnancy. This procedure is performed in the hospital just in case an emergency occurs. It involves placing hands on your abdomen and applying firm pressure to turn your baby to a head-down position while your baby is still in your uterus.
It is about 65% effective and carries some risks.
What are the risks of turning my breech baby?
The risks of ECV include the following:
- Premature labor.
- Premature rupture of the amniotic sac.
- Blood loss for either you or your baby.
- Emergency C-section.
- Your baby might turn back to the breech position.
Although the risk of having these complications is small, some healthcare providers prefer not to try to flip a breech baby.
Will my breech baby flip on their own?
Most babies will flip to a head-down position before they reach full term (37 weeks). If your baby is still in a breech position at this time, your healthcare provider will determine if you can deliver vaginally or if you will need a C-section.
How can I flip my baby if it's breech?
Some women will try at-home methods to flip their baby to a head-first position. They may help, but there is no scientific evidence that they work.
- Bridge position: Lie on the floor with your legs bent and your feet flat on the ground. Raise your hips and pelvis into a bridge position. Hold this position for 10 or 15 minutes several times a day.
- Child’s pose: Rest in the child’s pose for 10 to 15 minutes. It can help relax your pelvic muscles and uterus. You can also rock back and forth on your hands and knees or make circles with your pelvis to promote activity.
- Music: Place headphones or a speaker at the bottom of your uterus to encourage your baby to turn.
- Temperature: Try placing something cold at the top of your stomach where your baby’s head is. Then, place something warm at the bottom of your stomach.
A chiropractic technique, called the Webster technique, can also help your uterus relax. Some providers even recommend acupuncture. Both of these techniques need to be done by a professional that your healthcare provider has recommended.
Prevention
How can I reduce my risk of having a breech baby?
There is nothing you can do to prevent your baby from being in a breech position. If your baby is in a breech position, it’s not because you did anything wrong.
Outlook / Prognosis
Can you deliver vaginally with a baby breech?
It's possible to deliver a breech baby vaginally. It can be more dangerous for the baby and the risk of injury is much higher. If the umbilical cord is compressed during birth, the baby could be deprived of oxygen and this could harm their brain and nerves. The cord could also slip around the baby’s neck or arms, causing injury. Healthcare providers have various levels of comfort with vaginal deliveries of breech babies. Talk to your provider about the risks and benefits of different types of birth for a breech baby.
Living With
When should I see my healthcare provider?
Contact your healthcare provider if you experience any of the following symptoms during pregnancy:
- Severe cramping or contractions.
- Vaginal bleeding.
What questions should I ask my doctor?
Learning your baby is breech may give you concerns about your delivery. It’s completely natural to have questions. Some questions to ask your doctor can include:
- How can I tell if my baby is breech?
- Is my baby OK?
- What are the benefits and risks of turning my baby?
- What are my options for delivery if my baby remains in the breech position?
- What are the health risks to my baby and me if they are born breech?
Frequently Asked Questions
Do birth defects cause breech position?
Birth defects are slightly more common in breech babies. It might be the reason that the baby didn’t move to the head-down position. Most babies who are breech at delivery are born without any health complications.
Will I need a C-section if my baby is breech?
Most of the time, a C-section is the safest way to deliver a breech baby. Your risks of developing complications are much higher if you try to deliver a breech baby through the vagina.
However, some healthcare providers may feel comfortable performing a vaginal breech birth.
How does labor start if your baby is breech?
Having a breech baby doesn’t change some of the first signs of labor like contractions or rupturing of your membranes. In most cases, your healthcare provider will recommend a planned C-section. If your delivery is planned, you may not have any labor symptoms.
If you are in labor and go to the hospital for delivery, your provider will confirm your baby’s position a final time. Your provider could attempt a vaginal delivery, but it's more likely they will proceed with a C-section to be safe.
A note from Cleveland Clinic
Having a breech baby can be unexpected and change the vision you had for childbirth. Talk to your healthcare provider about what to expect during a breech delivery. They can help you understand the risks and benefits of a breech birth so that you and your baby are kept safe.
Causes, Complications, Turning & Delivery
Overview
Types of breech positions during pregnancy.
What is a breech baby?
A breech baby, or breech birth, is when your baby’s feet or buttocks are positioned to come out of your vagina first. Your baby’s head is up closest to your chest and its bottom is closest to your vagina. Most babies will naturally move so their head is positioned to come out of the vagina first during birth. Breech is common in early pregnancy and most babies will move to a head-first position by 36 weeks of pregnancy. This head-first position is called vertex presentation and is the safest position for birth.
How common is a breech baby?
There is a small chance that your baby will not move into a head-first position before 37 weeks of pregnancy. Breech babies account for about 3% to 4% of all full-term pregnancies.
What are the types of breech position a baby can be in?
There are several fetal positions your baby may present in. Ideally, your baby is positioned head-down, facing your back, with their chin tucked to their chest.
Breech babies can be in a few different positions:
- Frank breech: The baby’s buttocks are aimed at the vaginal canal with its legs sticking straight up in front of their body and the feet near their head.
- Complete breech: The baby’s buttocks are pointing downward and both the hips and the knees are flexed (folded under themselves).
- Footling breech: One or both of the baby’s feet point downward and will deliver before the rest of their body.
- Transverse lie: This is a form of breech presentation where your baby is positioned horizontally across your uterus instead of vertically. This would make their shoulder enter the vagina first.
How does a breech baby affect pregnancy?
Your pregnancy is usually not affected. Most breech babies are born healthy, although there is a slightly elevated risk for certain birth defects. Your baby’s movements may feel a little different.
You will feel your baby’s kicks lower in your belly. You may feel a hard lump closer to your ribs. This is your baby’s head.
If you planned a vaginal delivery, a breech baby could change these plans. When your baby is breech, a vaginal delivery can be complicated and dangerous. Your healthcare provider may feel comfortable attempting a vaginal breech delivery, but in most cases, they will recommend a Cesarean birth (C-section).
How does a breech baby affect delivery?
If your baby presents in a breech position after 36 weeks of pregnancy, your birthing plan will likely change. It's usually unsafe for a breech baby to be born vaginally due to risks of injury. In most cases, a planned C-section is the safest way to deliver your baby. Some healthcare providers may be comfortable with a vaginal breech birth. In some cases, turning your baby to a head-down position while they are still inside your uterus is an option. Your baby is then born head first.
Symptoms and Causes
How can you tell if your baby is breech?
You may be able to tell if your baby is breech, especially if you have had past pregnancies where your baby was head-first.
The places where you feel lumps and kicks might indicate that your baby is breech. Let your healthcare provider know where you feel movement. They will feel your belly or do an ultrasound to confirm that your baby is breech.
What causes a baby to be breech?
It’s not always known why a baby is breech. Some factors that may contribute to this position are:
- You are expecting multiples (twins or more). This makes it harder for each baby to get into the right position.
- There is too much or too little amniotic fluid.
- The uterus is not normal in shape or has abnormal growths such as fibroids. Most of the time, the uterus is shaped like an upside-down pear. If it's shaped differently, there might not be enough room for a full-grown baby to move into position.
- The placenta covers all or part of the cervix (a condition called placenta previa).
- The baby is preterm. This means they are less than 37 weeks gestation and may not have turned to a head-first position.
- Your baby has a birth defect that causes them to not turn head-down.
Diagnosis and Tests
How is a breech baby diagnosed?
Your healthcare provider may be able to tell which way your baby is facing by placing their hands at certain places on your abdomen. By feeling where the baby’s head, back and buttocks are, it’s usually possible to find out what part of the baby is positioned to come out of the vagina first. An ultrasound may be used to confirm the baby’s position.
When is a breech baby diagnosed?
Almost all babies are breech at some point. As your pregnancy progresses, your baby will naturally move to a head-down position — probably between 32 and 36 weeks. Your healthcare provider will feel your belly and determine where your baby is positioned. This will happen during most of your appointments in the third trimester. After 37 weeks, a breech baby usually does not turn on their own. Your healthcare provider will discuss delivery options with you.
Management and Treatment
What are the options for treating a breech baby?
If your baby is breech at 37 weeks of pregnancy, your healthcare provider may:
- Try turning your baby in your uterus into the head-first position.
- Plan a C-section birth.
- Plan a vaginal breech birth.
What are some complications of having a breech baby?
The complications of having a breech baby usually do not occur until it's time to deliver. Some breech babies can be safely delivered through the vagina.
The risks of attempting a vaginal breech birth are:
- Injuries to your baby’s legs or arms such as dislocated or broken bones.
- Umbilical cord problems. The umbilical cord can be flattened or twisted during delivery. This can cause nerve or brain damage due to a lack of oxygen.
Will my doctor try to flip my baby if it's breech?
If your baby is breech, your healthcare provider may consider turning your baby so that you can have a vaginal delivery.
In some cases, trying to turn your baby may not be safe or the risks outweigh the benefits.
Flipping your baby may not be safe if you have any of the following:
- Bleeding from your vagina.
- Placenta previa. This is when your placenta covers all or part of your cervix.
- A nonreactive nonstress test.
- An abnormally small baby.
- Low level of amniotic fluid.
- Low or high fetal heart rate.
- Premature rupture of the membranes.
- Twins or multiples.
The most common method used to turn a breech baby is called external cephalic version (ECV). It's performed by your healthcare provider around 37 weeks of pregnancy. This procedure is performed in the hospital just in case an emergency occurs. It involves placing hands on your abdomen and applying firm pressure to turn your baby to a head-down position while your baby is still in your uterus. It is about 65% effective and carries some risks.
What are the risks of turning my breech baby?
The risks of ECV include the following:
- Premature labor.
- Premature rupture of the amniotic sac.
- Blood loss for either you or your baby.
- Emergency C-section.
- Your baby might turn back to the breech position.
Although the risk of having these complications is small, some healthcare providers prefer not to try to flip a breech baby.
Will my breech baby flip on their own?
Most babies will flip to a head-down position before they reach full term (37 weeks). If your baby is still in a breech position at this time, your healthcare provider will determine if you can deliver vaginally or if you will need a C-section.
How can I flip my baby if it's breech?
Some women will try at-home methods to flip their baby to a head-first position. They may help, but there is no scientific evidence that they work.
- Bridge position: Lie on the floor with your legs bent and your feet flat on the ground. Raise your hips and pelvis into a bridge position. Hold this position for 10 or 15 minutes several times a day.
- Child’s pose: Rest in the child’s pose for 10 to 15 minutes. It can help relax your pelvic muscles and uterus. You can also rock back and forth on your hands and knees or make circles with your pelvis to promote activity.
- Music: Place headphones or a speaker at the bottom of your uterus to encourage your baby to turn.
- Temperature: Try placing something cold at the top of your stomach where your baby’s head is. Then, place something warm at the bottom of your stomach.
A chiropractic technique, called the Webster technique, can also help your uterus relax. Some providers even recommend acupuncture. Both of these techniques need to be done by a professional that your healthcare provider has recommended.
Prevention
How can I reduce my risk of having a breech baby?
There is nothing you can do to prevent your baby from being in a breech position. If your baby is in a breech position, it’s not because you did anything wrong.
Outlook / Prognosis
Can you deliver vaginally with a baby breech?
It's possible to deliver a breech baby vaginally. It can be more dangerous for the baby and the risk of injury is much higher. If the umbilical cord is compressed during birth, the baby could be deprived of oxygen and this could harm their brain and nerves. The cord could also slip around the baby’s neck or arms, causing injury. Healthcare providers have various levels of comfort with vaginal deliveries of breech babies. Talk to your provider about the risks and benefits of different types of birth for a breech baby.
Living With
When should I see my healthcare provider?
Contact your healthcare provider if you experience any of the following symptoms during pregnancy:
- Severe cramping or contractions.
- Vaginal bleeding.
What questions should I ask my doctor?
Learning your baby is breech may give you concerns about your delivery. It’s completely natural to have questions.
Some questions to ask your doctor can include:
- How can I tell if my baby is breech?
- Is my baby OK?
- What are the benefits and risks of turning my baby?
- What are my options for delivery if my baby remains in the breech position?
- What are the health risks to my baby and me if they are born breech?
Frequently Asked Questions
Do birth defects cause breech position?
Birth defects are slightly more common in breech babies. It might be the reason that the baby didn’t move to the head-down position. Most babies who are breech at delivery are born without any health complications.
Will I need a C-section if my baby is breech?
Most of the time, a C-section is the safest way to deliver a breech baby. Your risks of developing complications are much higher if you try to deliver a breech baby through the vagina. However, some healthcare providers may feel comfortable performing a vaginal breech birth.
How does labor start if your baby is breech?
Having a breech baby doesn’t change some of the first signs of labor like contractions or rupturing of your membranes.
In most cases, your healthcare provider will recommend a planned C-section. If your delivery is planned, you may not have any labor symptoms.
If you are in labor and go to the hospital for delivery, your provider will confirm your baby’s position a final time. Your provider could attempt a vaginal delivery, but it's more likely they will proceed with a C-section to be safe.
A note from Cleveland Clinic
Having a breech baby can be unexpected and change the vision you had for childbirth. Talk to your healthcare provider about what to expect during a breech delivery. They can help you understand the risks and benefits of a breech birth so that you and your baby are kept safe.
Breech presentation of the fetus: signs, diagnosis
Consultation with a specialist:
Breech presentation of the fetus is one of the options for the location of the child in the womb. In this case, the fetus, as it were, "sits" in the uterus, and its head is directed upwards.
Normally, breech presentation is observed up to 32 weeks, after this period such an arrangement of the fetus is considered pathological.
Only a gynecologist can determine the breech presentation during an examination or according to the results of an ultrasound scan. If the baby is positioned incorrectly, the doctor may prescribe special exercises or manipulations to correctly position the fetus. nine0003
To determine whether the baby has taken the correct position for childbirth, it is necessary to undergo an examination by a gynecologist and ultrasound at 32-34 weeks.
Types of breech presentation of the fetus
Breech presentation of the fetus is divided into types:
- gluteal;
- foot.
In breech presentation of the fetus during childbirth, the baby's buttocks are the first to appear. At the same time, its legs are located along the body and straightened at the knees. In such a situation, we can say that the woman is lucky, since in this case she practically does not need additional help, and the risk of complications is reduced to a minimum.
With a mixed breech presentation, the legs and pelvis may appear at the same time. nine0003
Foot presentation is considered more unfavorable. According to statistics, up to 15% of children with breech presentation are born this way. In the foot position, the first of the birth canals are the legs, not the pelvis. Usually in the case of a foot presentation, a caesarean section is performed.
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Causes of breech presentation
The reasons that caused the pelvic presentation of the fetus can be quite a lot, but the most common are: nine0003
- polyhydramnios - usually in this case, the baby is highly mobile and simply does not have time to take the desired position by the time of birth;
- oligoamnios - in this case, the child's ability to change his position is limited, as a result of which the baby simply cannot take a physiological position;
- twin pregnancy - in this case, it is very difficult for babies to move due to lack of space, it is worth noting that the "traditional" head presentation of the fetus in multiple pregnancy is rare regardless of the week of pregnancy; nine0016
- cord entanglement - sometimes a very active baby can wrap the umbilical cord around himself so much that it becomes completely impossible for him to take the correct position for childbirth;
- pathology of the uterus - some diseases of the uterus (for example, fibroids) can directly affect the position of the fetus.
In some cases, in the presence of the problems described above, the breech presentation of the fetus can threaten the following dangers: nine0003
- premature birth;
- hypoxia - if the child in the gluteal position pinched the umbilical cord;
- difficult delivery with the risk of injury to both mother and child..
Breech diagnosis
It is almost impossible to independently suspect a breech presentation of the fetus without understanding obstetrics and gynecology. In addition, such a situation before a certain period should not bother the expectant mother at all. Usually, the first symptoms of breech presentation in the uterus are determined by the obstetrician at the examination at 32-34 weeks. In this case, the doctor pays attention to the area where the child's heartbeat is heard and palpates the abdomen. In the event that the symptoms indicate a breech presentation of the fetus, the specialist will prescribe an additional examination that will either confirm or refute his conclusion.
nine0003
There are several ways that experienced obstetricians resort to in order to determine the presence of a breech presentation in a fetus.
- First, it is a visual inspection and palpation of the abdomen. Usually, it is not difficult for a specialist to determine the position where the child's head is and where his feet are. In addition, the obstetrician may resort to listening to the heart. If his sounds are heard above the navel, then the child is in a breech presentation. This is the simplest and most affordable method of research and diagnosis. nine0016
- Secondly, the obstetrician can determine the presentation of the fetus and the location of the head at the time of the onset of labor. Usually, this method is resorted to if a woman goes into labor urgently and she has no data on previous examinations, and on the position of the fetus - pelvic or head. In this case, the specialist probes the position of the child through the vagina.
- Thirdly, the surest and most reliable way is to conduct ultrasound.
It is best to perform an ultrasound scan in breech presentation at 32-34 weeks, when the baby takes its final position. nine0016
Treatment
In fact, in the absence of pathology, breech presentation of the fetus is not some kind of terrible diagnosis that needs to be feared. In addition, in some cases, correcting such a situation can be quite simple.
Remember that any exercises and manipulations aimed at giving the child the desired position must be fully coordinated with the specialist. Otherwise, you risk causing irreparable harm to the unborn baby. nine0077
- Exercise "Turns". To turn, lie on your back and bend your knees slightly. After that, you need to smoothly turn on your side and lie down in this position for about 2 minutes. Then the manipulation must be repeated, but on the other side. The number of repetitions in such an exercise should not exceed 8-10.
- Butt Lift Exercise. This exercise is contraindicated in women with placenta previa or with a scar on the uterus.
Its essence is to lift the pelvis and put a soft roller under it. In this position, you need to spend 10-15 minutes. nine0016
All exercises in breech presentation must be performed carefully. Otherwise, premature birth can be provoked. During pregnancy, you should carefully listen to the doctor's recommendations and not neglect visits to the gynecologist. Remember that with a breech presentation of the fetus, a woman needs more careful observation.
If the methods described above did not give a positive result, then at about 35-38 the doctor can perform an "obstetric coup". In this case, the specialist, with the help of special manipulations, by pressing on the woman's stomach, gives the fetus the desired position. However, most babies rotated in this way will soon return to the pelvic position again. nine0003
Breech presentation increases the chance of delivery by caesarean section, but many women give birth safely by vaginal delivery. A contraindication for vaginal delivery in this case may be a too large fetus or entanglement with the umbilical cord.
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Breech presentation of the fetus - causes, types, diagnosis
Contents:
breech presentation
Breech classification
Causes of breech presentation
Diagnosis of breech presentation
Exercises for flipping the fetus in breech presentation
External rotation of the fetus in breech presentation
Natural childbirth with breech presentation of the fetus
Cesarean section with breech presentation of the fetus
Breech presentation of the fetus: complications
Breech presentation
Normally, the fetus is located in the uterus head down. This is the correct, head presentation, optimal for the birth process. But sometimes it happens that the baby turns head up, then the presenting part (the one that is born first) is the ass or legs.
This is a breech presentation. This situation occurs in about 5% of pregnancies and is not considered pathological, but it can complicate the course of childbirth. nine0003
Breech classification
Depending on the location of the legs of the fetus, breech presentation is divided into several subspecies. Such a classification justified itself with anatomical information content, in addition, depending on the type of breech presentation, the tactics of managing pregnancy and childbirth will differ.
Distinguish:
- Purely breech presentation - with this arrangement of the baby, the ass is born first, the legs are thrown back to the head; nine0016
- Incomplete breech presentation - the legs are bent at the knees, the ass and feet are born first;
- Full foot presentation - the baby is born legs forward, with such a presentation, the Tsovyanov 2 manual is used so that the baby “squats down” and the fetus is born with the cervix fully dilated;
- Incomplete foot presentation - only one leg is presented;
- Knee presentation is extremely rare.
nine0016
Causes of breech presentation
The causes of breech presentation are manifold. These may be prerequisites on the part of the mother and fetus. Consider the main groups of reasons, each of which includes private explanations.
1) Changes in uterine tone
- The elastic muscles of the abdomen and uterus in primiparas interfere with the flexion of the unbent legs of the fetus;
- Flabbiness of the muscles of the abdominal wall and uterus in multiparous women contributes to the unstable position of the fetus; nine0016
2) Lack of space
- The irregular shape of the uterine cavity causes the fetus to take bizarre postures;
- Multiple pregnancy contributes to cramped position of fetuses;
- Anomalies of localization of the placenta and placenta previa can also cause breech presentation of the fetus;
- Uterine fibroids lead to deformation of the uterine cavity, nodes located closer to the cervix prevent the insertion of the head; nine0016
3) The narrow pelvis also prevents the insertion of the head;
4) Suboptimal amount of amniotic fluid
- Low water restricts fetal movements;
- Polyhydramnios promotes increased motor activity of the fetus.
Normal, physiological polyhydramnios is typical for mid-pregnancy;
5) Insufficient cord length
A short or twisted umbilical cord prevents the baby from turning from breech to cephalic presentation. nine0003
Breech presentation diagnostics
Diagnosis of breech presentation is not difficult. The expectant mother notes the movement of the fetus in the lower abdomen.
The fetal heartbeat is heard above the umbilicus. Breech presentation is also diagnosed with an external obstetric examination, with a vaginal examination, the final diagnosis is made after an ultrasound scan. It should be borne in mind that up to 35 weeks, breech presentation is usually not made into a diagnosis, but is only recorded in the ultrasound protocol, since before the fetus still has a chance to take the correct position. nine0003
Exercises for turning the fetus in breech presentation
A number of experts believe that special exercises can help change the location of the fetus.
Attention!
Each exercise has its own contraindications for performance, in addition, in some cases, the breech presentation of the fetus is safer for the expectant mother, therefore, before performing the exercises, be sure to consult a specialist.
Tips
First of all, the expectant mother should talk to the baby, explain to him why it is so important that he roll over.
Visualization helps a lot. Imagine how your baby rolls over, how he goes from breech to cephalic, how he is and is born in cephalic presentation. To make it easier to imagine what it looks like, look at the corresponding pictures.
Try also to attract the baby's attention by turning on pleasant soft music and placing the headphones in the lower abdomen. Don't put your mobile phone on your stomach. nine0003
In the absence of other recommendations from your gynecologist, you should sleep on the side on which the fetal head is located.
Swimming also helps to turn the baby into head presentation, but only if the mother loves water, the water is at a comfortable temperature, there are no contraindications for swimming.
Exercise used in breech presentation by German obstetricians: Indian bridge
To perform this exercise, lie on your back on a yoga mat. Place your feet shoulder-width apart, arms loosely palms down along the torso. Relax inhale and exhale. Then, as you exhale, lift your pelvis so that it is about 20 centimeters from the floor. Hold this position for as long as you feel comfortable and continue to breathe freely. Then lower your pelvis back and stand with a slight momentum through one side. nine0003
Since the Indian bridge in its original form is very stressful, especially for late pregnancy, it is recommended to elevate the pelvis with a pillow, roller or something similar and, alternatively, put your feet on a chair, sofa or bed. You can hold this position for ten to fifteen minutes. First of all, it is not about raising the pelvis as often as possible, but about keeping the pelvis in a stable position for several minutes.
The main thing is to relax.
If you experience nausea, dizziness, or back pain, stop exercising immediately.
You can start the exercise from the 32nd week of pregnancy and do it regularly several times a week. If you feel that your baby has rolled over, stop exercising and report your suspicion to the doctor.
The Indian bridge is an uncomfortable position for both the pregnant woman and the child, so the relaxation that this exercise is aimed at may often not occur. This is intentional, as the awkward position is intended to encourage the child to turn around. However, a greatly enlarged uterus in this position can compress the veins, which can cause dizziness, nausea, and even fainting. Therefore, it is recommended to do the exercise not alone, but under the supervision of a partner who can provide additional support. nine0003
External rotation of the fetus in breech presentation
If the baby did not roll over by itself and the exercises that help change the position of the fetus also did not work, the clinic can perform an external rotation of the fetus.
This manipulation can be carried out if:
- the fetus is of normal size;
- amniotic fluid is enough;
- placenta not present; nine0015 pregnancy has so far had no complications.
Under the control of ultrasound and CTG, the specialist will gently turn the baby from breech to cephalic. After a successful turn, short-term observation is necessary to rule out complications.
The process is associated with the risk of entanglement of the umbilical cord, and placental abruption can also occur.
In both cases, an immediate caesarean section is necessary. Therefore, an external rotation is usually performed at a period of 37 weeks, so that if a caesarean section is necessary, a mature fetus is born. nine0129 The success rate of the outer turn is between 50 and 70 percent. In case the attempt fails, everything should be ready for an emergency caesarean section.
Manipulation is more likely to be effective for women who have already had a natural childbirth.
External rotation is contraindicated if the baby does not have enough room to rotate (as mentioned above, this may be due to abnormalities in the development of the uterus), if there is little amniotic fluid or placenta previa prevents rotation. nine0003
Natural birth with breech presentation of the fetus
Neither expectant management, nor exercises, nor external obstetric rotation give the expected result of 100%, so the question arises of what kind of birth with breech presentation.
Differences in the birth process in breech and cephalic presentation are due to the fact that the head of the unborn child is the hardest and largest part of his body. It stretches the birth canal, so the rest of the body is born more easily. The birth of the head also causes the release of hormones that facilitate childbirth. nine0129 Breech presentation does not necessarily lead to a caesarean section.
Thus, the most important conditions for considering the possibility of vaginal delivery are:
From the side of the fetus -
- the fetus must be in pure breech presentation,
- arms and legs not tilted,
- the baby should not be lighter than 2500 and heavier than 3600 grams.
In addition, the circumference of the abdomen of the child should not be significantly less than the circumference of the head, so that the birth canal is sufficiently stretched when the abdomen appears, so that the head does not have to be born for too long. The head should be born within 20-60 seconds. For better relaxation and faster delivery, the expectant mother should undergo epidural anesthesia. nine0129 If vaginal delivery is too dangerous for the mother or baby (for example, if the baby has a large head circumference or fetal growth retardation), doctors recommend a caesarean section.
Caesarean section with breech presentation of the fetus
Absolute indications for operative delivery in breech presentation are:
- Subtype of presentation: full foot and knee,
- Time of delivery: preterm birth up to 32 weeks and post-term pregnancy (more than 40 weeks)
- Fetal weight: infant weight less than 2500 g or more than 3600 g
- Uterine deformities and placental abnormalities: uterine scars, placenta previa
- Multiple pregnancy
- Reducing the size of the pelvis by more than 2 cm
- Non-obstetric diseases
Breech presentation of the fetus: complications
As mentioned above, breech presentation is not a pathology, but potentially complicates the course of childbirth.
The possibility of developing complications cannot be ruled out, among which the most common are:
- Premature rupture of amniotic fluid, which increases the risk of infectious complications in the mother and newborn
- Cord prolapse (and risk of clamping)
- Weak labor activity (both primary and secondary)
Other possible complications:
- Fetal hypoxia
- Increased risk of maternal and neonatal trauma.
However, if the doctor recommends natural childbirth, then he is sure that the risks are minimal and the expectant mother should trust the specialists. nine0129 Health to you and your baby!
Author of the article: obstetrician-gynecologist Zalyalova Guzalia Faritovna
References:
1. Ignatenko, I.V Breech presentation of the fetus: modern approaches to delivery / Ignatenko I.V., Strizhakov A.N. // Mother and child: materials of 13 All-Russian.
