Cesarean section in breech presentation

Cesarean section in breech presentation

24.05.2022 0 By admin

caesarean section in breech presentation

Breech presentation is such an arrangement of the fetus in the uterus, in which the pelvic end of the fetus (buttocks, legs) is located above the entrance to the woman’s small pelvis.

In the first and second trimester of pregnancy, the size of the fetus is still too small compared to the size of the uterine cavity, so the fetus has the ability to move freely and take any position. That is why, until the 28th week of pregnancy, you should not worry about the presenting (located closer to the entrance) part of the fetus.

As the childbirth approaches, the fetus becomes larger, as a result of which it cannot freely change its position. If by the 34th week of pregnancy the presenting part is the pelvic end, they speak of pelvic presentation of the fetus , in which childbirth is possible using caesarean section .

Types of breech presentation

They depend on which part of the fetal body is adjacent to the exit from the mother’s small pelvis.

Breech presentation (with bent legs)

The most common variant of the breech presentation of the fetus.

  1. Pure buttocks. The buttocks of the fetus are facing the entrance to the pelvis, and the legs are extended along the body, that is, bent at the hip and unbent at the knee joints. The feet are located in the area of the chin and face.
  2. Mixed berries. The buttocks are facing the entrance to the pelvis along with the legs bent at the hip and knee joints. The ankle joints are slightly extended. The posture of the fetus is “squatting”.

Leg presentation (extensor)

They are much less common than gluteal ones.

  1. Full. Both legs of the fetus are presented to the entrance to the pelvis. They are slightly extended at the hip and bent at the knee.
  2. Incomplete. More common than complete. One leg is presented, unbent at the hip and knee joints. The other leg, bent at the hip and knee joints, is located higher.
  3. Knees . The legs are extended at the hip joints and bent at the knees. The knees are presented to the entrance to the pelvis.

What are the causes of breech presentation

Unfortunately, there is currently no clear answer to this question. Allocate a set of factors that can lead to the formation of a breech presentation of the fetus.

1. Maternal factors. These include:

  • anomalies in the structure of the uterus ( saddle-shaped, bicornuate, hypoplastic uterus );

The saddle uterus is a congenital defect in which the upper part of the organ looks like a saddle: it is wider than with a normal structure.

A bicornuate uterus is an anomaly in the development of the uterus, in which it is completely or partially divided into two horns, merging at the neck.

Hypoplasia of the uterus is an underdevelopment of the organ, which is accompanied by a decrease in its size relative to physiological and age norms.

  • tumors of the uterus (in particular, fibroids) and small pelvis;
  • anatomically narrow pelvis;
  • scar on the uterus after surgery;
  • multiple births.

2. Factors related to the fetus:

  • prematurity;
  • multiple pregnancy;
  • intrauterine growth retardation;
  • malformations of the fetus (anencephaly, hydrocephalus).

3. Placental causes:

  • placenta previa;
  • oligohydramnios or polyhydramnios;
  • short umbilical cord.

It has been proven that premature babies are most often in the breech presentation: the deeper the prematurity, the higher the likelihood of this location.

What are the dangers of natural childbirth in breech presentation

Normally, a baby is born head first. Breech birth is always an increased risk for both the fetus and the mother. Therefore, there is a high probability of such dangerous complications as:

  • weakness of labor activity and, accordingly, prolonged prolonged labor;

The soft pelvic end is not able to exert the necessary pressure on the cervix and ensure its disclosure.

  • infections (due to the duration of the birth process);
  • prolapse of umbilical cord loops, impaired blood circulation in it and fetal hypoxia;
  • fetal trauma (extension of the head, tilting of the arms, etc.);
  • bleeding and lacerations in the mother.

Modern obstetricians, in order to reduce the risk of dangerous complications in cases of breech presentation of the fetus, most often tend to cesarean section (planned operative delivery).

caesarean section in breech presentation

Indications for a planned caesarean section in breech presentation

Doctors decide on a planned caesarean section if:

  • fetal weight is 2500-3500 g;
  • there is no biological readiness for childbirth during full-term pregnancy;
  • the age of the primiparous woman is more than 35 years;
  • there is a history of infertility;
  • delayed pregnancy;
  • aggravated obstetric anamnesis (presence of genital pathology in anamnesis);
  • narrow pelvis and anomalies in the structure of the genital organs of a woman;
  • late gestosis (toxicosis) in history;
  • a woman has extragenital pathology (diseases of a therapeutic, surgical and infectious nature);
  • fetal hypoxia was diagnosed;
  • presentation of the umbilical cord;
  • low placentation;

Normally, the lower edge of the placenta is located 5 cm above the internal pharynx of the cervical canalconnecting the uterine cavity and the vagina. If the edge of the placenta is closer than 5 cm from the internal os, they speak of low placentation.

  • multiple pregnancy with breech presentation of the first fetus;
  • mixed and foot breech presentations.

Premature birth (at 22-26 weeks) in the breech presentation of the fetus, doctors try to lead through the natural birth canal, without resorting to a caesarean section.

How is a planned caesarean section performed?

breech presentation of the fetus cesarean

1. The issue of conducting a planned caesarean section is decided in advance. A woman is determined with the maternity hospital and / or a specialist who will perform the operation. Hospitalization is carried out in a planned manner for a period of 38-39 weeks.

2. Currently, caesarean section is performed under epidural anesthesia (if there are no contraindications). A woman, remaining fully conscious, does not feel only the lower half of the body. The duration of the operation is no more than an hour (in the absence of complications).

Epidural anesthesia is a method of pain relief that relieves pain only in a specific area of the body.

3. A woman can hug and attach her baby to her breast while still on the operating table.

4. Already on the first day after the operation, the woman will be helped to stand up. If her condition allows, they will bring a newborn.

5. Operative delivery is not a contraindication to breastfeeding. A woman can breastfeed her baby just like mothers who have had a natural birth.

6. In the absence of complications, the discharge of a mother with a baby after a planned caesarean section in the Russian Federation takes place on the 4th-5th day.

Video

Bibliography:

  1. Obstetrics: national guide / ed. G. M. Savelyeva, G. T. Sukhikh, V. N. Serov, V. E. Radzinsky. – 2nd ed., revised. and additional M. : GEOTAR – Media; 2018.
  2. Clinical lectures on obstetrics and gynecology / ed. A. N. Strizhakova, A. I. Davydov, L. D. Belotserkovtseva. Moscow: Medicine, 2000. 379 p.

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