Pelvic presentation of the fetus refers to the pathology of pregnancy. The main cause of pelvic presentation of the fetus is a decrease in the tone and excitability of the uterus, which leads to a decrease in its ability to reduce the position of the fetus in the uterine cavity by contractions of the muscles. The frequency of occurrence of pelvic presentation is 3-5%.
There is pure and mixed breech pelvic presentation and foot presentation (complete and incomplete). The most common are pure fit (67%), buttocks mixed (20%) and foot (13%).
Conducting pregnancy with pelvic presentation.
If a pelvic presentation is detected at 28 weeks of gestation, then the fetus can independently change its presentation in the future.
If from the 32th week of pregnancy the pelvic presentation persists, then it can be recommended a set of exercises for changing pelvic presentation to the head. The effectiveness of such exercises has been proven by some researchers.
At 34-37 weeks of pregnancy, it can be held an external preventive turn on the head. This procedure is performed only in the obstetric hospital under ultrasound control using drugs that relax the uterus. External preventive turn on the head is an unsafe procedure and is fraught with many complications, such as premature placental abruption, premature birth. There are also contraindications for this procedure. The efficiency of the outer rotation is about 65%. Due to the large number of contraindications and complications, this procedure is rarely performed.
Deliveries through the birth canal with pelvic presentation are possible and can be with a favorable outcome. However, given the high risk of asphyxia of the fetus, birth injury, before choosing a method of delivery, a comprehensive assessment of the condition of the fetus and the woman in labor should be carried out. What includes the history of women, the presence of other diseases, the weight of the fetus, the condition of the fetoplacental blood flow, etc.
The danger of childbirth in pelvic presentation is that when a baby is born before the navel, its head enters the pelvic cavity and presses the umbilical cord, and fetal hypoxia develops. If within the next 5-10 minutes the child is not born, then it is dangerous for his life.
With pure presentation in childbirth, there is a manual for Tsovianov, a method of Moriso-Levre for removing the head of the fetus.
Very often, pregnant women, after consulting with their gynecologist, choose abdominal delivery for pelvic presentation of the fetus by caesarean section.