Vertex pregnancy definition
What Is the Vertex Position?
Written by Alexandra Benisek
Reviewed by Nivin Todd, MD on August 28, 2022
In this Article
- Birth in Vertex Position
- Other Positions Your Baby Can Be In
- Risks of Breech and Transverse Position
When you give birth, your baby usually comes out headfirst, also called the vertex position. In the weeks before you give birth, your baby will move to place their head above your vagina.
Your baby could also try to come out feet-first, bottom-first, or both feet- and bottom-first. This is the breech position and only happens in about 3% to 4% of births. Your baby could also be in transverse position if they’re sideways inside of you. If your baby is in breech position or transverse position, your doctor will talk to you about different options that you have to give birth.
Birth in Vertex Position
Before you give birth, your baby will change positions inside of you. But when labor begins, babies usually move into the vertex position.
They will move farther down to the opening of your vagina. The doctor or midwife will instruct you on pushing your baby until their head is almost ready to come out. You'll take long, deep breaths to oxygenate the baby. A slow birth of your baby’s head will also help stretch the skin and muscles around your vagina.
Other Positions Your Baby Can Be In
Breech position. If your baby is still in the breech position at 36 weeks of pregnancy, your doctor may offer you an external cephalic version (ECV), which is where a doctor puts pressure on your uterus to try to turn your baby to a headfirst position. It may be slightly uncomfortable or even painful, but it’s generally a safe way to help your baby reach the vertex position. ECV helps babies get to a headfirst position about 50% of the time.
You shouldn’t have an ECV if you have had recent bleeding from your vagina, if your baby’s heartbeat is abnormal, if your water is broken, or if you’re pregnant with more than one baby.
If ECV doesn’t work, you’ll either have a cesarean section (C-section), which is when a baby is delivered through a cut in the uterus and abdomen, or a vaginal breech birth.
It may not be safe to have a vaginal breech birth if your baby’s feet are under their bottom, your baby is bigger or smaller than average, your baby is in an odd position, you have a low placenta, or you have preeclampsia, which is when you have high blood pressure and damage to organs with pregnancy.
Transverse position. If your baby is laying sideways across your uterus close to the time of delivery, your doctor would offer an ECV or C-section.
Your doctors may be able to turn your baby to a headfirst position, but if they can’t or you begin labor before they can turn your baby, you’ll most likely have a C-section.
Risks of Breech and Transverse Position
ECV problems. If your baby isn’t in vertex position and your doctor uses ECV to move them, some problems can happen.
Your amniotic sac, or the part that holds liquid during pregnancy, can break early, your baby’s heart rate may change, your placenta may pull apart from your uterus, or you could go into labor too early.
Your baby may also move back into a breech position once your doctor moves them into vertex position. Your doctor can try to move them again, but this gets harder as the baby gets bigger.
Breech birth problems. If you give birth in the breech position, your baby’s body may not be able to stretch your cervix enough for their head to come out. Your baby’s shoulders or head could get stuck against your pelvis.
Breech births can also cause your umbilical cord to go into your vagina before your baby does. This is an emergency and requires an immediate C-section.
C-section problems. Since this is a major surgery, infections, bleeding, and organ damage can happen. C-sections can also cause you to have issues with later pregnancies, such as a tear in your uterus or issues with your placenta.
What It Means for Delivery
While I was pregnant with my fourth baby, I learned that she was in the breech position. That meant my baby was facing with her feet pointing down, instead of the normal head down position.
In official medical lingo, the head down position for a baby is called a vertex position, while babies that have their feet or body pointed down instead of their head are considered to be in a breech position.
In my case, I had to work very hard to turn my breech baby into the correct head down, vertex position she needed to be in for delivery. If you have heard your doctor talking about your baby being in a vertex position, you may have wondered what exactly that means for the rest of your pregnancy, labor, and delivery. Here’s what you need to know.
The vertex position is the position your baby needs to be in for you to give birth vaginally.
Most babies get into a vertex, or head down, position near the end of your pregnancy, between 33 and 36 weeks.
Even babies who are breech up until the very end of pregnancy can turn at the last minute. Typically, once a baby is head down and low enough in your pelvis, they’ll stay put.
As the American College of Obstetricians and Gynecologists (ACOG) explains, the vertex position is when a baby is positioned to come head down through a woman’s vagina during birth. Although there are different, more specific positions that the baby’s head can take during the actual delivery process, if your baby’s head is pointing down toward your vagina, you’re in good shape.
Even though a baby is head down at the start of delivery, as they move through the birth canal they’ll actually do quite a bit of twisting and turning to fit through. Unlike other mammals, who have straight, wide birth canals where the babies can just pretty much drop straight through, the ratio of the human head to the space in the birth canal is a very tight squeeze.
To fit through, the baby has to flex and turn their head in different positions.
It’s actually pretty amazing when you think about what the baby has to go through. How does the baby know what to do?
Even for babies who are in a vertex position, there may be some complications that come up as your baby moves through the birth canal. For example, babies that are on the large side, despite being in the head down position, may encounter difficulty passing through the birth canal.
Babies who are over 9 pounds and 4 ounces (4,500 grams) are considered “macrosomic.” That’s simply a medical term for big babies. Babies who are that big are more at risk for getting their shoulders stuck during delivery, even though they are head down. In cases of macrosomia, your doctor may monitor you more frequently. And depending on your baby’s age and size, he will work out an individualized birth plan for you.
To avoid potential birth trauma, ACOG recommends that cesarean delivery be limited to estimated fetal weights of at least 5,000 grams in women without diabetes and at least 4,500 grams in women with diabetes.
As you approach your due date, be sure to ask your doctor the following questions.
Is My Baby in the Vertex Position?
Ask your doctor if they’re confident that your baby is in the vertex position.
Most care providers are able to use their hands to feel what position your baby is in. This is a technique called Leopold’s maneuvers. Essentially, they use physical landmarks to feel what position the baby is in. But if they aren’t able to accurately determine what position your baby is in with their hands, they can schedule an ultrasound to confirm the position.
Is There Any Risk of My Baby Turning?
Some women whose baby is in the correct vertex position may still be at risk of having a baby who turns at the last minute. Women who have extra amniotic fluid (polyhydramnois) may be at risk for having a vertex positioned baby turn breech at the last minute. Talk to your doctor about the risk of your baby turning and if there is anything you can do help your baby stay in the correct position until D-day.
What Can I Do to Have a Healthy Delivery?
No matter what position your little one happens to be in, be sure to have an honest discussion with your doctor about how to best get your baby in the position that matters the most: safely into your arms.
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Postterm pregnancy - causes, symptoms, management in InTime clinic
home » Services of the center of reproduction and family planning » Postterm pregnancy
Postterm pregnancy occurs when the fetus is not born before 42 weeks. Such births are called belated, they carry a number of complications for both the baby and the woman in labor. Overwearing is observed in women in 2% of cases.
The duration of a standard pregnancy is 40 weeks from the start of the last period. This period is sufficient for the normal development of the fetus. Doctors judge the presence of pathology in terms of the state of the placenta. While maintaining the integrity of the placenta and the absence of signs of aging, such a pregnancy is called prolonged.
If aging and violation of the integrity of the placenta, as well as a number of other characteristic signs, are observed, then they speak of a post-term pregnancy.
Causes of post-term pregnancy
- Menstrual irregularity;
- Fetal abnormalities;
- Childhood infectious diseases;
- Disruption of the endocrine system;
- Diseases of the liver, gastrointestinal tract;
- Uterine fibroids, preeclampsia, termination of pregnancy;
- Psychological trauma, sedentary lifestyle;
- Hormonal disorders.
Postterm pregnancy symptoms
Such a pregnancy is characterized by a sharp reduction in the volume of the abdomen, weight loss, which indicates a decrease in amniotic fluid. Milk is released from the nipples, and false contractions may also appear. However, the main symptom is the aging of the placenta and the lack of labor activity at the appointed time.
Treatment of post-term pregnancy
Regardless of the cause of the delayed pregnancy, the main task of the doctor is to induce labor with the help of medications.
A pregnant woman is hospitalized without fail at 41 weeks and is under observation.
After a thorough analysis of the causes of post-term pregnancy and delayed delivery, the duration of pregnancy and the state of the body of the woman in labor, the method of delivery is determined.
Induction of labor begins 2-3 weeks after the expected onset of their normal onset with the help of special hormonal preparations. Then activities begin that stimulate uterine contractions.
If there is a threat to the life of the fetus or a discrepancy between the size of the head to the mother's pelvis, a caesarean section is used.
Consequences of post-term pregnancy
The main danger of a post-term pregnancy is that the baby begins starvation. In connection with the aging of the placenta, he can no longer receive nutrients, and from here problems with development begin, oxygen starvation.
Post-term pregnancy is dangerous for the nervous system of the fetus, and increased dryness and wrinkling of the skin can also be observed.
In the future, such children have reduced immune protection, and, accordingly, the risk of various diseases increases.
It is important to note that post-term pregnancy does not have the best effect on the health of the mother. Injuries to the birth canal, hormonal imbalance, problems with the uterus - all these are just a few of the consequences that a woman may face. After childbirth, doctors prescribe the necessary course of recovery for the patient and the child in order to avoid the unpleasant consequences of a post-term pregnancy.
Miscarriage, frozen pregnancy genetic analysis
If you have visited this page of ours, it means that you are looking for answers to a painful question for you today - why did your unborn baby die in utero, why is this not the first time, who is to blame and, most importantly, what to do?
You may have already undergone costly, lengthy follow-up medical examinations and still haven't received an answer to your question.
Perhaps you are currently preparing for a scraping. In any case, we are ready to help you and your doctor in solving the problem.
We will help you not only to determine the causes of what happened, but also to answer the following questions together with your personal doctor:
- could this happen again in the future?
- But what can really be done to avoid this?
- what is the path of treatment and will there be a result?
- what is the path in planning and managing the next pregnancy?
Unfortunately, 90% of upcoming pregnancies are spontaneous pregnancies, and despite the couple's belief that the pregnancy is allegedly planned, the couple often does not undergo the necessary amount of previous planned examination. But many problems could have been avoided. Among the variety of causes, the “first violin” in the failures of conception and pregnancy is played by genetic, and often hereditary factors.
Despite the rapid development of clinical genetics, the expansion of the information field of this area, neither patients nor doctors are still ready to use, and simply do not know about modern and already absolutely accessible molecular laboratory methods for making a diagnosis.
Abortive material is not always subjected to at least classical cytogenetic analysis, and if this happens, then the method itself carries many unsuccessful failures.
What do couples experiencing miscarriage need to know?
Almost every fifth of all clinical pregnancies ends in its spontaneous termination. The official language of statistics is spontaneous miscarriages and miscarriages account for about 20% of all clinical pregnancies.
What is the essence behind such statistics? It is generally accepted that even under very good conditions for conception, the maximum probability of pregnancy in the menstrual cycle does not exceed 40%. 60 percent are preclinical losses (that is, even before pregnancy). After this primary filter has occurred, the chances of a successful pregnancy increase dramatically and 80% of the pregnancies that occur progress, and 20% end in spontaneous abortion. Pregnancy either freezes or spontaneous miscarriage occurs. Most of the terminated pregnancies - up to 80% - occur in the first trimester of gestation.
And the most common reason for this is the pathological genetic status of the embryo, the presence of one or another defect incompatible with development and life in its genetic material.
Often, various genetic abnormalities of the embryo are random, and much less often they have a hereditary cause. And we are talking about the so-called "natural selection", when nature itself gets rid of "defective" products of conception. It is most often not possible to save such a pregnancy, but you can avoid such a situation in the future by visiting a geneticist, and especially for couples with a burdened reproductive history.
Miscarriage is considered to be its spontaneous termination at any time from the moment of conception to the full 37 weeks of pregnancy. Miscarriage can go according to two scenarios: spontaneous miscarriage and non-developing (frozen) pregnancy. A non-developing pregnancy differs from a spontaneous miscarriage only by the fact that there is no independent emptying of the uterine cavity in the first case, and then the patient is sent for a medical abortion.
The worst is when miscarriage transforms into recurrent miscarriage (in 3% of couples who have lost a pregnancy at least once). And these statistics are only increasing in recent times. The diagnosis of habitual miscarriage is established in the presence of two or more spontaneous abortions in the anamnesis (in the past, in history).
The risk of miscarriage increases with a woman's age, from about 5% at age 20 to almost 50% for women beyond 35-40 years of age.
The relationship between early pregnancy loss and two factors has been most reliably proven - older and late reproductive age of the mother; a large number of previous miscarriages. And the more episodes of miscarriage, the worse the prognosis for subsequent conception: the risk of another loss after two previous losses reaches 29%, after three - 33%.
What are the genetic causes of missed pregnancies and miscarriages?
One of the main causes of miscarriage is a chromosomal imbalance in the fetus.
In most cases, such a chromosomal imbalance is an accidental event and no one is immune from it. However, the frequency of occurrence of chromosomal disorders is directly proportional to the age of the pregnant woman, the impact of harmful external factors, depends on the presence of any genetic pathology in the close environment of kinship and a number of other factors.
Do not forget that some forms of such a chromosomal imbalance can also lead to severe diseases in the woman who has lost her pregnancy, including cancer.
Chromosomal imbalance in the fetus can be represented either by quantitative chromosomal abnormalities (when the number of chromosomes in the chromosome set is disturbed), or by structural chromosomal anomalies, aberrations (when part of the genetic material falls out in the chromosome structure or additional genetic material appears, or the genetic material is rearranged inside the chromosome , between chromosomes), or a combination of quantitative and individual structural defects.
Quantitative anomalies:
Trisomy of autosomal chromosomes - the presence in the chromosome set of three homologous chromosomes instead of two. Most trisomies of autosomal chromosomes are lethal to the fetus. And examples of viable trisomies are Down, Edwards, Patau syndromes.
Monosomy of autosomal or sex chromosomes - the absence of one of the paired chromosomes in the chromosome set. With monosomy for any of the autosomes, the normal development of the embryo is impossible. The only monosomy compatible with life in humans is monosomy on the sex chromosome X, which leads to the development of Shereshevsky-Turner syndrome (45,X0).
Triploidy is the presence of an additional haploid set of chromosomes in the chromosome set. Triploidy is lethal to the fetus.
Sex chromosome polysomy - the presence in the chromosome set of additional sex chromosomes instead of two. An example is Klinefelter's syndrome - the presence of one or more extra X or Y chromosomes in men.
Structural anomalies:
Deletion is the loss of a DNA fragment within a specific locus, a chromosome gene.
Duplication - on the contrary, an increase in chromosomal material, doubling of a section of chromosomes.
The size of deletions and duplications can vary from large, accessible to modern microscopes, to microdeletions and microduplications, which can only be detected by modern high-resolution molecular methods.
Translocations - exchange of regions between two pairs of homologous or non-homologous chromosomes.
Insertions are insertions of genetic material into a chromosome.
Inversions - rotation of a section of chromosomes by 180 degrees within one chromosome.
The most common causes of pregnancy loss among quantitative disorders in the set of chromosomes are:
- complete autosomal trisomies (both one pair of chromosomes and double, triple trisomies). They account for about 60% of all known genetic causes of fetal death
- polyploidy (up to 15-20%%), most often - triploidy
- monosomy of the X chromosome (up to 15%).
More rarely, a miscarriage can be caused by disorders in the structure of chromosomes, a combination of various such aberrations:
- Translocations. Unbalanced chromosomal rearrangement (disproportionate exchange of sections between chromosomes with a violation of the quantitative and qualitative balance of chromosomal material) in the fetus may result in spontaneous abortion or lead to the appearance of a child with birth defects and / or mental retardation. This type of rearrangement occurs when the parents are carriers of a balanced chromosomal rearrangement (without changing the amount of chromosomal material). And then, following the study of the fetal DNA, an additional examination of the chromosomal material of the parents will be required in order to avoid pregnancy loss next time.
How to diagnose a genetic defect in case of pregnancy regression?
For this, first of all, it is necessary to examine the abortive material in the conditions of a genetic laboratory.
Unfortunately, not always a married couple, faced with an unexplained cause of an aborted pregnancy, ends up in the office of a geneticist to receive a professional "guide" in a subsequent examination and try to establish these causes and receive recommendations for the next pregnancy.
However, if you are experiencing miscarriage, discuss the possibility of a genetic test with your doctor. And you can do this in our center, where we will not only quickly and accurately carry out the laboratory analysis itself, but we will accompany you and your doctor with consultations before and after the results.
Indications for the study of abortive material
- there are already two or more episodes of spontaneous abortion or miscarriage in the anamnesis
— if during a previous miscarriage or medical abortion a chromosomal pathology was already detected in the fetus
— one of the spouses was previously identified as a carrier of a chromosomal imbalance or hereditary diseases
— if the family already has a child with a chromosomal pathology or congenital malformations
3
3 And even in the case of the first unsuccessful pregnancy, you can learn more about the causes of fetal death.
The essence of the study
Whichever of the known methods of laboratory analysis of abortive material is assigned to you, its essence lies in assessing the karyotype of the deceased fetus for deviations in its chromosomal material. During the subsequent assessment of the karyotype map, the type of chromosomal defect, its location and the association of this defect with the pathological effect of pregnancy loss are established.
The material for research is any tissue belonging to the fetus - a fetal egg in case of spontaneous miscarriage, membranes and tissues of abortive material obtained during a medical abortion. The only difference is that one method requires only tissue with dividing cells, as in the case of a standard classical cytogenetic study (microscopy), while others, more innovative, molecular cytogenetic, molecular genetic, do not require this and the study can be carried out in a much shorter time and with maximum accuracy, surpassing the standard method of cytogenetic analysis.
Which laboratory method to choose?
We will select the best research method for you, based on your specific clinical case. It doesn’t matter to us how far from our laboratory you are, in which region of Russia you live. Our logistics capabilities will allow you to deliver your biological material from any city and in the preanalytical state that we need to carry out the study.
Currently, there are various methods of karyotype analysis: from those that have appeared in laboratory practice for a long time and have become standard routine analysis, to innovative molecular modern genetic tests with incredibly high accuracy and speed of production.
The capabilities of our laboratory are the methods of the latest generations, which eliminate the shortcomings and inaccuracies of standardized routine methods. In one clinical case, one can limit oneself to a targeted (targeted) study of individual chromosomes, in which defects occur with the greatest frequency.
In another case, we will recommend you a genome-wide method of molecular karyotyping (that is, examining all chromosomes completely and for all defects known for their clinical significance, even the smallest ones that are inaccessible to modern microscopes).
Why don't we test abortive material with the standard cytogenetic method?
Standard cytogenetic karyotype analysis is a method that has long been used in domestic cytogenetic laboratories. However, with the advent and rapid development of more modern methods of genetic diagnostics - molecular cytogenetic, molecular genetic, which are 100-1000 times superior in their accuracy and diagnostic significance, standard karyotyping can be considered outdated in relation to more modern and popular technologies. Moreover, the cost of molecular methods is not much higher than the classical cytogenetic one.
Cytogenetic analysis of the karyotype is carried out by microscopy, that is, using various modifications of microscopes, various algorithms for processing and preparing preparations of abortive material to ensure visualization of chromosomal material, various degrees of training and professionalism of cytogeneticists who evaluate the result.
That is, one way or another, there is a certain effect of subjectivity in the assessment and interpretation, which means that the percentage of false results is not excluded.
Disadvantages
This method of karyotyping is possible only if “living” cells of material capable of dividing are delivered to the laboratory. Hence, difficulties in transportation under special conditions, difficulties in delivery from separate regions, an increase in the cost of transport services due to special preanalytical requirements, a long time for cell division (the study period will be from 15 to 26 days).
Another question is the possible and by no means rare cases of false results due to the impossibility of this method to exclude contamination of the test sample with maternal genetic material. Often, the karyotype of the mother is given as the karyotype of the fetus. And since the mother's karyotype is not abnormal, the cause will not be established.
The sample may also be contaminated with other biological material, it all depends on the conditions under which the sample of abortive material was taken.
In the event of an unfavorable combination of the above, the chance to establish the cause is missed, the abortive material is simply disposed of.
And finally, the limitations of the diagnostic value of the method due to its low resolution (what the method can and cannot reveal). The 100% method will detect aneuploidies (numerical deviations in the set of chromosomes), determine the sex of the fetus (if there is a Y chromosome in the karyotype, it will be male), and can see that a large fragment / section of the chromosome has been lost, or an equally large additional fragment has appeared. A huge number of micro-rearrangements, which can also lead to serious consequences - pregnancy loss, the birth of a child with a severe chromosomal disease, remain beyond the scope of this method.
Our alternative - molecular karyotyping on microarrays - is a chance for one study to quickly, reliably, without "misfires" either find the cause or exclude it.
CREDO is a first-line test in diagnosing the causes of miscarriage - accelerated, automated, accurate, reliable, convenient, affordable.
A test that eliminated the shortcomings of other methods.
A test that combines the required diagnostic goals.
A test that has gone through many years of practice after the first clinical trial and gained reliable statistics.
A test that will eliminate unnecessary costs for diagnostics and sometimes ineffective treatment, and therefore is optimal in terms of cost savings.
A test that won't make you worry about possible "lab failure" or "lab error"
A test that is available from any region.
A test that will suit your doctor with its diagnostic and useful features will really help you in the fight against miscarriage.
CREDO is a first-line test in diagnosing the causes of miscarriage.
Indisputable advantages
The test does not require a "live" dividing cell, which excludes such strict requirements for biological tissue samples of abortive material in the case of the cytogenetic method, their safety, and transportation.
We will isolate a small amount of DNA from any cell for research. For us, only a minimum of pre-analytical requirements is fundamental - to place the abortive material in a sterile container, which we will provide you free of charge along with the shipping package, add saline, and keep the material at a temperature of +2 - +8 until the arrival of our courier.
The test algorithm completely excludes subjectivity, in view of the standardization, automation and software of the entire laboratory process. Modern matrices and scanners, reagents that provide modern study design, access to constantly updated bioinformatic databases - all this brings molecular karyotyping to high reproducibility and worthy analytical value of the method.
The resolution of the test is from 100 to 1000 times higher than conventional cytogenetic karyotyping under a microscope, and therefore, much more information about the genetic status of the deceased fetus will be obtained. Depending on the resolution characteristics of microarrays/platforms for the study of fetal DNA, a diagnostic search can be carried out simultaneously in more than 240 and up to 500 cytogenetically significant syndromic areas.
The speed of analysis execution is from 7 to 14 days, depending on the tasks assigned to this study.
About molecular karyotyping technology
We perform molecular analysis of chromosomal material based on aCGH technology - comparative genomic hybridization on microarrays. The use of several formats of such single nucleotide microarrays allows us to provide a full genome coverage (all chromosomes are examined simultaneously) and achieve certain research goals with a focus on the most significant syndromic regions and about 1000 functionally significant genes.
The method is based on automated analysis of CNVs / SNPs after hybridization of patient DNA samples and reference DNA on a microarray. A microchip is an industrially manufactured microarray with immobilized DNA containing genomic fragments with known nucleotide sequences. Each fragment is a probe/marker/different in length and specificity. A certain type of microchip is used for certain tasks, depending on the markers present on the platform.
From the supplied sample of abortive material, fetal DNA is isolated, which undergoes special processing and preparation, staining with fluorescent dyes. The DNA under test and the reference DNA are stained in different colors. DNA samples mixed in equal amounts are applied to the microchip, the hybridization process takes place, a modern scanner scans the result of this hybridization - the number of DNA fragments is determined by the intensity of the fluorescent glow at each point of the microarray, special software allows you to make an automated analysis of the results, based on which the geneticist , using the capabilities of the software of this study with access to international information databases on the correspondence of a particular chromosomal defect with a certain pathological condition, prepares its conclusion.
What can be detected using CREDO tests:
100% all aneuploidies on all chromosomes
All clinically significant known deletions / duplications within the resolving characteristics of the microarray, including submicroscopic defects.
Maternal cell contamination
Tests are limited
- Unable to detect balanced structural rearrangements
- Gene point mutations
- Low level mosaicism <15%
The presence of SNP markers on the microarray will provide additional detection capabilities:
- Microdeletions/microduplications (only those that are within the resolution of the matrix)
- Unbalanced translocations (within the resolution of the matrix)
- Loss of heterozygosity (within the resolution of 5- 10 Mb)
- Uniparental disomies (within the resolution of 5-10 Mb)
- Determining the level of mosaicism
- Ability to differentiate triploidy.
If chromosomal abnormalities are detected
Of course, having received our conclusion, discuss it with your doctor.
In some cases, additional consultation with a geneticist may be required.
Call us at +7 499 551 7751 and our specialist will help you figure it out.
