Pelvic prelying of a fruit
Pelvic prelying of a fruit – a longitudinal arrangement of a fruit in a uterus with the legs or buttocks turned to an entrance to a small pelvis. Pregnancy at pelvic prelying of a fruit quite often proceeds in the conditions of threat of interruption, a gestoz, fetoplatsentarny insufficiency, a hypoxia of a fruit, patrimonial injuries. Diagnostics of pelvic prelying of a fruit is made by means of an external and vaginal research, an ekhografiya, doppler sonography, KTG. Treatment of pelvic prelying includes complexes of corrective gymnastics, carrying out preventive external turn of a fruit, the preliminary choice of a way of a rodorazresheniye.
Pelvic prelying of a fruit
Pelvic prelying of a fruit in obstetrics and gynecology meet in 3-5% of cases of all pregnancies. Conducting pregnancy and childbirth at pelvic prelying of a fruit demands the qualified and highly professional help to the woman and the child. At pelvic prelying of a fruit at the time of delivery the first on patrimonial ways there pass buttocks or the child's legs. At the same time the neck of a uterus is in insufficiently maleficiated and opened state therefore advance of a head as largest and dense part of a fruit, it is difficult. At pelvic prelying childbirth can proceed neoslozhnenno, however there is an increased danger of asphyxia, a still birth of a fruit, patrimonial injuries of the child and mother.
Classification of pelvic predlezhaniye of a fruit
Treat options of pelvic prelying of a fruit foot and buttock prelying. 11-13% of cases of all pelvic predlezhaniye of a fruit fall to the share of foot predlezhaniye. Foot prelying can be full (both legs), incomplete (one leg) or knee (fruit knees). Buttock prelying meet most often. In 63-75% of cases incomplete (purely buttock) prelying at which to an entrance to a small pelvis only buttocks, and legs of a fruit are extended along a trunk is diagnosed. At the mixed buttock prelying (20-24%) to an entrance to a small pelvis not only buttocks, but also the fruit legs bent in knee or coxofemoral joints are turned.
At various options of pelvic prelying of a fruit development of the biomechanism of childbirth has the features. At purely buttock prelying, a medium-sized fruit and the normal sizes of a basin of mother uncomplicated independent childbirth is possible. At the foot and mixed prelying childbirth in natural patrimonial ways is accompanied by considerable risks for the newborn – asphyxia, loss of an umbilical cord and separate parts of a fruit.
Reasons of pelvic predlezhaniye of a fruit
Factors, the causing pelvic prelying of a fruit, are numerous and studied not up to the end. Presence at the woman of fibroma of a uterus, tumors of ovaries, anatomic narrowing or irregular shape of a basin, anomalies of a structure of a uterus (an intrauterine partition, a hypoplasia, a two-horned or saddle uterus) can interfere with establishment of a head to an entrance to a small pelvis.
Pelvic prelying can be observed at the increased mobility of a fruit caused by abundance of water, a hypotrophy or prematurity, a hypoxia, a mikrotsefaliya, an anentsefaliya, hydrocephaly and other factors connected with pathology of the child. On the other hand, limited mobility of a fruit in a uterus cavity at lacks of water, a short umbilical cord or its obvitiya also promotes formation of the wrong prelying.
Can lead the obstetric and gynecologic anamnesis of mother burdened by numerous vyskablivaniye of a uterus, endometritises, tservitsita, the repeated pregnancies, abortions complicated by childbirth to pelvic prelying of a fruit. These states often lead to development of a pathological hyper tone of the lower segments of a uterus at which the head seeks to reach position in the top, less spazmirovanny departments of a cavity of a uterus. Change of a tone a miometriya can be also caused by a hem on a uterus, neurocirculator dystonia, the neurosis, overfatigue of the pregnant woman postponed a stress etc. Pelvic prelying of a fruit is quite often combined with a low arrangement or prelying of a placenta.
In numerous observations which are made by obstetrics and gynecology, are noted that pelvic prelying of a fruit develops at those women who were given birth in a similar situation therefore the question of hereditary conditionality of foot and buttock predlezhaniye is considered.
Features of a course of pregnancy
At pelvic prelying of a fruit the course of pregnancy, much more often than at head, it is accompanied by threat or spontaneous interruption, development of a gestoz and fetoplatsentarny insufficiency. These states, in turn, negatively influence on maturing nervous, endocrine and other systems of a fruit. At pelvic prelying the fruit about 33-36 weeks of a gestation has a delay of processes of maturing of structures of a medulla that is followed by peritsellyulyarny and perivaskulyarny hypostasis. At the same time neyrosekretorny cells of a fetalny hypophysis begin to work with hyperactivity, leading to premature exhaustion of function of a cortical layer of adrenal glands, decrease in protective and adaptation reactions of a fruit.
Changes in fetalny gonads are presented by haemo dynamic frustration (a venous staz, melkotochechny hemorrhages, fabric hypostasis) that can be shown further by pathology of gonads – a gipogonadizm, a syndrome of exhaustion of ovaries, oligo-or an azoospermiya etc. At pelvic predlezhaniye the frequency of development of congenital heart diseases, TsNS, a GIT, the musculoskeletal device at a fruit increases. Violations of a uterine and placentary blood-groove are shown by a hypoxia, high frequency of serdtsebiyeniye, decrease in physical activity of a fruit. At the time of delivery at pelvic prelying of a fruit the dicoordinated or weak patrimonial activity quite often develops. The most rough changes are observed in cases of the mixed buttock or foot prelying.
Diagnostics of pelvic prelying of a fruit
It is necessary to speak about steady pelvic prelying of a fruit after the 34-35th week of a gestation. To this term the arrangement of the prelying part can be changeable. Pelvic prelying of a fruit is defined thanks to carrying out external obstetric and vaginal researches.
Pelvic prelying of a fruit is characterized by higher standing of a bottom of a uterus which is not answering to gestation term. Receptions of an external research allow to define in the field of a bosom softish, irregular shape, the inactive part of a fruit not capable to balloting. In the field of a uterus bottom, on the contrary, it is possible to palpate a large, roundish, firm and mobile part - a fruit head. Heartbeat is listened above or at the level of a navel.
At an internal gynecologic research in case of purely buttock prelying a volume softish part in which it is possible to distinguish a sacrum, a tailbone, a pakhovy bend is probed. At the foot or mixed buttock prelying it is possible to distinguish fruit feet with calcaneal hillocks and short fingers.
The position and its look at pelvic prelying are established on an arrangement of a back, a sacrum and the mezhvertelny line of a fruit. Buttock prelying of a fruit needs to be distinguished from such options of head prelying as front and frontal. Specification of data concerning pelvic prelying of a fruit is made by means of ultrasonography, in particular, of a three-dimensional ekhografiya. The functional condition of a fruit is estimated by means of doppler sonography of a uterine and placentary blood-groove and a kardiotokografiya.
Conducting pregnancy and childbirth
At the patients belonging to groups of the increased risk on formation of pelvic prelying during pregnancy events for prevention of fetoplatsentarny insufficiency, violations of sokratitelny activity of a uterus, complications from a fruit are held. Observance of the sparing mode with a full-fledged night dream and day rest, the balanced diet for prevention of a hypertrophy of a fruit is recommended to the pregnant woman.
With pregnant women the psychoscheduled maintenance directed to training in receptions of a muscular relaxation and removal of nervous excitability is carried out. From 35th week of a gestation the corrective gymnastics across Dikan, Grishchenko and Shuleshova, Cayo promoting change of a tone a miometriya and muscles of a belly wall, to the translation of a fruit from pelvic prelying in head is appointed. In some cases spazmolitichesky medicines faltering courses are appointed.
Carrying out external preventive turn of a fruit on a head on Arkhangelsk in some cases is inefficient and even dangerous. As risks of such obstetric reception approach of a premature otsloyka of a placenta, rupture of fetal covers, premature birth, a rupture of a uterus, injuries and a sharp hypoxia of a fruit can serve. These circumstances limit applications of an external obstetric grant in practice of treatment of pelvic predlezhaniye of a fruit in recent years.
The pregnant woman with pelvic prelying of a fruit on the 38-39th week of a gestation is hospitalized in an obstetric hospital for planning of tactics of childbirth. At an uncomplicated obstetric situation (satisfactory condition of a fruit and the woman in labor, harmony of a basin and a fruit, biological readiness of a maternal organism, purely buttock prelying, etc.) childbirth in natural patrimonial ways is possible. At the same time prevention of premature opening of a fetal bubble, constant monitor KTG-control of a fruit and reductions of a uterus, the medicamentous prevention of anomalies of patrimonial activity and a hypoxia of a fruit, anesthesia (epiduralny anesthesia in labor), obstetric care for the fastest birth of a head is performed.
Cesarean section at pelvic prelying of a fruit is planned at the burdened obstetric anamnesis of mother (long infertility, a still birth, gestoza, perenoshenny pregnancy, a Rhesus factor conflict, habitual not incubation), age of primipara 30 years, approach of this pregnancy owing to EKO, a large fruit, prelying of a placenta, a hem on a uterus, etc. indications are more senior. The emergency Cesarean section is also shown in case of unusual situations at independent childbirth.
Complications of childbirth at pelvic prelying
At the children born in pelvic prelying intra cranial injuries, encephalopathy, spine injuries, a dysplasia of coxofemoral joints quite often are defined. At detection of asphyxia of a fruit or aspiration of amniotic waters the relevant resuscitation activities are required. Newborns during the early neonatal period are subject to careful inspection of the neurologist. Ruptures of a crotch, neck of a uterus, vagina and vulva, injury of bones of a basin belong to patrimonial injuries, typical for pelvic prelying of a fruit, at women.
The preventive direction provides careful inspection and correction of violations at the women planning pregnancy; identification of pregnant risk groups on development of pelvic prelying of a fruit and carrying out timely and adequate preparation for childbirth; the preliminary choice of tactics of childbirth and their maintaining under continuous control of the obstetrician-gynecologist.