Head prelying of a fruit
Head prelying of a fruit – the longitudinal provision of a fruit with the head turned to an entrance to a small pelvis. Depending on the prelying part of a head of a fruit distinguish an occipital, perednegolovny, frontal and front arrangement. Definition of prelying of a fruit in obstetrics matters for forecasting of childbirth. Prelying of a fruit becomes clear during inspection by means of special obstetric receptions and ultrasonography. Head prelying is the most widespread and desirable for independent childbirth. However in certain cases (at frontal prelying, a rear view of front prelying, etc.) the surgical rodorazresheniye or imposing of obstetric nippers can be shown.
Head prelying of a fruit
Head prelying of a fruit is characterized by a frontage of a head of the child to an internal pharynx of a neck of a uterus. At head prelying of a fruit the largest part of a body of the child – the head, the first moves ahead on patrimonial ways, allowing quickly and without special difficulties after it to be born to coat hanger, a trunk and legs. Up to 28-30 weeks of pregnancy the prelying part of a fruit can change, however is closer to the term of childbirth (to 32-35 weeks) at the most part of women the fruit accepts head prelying. In obstetrics distinguish head, pelvic and cross prelying of a fruit. Head prelying occurs among them most often (in 90% of cases), and the absolute majority of natural childbirth proceeds at such arrangement of a fruit.
Options of head prelying of a fruit
At head prelying of a fruit several options of an arrangement of a head are possible: occipital, perednegolovny, frontal and front. Among them the obstetrics and gynecology considers the most optimum sgibatelny occipital prelying. As the leading point of advance on the patrimonial channel serves the small fontanel.
At occipital option of head prelying of a fruit in time passing on patrimonial ways the neck of the child is bent in such a way that at the birth the first there is a nape turned forward. Thus 90-95% of all childbirth proceed. However at head prelying of a fruit the options of razgibatelny insertion of a head differing among themselves meet.
- The I extent of extension of a head – perednegolovny (perednetemenny) prelying. In case of perednegolovny prelying of a fruit the big fontanel becomes a wire point during exile. Perednegolovny prelying of a fruit does not exclude a possibility of independent childbirth, however at the same time the probability of patrimonial traumatism of the child and mother is higher, than at occipital option. Childbirth is characterized by a long current therefore at such prelying performing prevention of a hypoxia of a fruit is necessary.
- The II extent of extension of a head - frontal prelying. Frontal head prelying is also characterized by entry into a small pelvis of a head of a fruit the maximum size. As a wire point via the patrimonial channel serves the forehead lowered below other parts of a head. At this option natural childbirth is impossible in this connection the operational rodorazresheniye is shown.
- The III extent of extension of a head - front prelying. As extreme extent of extension of a head serves the front option of head prelying of a fruit. At such option the leading point is the chin; the head goes out of the patrimonial channel a nape back. In this case the possibility of independent childbirth is not excluded on condition of the sufficient size of a basin of the woman or a small fruit. Nevertheless, front prelying in most cases is considered as the indication to Cesarean section.
Razgibatelny options of head prelying of a fruit make about 1% of all cases of longitudinal provisions. As the reasons of various non-standard provisions and predlezhaniye of a fruit can serve presence at the pregnant woman of a narrow basin; anomalies of a structure of a uterus, uterus myoma which limit space, available to the child; prelying of a placenta, abundance of water; flabby belly wall; heredities, etc. factors.
Diagnostics of head prelying
Prelying of a fruit is defined by the obstetrician-gynecologist, since 28th week of pregnancy by means of receptions of an external obstetric research. For this purpose the doctor has the opened palm of the right hand over simfizy and covers the prelying part of a fruit. At head prelying of a fruit over an entrance to a small pelvis the head which is palpated as a dense roundish part is defined. Balloting (mobility) of a head in amniotic waters is characteristic of head prelying of a fruit.
Data of external inspection are specified at a vaginal gynecologic research. Heartbeat at head prelying of a fruit is listened under the woman's navel. By means of obstetric ultrasonography situation, a chlenoraspolozheniye, prelying, a position of a fruit and its look is specified.
Tactics of childbirth at head prelying
And predictively favorable in obstetrics the childbirth proceeding at a forward type of occipital head prelying of a fruit (the nape is turned kpered) is considered correct that promotes creation of optimum relationship between the sizes and a form of a head, and also the woman in labor basin.
In this case at an entrance to a small pelvis the head of a fruit is bent, the chin is brought closer to a thorax. At advance via the rodovy channel the small fontanel is the leading wire point. Bending of a head reduces a little prelying parts of a fruit therefore the head passes through a small pelvis the smaller size. Along with advance forward the head makes internal turn as a result of which the nape is turned to a lonny joint (kpereda), and a face – to a sacrum (kzada). At eruption of a head its extension is made, then there is an internal turn of a coat hanger and an external turn of a head in such a way that the face of the child is turned to mother's hip. After the birth of a humeral belt the trunk and the child's legs without effort appear.
In case of the course of childbirth in a rear view of head occipital prelying of a fruit the nape is developed to a sacral hollow, i.e. kzad. Forward advance of a head at back and occipital head prelying of a fruit drags on in this connection there is a probability of development of secondary weakness of patrimonial activity or asphyxia of a fruit. Such childbirth is conducted expectantly; in case of weak patrimonial activity stimulation is made, at development of asphyxia obstetric nippers are imposed.
The mechanism of childbirth at forward head prelying of a fruit in highlights coincides with the previous option. A wire point at such prelying of a head – a big fontanel. Tactics of childbirth has waiting character; the operational rodorazresheniye is undertaken in case of threat to health of mother or a fruit.
At frontal head prelying of a fruit independent childbirth meets extremely seldom, proceeds is long with the long period of exile. At independent childbirth the forecast is more often adverse: complications in the form of deep ruptures of a crotch, ruptures of a uterus, education vaginal fistulas, asphyxia and death of a fruit are frequent. At suspicion or definition of frontal head prelying even before insertion of a head the turn of a fruit can be made. In case of lack of a possibility of turn Cesarean section is shown. At the complicated course of independent childbirth the kraniotomiya is made.
As conditions of a safe independent rodorazresheniye at front head prelying of a fruit serve the normal sizes of a basin of the woman in labor, vigorous patrimonial activity, a medium-sized fruit, a forward type of front prelying (a frontage of a chin of a kpereda). Childbirth conducts expectantly, carry out careful control of dynamics of patrimonial activity and a condition of the woman in labor, heartbeat of a fruit by means of a kardiotokografiya, a fruit phonocardiography. At a rear view of front prelying when the chin is turned kzad, Cesarean section is required; at a dead fruit plodorazrushayushchy operation is carried out.
Prevention of complications in labor
Conducting pregnancy at women of risk groups is accompanied by the abnormal course of childbirth. Such women have to be hospitalized in maternity hospital for definition of optimum tactics of childbirth in advance. At timely diagnostics of the wrong situation or prelying of a fruit operation of Cesarean section is optimum for mother and the child.