Buttock prelying of a fruit
Buttock prelying of a fruit — the most widespread option of pelvic prelying at which the child enters a small pelvis buttocks or buttocks and stupnyam. Specific symptoms are absent, pathology comes to light when performing external obstetric and vaginal researches, planned ultrasonography. Before childbirth attempts to turn a fruit a head down are made. The way of a rodorazresheniye is chosen taking into account data on age of the patient, frequency of childbirth, the sizes of a fruit, the found obstetric, genital and ekstragenitalny pathology. The majority of pregnancies finish Caesarian section. At natural childbirth often apply obstetric grants and operations.
Buttock prelying of a fruit
The buttock option of prelying, according to results of researches, comes to light in 2,6-4,9% pregnancy cases. Such obstetric pathology is diagnosed for repeatedly giving birth women twice more often than in first labor. As at this prelying on patrimonial ways at first there pass buttocks or buttocks from the child's stupnyama, childbirth often is followed by different types of complications (damage of soft fabrics, the child's travmatization, threat of oxygen starvation). At the same time the risk of perinatal mortality significantly increases, a preferable way of permission of pregnancy is an operation of Cesarean section. Maintaining pregnant women and women in labor at different buttock predlezhaniye demands high professionalism of medical personnel.
Reasons of buttock prelying of a fruit
Usually factors because of which the fruit does not occupy natural head prelying remain unknown. However experts in the sphere of obstetrics and gynecology allocate a number of the prerequisites increasing probability of buttock prelying. Such obstetric pathology can be provoked:
- Prematurity. Is the most frequent prerequisite of buttock prelying (about 20%). On the one hand, it is connected with the beginning of childbirth before the fruit managed to turn on the head. With another — with a low mass and small length of the child that causes his increased mobility.
- Polycarpous pregnancy. Mnogoplodiye leads to buttock prelying more than in 10% of cases. When in a uterus not one develops, and several fruits, space for their free movement and turn decreases. Besides, in such situations abundance of water and a hypotrophy of a fruit is more often observed.
- Repeated childbirth. Almost in 4% of cases buttock prelying is diagnosed for the pregnant women having many childbirth in the anamnesis. At these women muscles of a forward wall of a stomach are weakened, some insolvency the miometriya caused by its anatomic and neurotrophic changes is noted.
- Violation of the sizes or form of a basin. The reason of buttock prelying, the fourth on prevalence (to 1,5%). At the narrowed basin or its abnormal form mobility of a fruit is a little limited. As a result to 36 weeks term it does not hold the safest position for childbirth by a head down.
- Organic pathology of reproductive organs. The physiologic turn of a fruit can be interfered by defects of a structure of a uterus (a two-horned, saddle uterus), submukozny knots and other new growths in the lower uterine segment, a hem after gynecologic operation or an operational rodorazresheniye.
- Congenital anomalies of a fruit. Buttock prelying is revealed more often at hydrocephaly, an anentsefaliya, a Down syndrome, pathology of development of digestive organs, hearts. Usually it is about the defects which are followed by increase in the sizes of a fruit or its separate parts or change of their mobility.
- Pathology of fetal covers and placenta. The prelying placenta is capable to interfere with fixing of a head in an entrance to a uterus. At lacks of water and shortening of a funic kanatik mobility of the child is limited, and at a mnogovodiya — on the contrary, in connection with the increased mobility it is difficult to it to keep in the correct situation.
- The dicoordinated patrimonial activity. In such labor a tone the miometriya is inefficiently redistributed between various sites of a uterus. As a result a head, being the most dense and most part of a fruit, makes a start from area of a uterine pharynx, and the child turns over on buttocks.
Buttock prelying can become manifestation of "habitual pelvic prelying". By results of some observations, similar obstetric pathology develops in 10-22% of cases for the specified reason.
Buttock prelying arises against the background of discrepancy of volume of a cavity of a uterus and size of a fruit. In normal conditions to 28-30 weeks of gestational term the provision of a fruit repeatedly changes. Approximately by 36th week the child turns over the head down and quite so enters childbirth. However at emergence of conditions for the increased mobility (abundance of water, prematurity, weakening of belly and uterine muscles) or, on the contrary, restriction of space for movements (mnogoplody, the narrowed basin, malformations, volume processes, etc.) the natural turn of a fruit and its fixing in physiological situation become complicated or become impossible.
When determining option of buttock prelying consider how in relation to an internal uterine pharynx are placed a foot and a buttock of a fruit. Distinguish the following types of prelying:
- Pure buttock. Makes up to 63-68% of pelvic predlezhaniye. Fruit buttocks enter patrimonial ways, and his legs are extended along a trunk. Is more characteristic of first labor.
- The mixed buttock. It is observed in 20-23% of cases. The child enters a basin the buttocks and legs bent in knee joints. Arises at repeatedly rodyashchy more often.
After the beginning of patrimonial activity one type of prelying can be replaced by another. In every third case there is a transition of buttock prelying in foot that considerably worsens the forecast of childbirth.
Symptoms of buttock prelying of a fruit
Any subjective symptomatology demonstrating such prelying does not exist. Usually pathological arrangement of a fruit comes to light during the external obstetric research, planned or unplanned ultrasonography at pregnancy. The woman can suspect that the child is in situation buttocks down if she highly has a uterus bottom, and in the top part of body dense roundish education (a fruit head) is probed. Some pregnant women report that they feel more intensive stir and strong pushes of the child in the lower part of a stomach.
Childbirth with buttock prelying of a fruit constitutes danger both to the child, and to the woman in labor. In 28-32% they come prematurely at gestational term up to 34 weeks. Indicators of perinatal mortality at the same time in 4-5 times more, than at head prelying. In this labor twice more often amniotic waters prematurely stream, the fruit suffers from an intranatalny hypoxia, the umbilical cord drops out, weakness of patrimonial forces is noted, there are postnatal septic diseases. Because of the smaller sizes of the prelying buttock part the fruit begins to be expelled at not completely open uterine pharynx that increases probability of an injury of neck of a uterus or the spastic reduction of her muscles complicating the further birth of a head.
In labor with different options of buttock prelying the child often throws back handles that demands performance of additional manipulations. As the born head presses an umbilical cord to pelvic bones, the risk of death of a fruit owing to asphyxia increases. The greatest danger to the child is constituted by the excessive extension of a head leading to developing of subduralny hematomas, strokes in a cerebellum and gaps it is mashed, spinal injuries in cervical department. The majority of classical obstetric grants also differs in the increased injury at buttock predlezhaniye.
Apply both fizikalny, and tool techniques of researches to confirmation of buttock prelying. At similar pathology are most informative:
- External obstetric examination. The bottom of a uterus costs highly. The dense, well balloting head is defined at the top of a uterus, and the large not balloting buttock part of irregular shape is below palpated. At an auskultation heart beat of the child is listened around a navel and is even slightly higher.
- Vaginal research. Through an open uterine pharynx soft fabrics are palpated. The sacrum, a buttock crack and genitals of the child is probed. At the mixed type of buttock prelying near buttocks there is foot, at pure — an inguinal fold. The position of the child is estimated under the provision of a sacrum.
- Transabdominal ultrasonography of a uterus. Results of ultrasonography are especially important for the choice of optimum medical tactics and a successful rodorazresheniye. The method allows to define precisely, the head as legs of the child and an umbilical cord are located is how bent or unbent.
According to indications at a stage of prenatal preparation carry out a computer and magnetic and resonant pelviometriya, an amnioskopiya. For dynamic monitoring of a condition of a fruit in addition appoint a kardiotokografiya. Differential diagnostics is carried out with other types of provisions and predlezhaniye. If necessary the patient is advised by the intensivist and .
Treatment of buttock prelying of a fruit
On 32-37 week of the gestational period apply special complexes of physical exercises to correction of pathological provision of a fruit. If there are no contraindications, on 37-38 week the external turn on a head on Arkhangelsk, carried out under ultrasonic control is possible. However the increased risk of emergence of complications (an otsloyka of a placenta, a rupture of a uterus, premature birth) limits prescription of such manipulation. In an obstetric hospital the pregnant woman is usually hospitalized on 38-39 week. The choice of obstetric tactics depends on probability of the complicated course of childbirth. The method of a rodorazresheniye is defined with the patient's belonging to one of three risk groups:
- I group. High risk: the child presumably weighs over 3 600 g, the basin is narrowed, the age of the primipara woman in labor exceeds 30 years, symptoms of a hypoxia and the ekstragenitalny pathology influencing childbirth are revealed. Planned Cesarean section is shown.
- II group. Average risk: childbirth can be complicated. Continuous monitoring of patrimonial activity and a condition of the child is necessary. At detection of the first signs of complications the emergency Cesarean section is carried out.
- III group. Small risk: the weight of the child does not exceed 3 600 g, the woman has a basin of the usual sizes, pregnancy proceeded without complications, according to all available data from ultrasonography the child enters childbirth with the bent head. The standard scheme of observation of childbirth is recommended.
When diagnosing buttock prelying at primipara are guided by a number of absolute indications for a planned surgical rodorazresheniye. Surgery is carried out at age of 30 years, a pregnancy perenashivaniye, extracorporal fertilization, the narrowed basin, defects of reproductive system, existence of a hem on a uterus, detection of ekstragenitalny diseases at which it is important to switch off potuzhny activity, considerable violations of lipidic exchange, the expected fruit weight to 2,0 kg and from 3,6 kg. Statistically, childbirth at the revealed buttock prelying comes to the end Caesarian with section not less than in 80% of cases.
In natural labor it is important to provide high-quality monitoring of their current and obstetric protection of a crotch. For decrease in load of soft fabrics performance of an epiziotomiya is possible. At the mixed and pure buttock prelying childbirth often finishes a classical manual grant or a grant across Tsovyanov. At emergence of states, the life-endangering child and the woman in labor (a hypoxia, long childbirth etc.), make the forced rodorazresheniye with extraction of a fruit for the pelvic end. Upon completion of childbirth taking into account high probability of gaps it is important to execute qualitatively survey of soft fabrics of patrimonial ways.
Forecast and prevention
At the choice of the correct tactics of maintaining and a suitable way of a rodorazresheniye the forecast of childbirth at women with the diagnosed buttock prelying of a fruit favorable. In the conditions of regular observation at the obstetrician-gynecologist the risk for the woman in labor and the child increases only if childbirth begins prematurely. Preventive actions assume early registration in antenatal clinic, timely passing of planned ultrasonography, performance according to indications of special exercises which promote turn of the child on the head end. Secondary prevention is directed to the prevention of possible complications in labor.