Cross provision of a fruit
The cross provision of a fruit – the wrong arrangement of a fruit in a uterus at which its longitudinal axis is crossed with a uterus axis at an angle 90 °; at the same time large parts of a fruit (buttocks, a head) are located above the line of crests of podvzdoshny bones of a basin. The cross provision of a fruit decides on the help of an external obstetric and vaginal research, ultrasonography. Pregnancy at cross polozheyoniya of a fruit can proceed neoslozhnenno, however premature birth which can create threat for life of mother and a fruit are possible. Optimum tactics at cross polozheyoniya of a fruit is the operational rodorazresheniye.
Cross provision of a fruit
The cross provision of a fruit meets in 0,5-0,7% of pregnancies, and at primipara by 10 times less than at the multigiving birth women. Danger of cross provision of a fruit consists in probability of development of heavy complications in labor at not rendering timely obstetric care: early an izlitiya of waters, losses of parts of a fruit, a rupture of a uterus, emergence of the started cross provision of a fruit, death of a fruit and mother.
The slanting situation which is characterized by crossing of an axis of a fruit and a uterus at an acute angle and placement of one of large parts of a fruit also belongs to options of the wrong arrangement of a fruit (a head or the tazoyovy end) is lower than the line connecting crests of podvzdoshny bones. The slanting provision of a fruit is considered transitional – in the course of childbirth it can pass in longitudinal or cross.
The position at the cross provision of a fruit is determined by a head: the 1st position - at a head arrangement at the left, the 2nd position – a head is defined on the right. The type of a position depends on a back turn: the back frontage to a forward wall of a uterus is regarded as a forward look, to back – a rear view. At the cross provision of a fruit it is also important to consider the fruit back relation to a uterus bottom.
Reasons of cross provision of a fruit
The pre-natal cross provision of a fruit can be caused by various factors. The conditions providing excessive mobility of a fruit, first of all, concern to them: abundance of water, flabbiness of muscles of a belly wall, fruit hypotrophy, etc. On the other hand, prerequisites to formation of cross provision of a fruit can be connected with restriction of pre-natal activity owing to lack of water, a large fruit, a mnogoplodiya, the raised tone of a uterus, threat of spontaneous termination of pregnancy, anomalies of a structure of a uterus (a saddle or two-horned uterus), uterus fibroma, etc.
The cross provision of a fruit in some cases is a consequence of the anatomic reasons interfering insertion of a head in a small pelvis, in particular, of prelying of a placenta, tumors of the lower segment of a uterus or bones of a basin, a narrow basin. Cross situation can be promoted by such anomalies of development of a fruit as an anentsefaliya and hydrocephaly.
Diagnostics of cross provision of a fruit
Wrong (slanting or cross) the provision of a fruit is established during obstetric survey of the pregnant woman, a palpation of a stomach and a vaginal research. At the cross provision of a fruit the stomach gains cross stretched (slanting stretched) irregular shape. At the expense of cross stretching the uterus has a spherical, but not elongated and oval form. Excess of norm of a circle of a stomach in comparison with the term of a gestation and the insufficient height of standing of a bottom of a uterus pays attention.
In the course of a palpation the prelying part of a fruit is not defined; the head manages to be probed on the right or to the left of a median axis of a body of the pregnant woman, and large parts (the head or pelvic end) - in side departments of a uterus. At the cross provision of a fruit heartbeat is better listened in a navel. Difficulties with definition of situation and a position of a fruit can arise in situations a mnogoplodiya, abundance of water, a uterus hyper tone. Obstetric ultrasonography authentically confirms the cross provision of a fruit.
The gynecologic research which is carried out during pregnancy and an initial stage of childbirth at a safe fetal bubble, maloinformativno. Its carrying out only confirms absence in an entrance to a small pelvis of the prelying part of a fruit. After an otkhozhdeniye of waters and disclosure of a uterine pharynx at the cross provision of a fruit can be defined on 4-5 cm , a shovel, edges, an axillary hollow, awned shoots of vertebras, sometimes - an elbow or a brush of the handle. In case of loss of the handle of a fruit from a sexual crack available there is no cross provision of a fruit left doubts.
Risks of cross provision of a fruit
Existence of cross provision of a fruit, as a rule, does not break the general course of pregnancy. However most often at the cross provision of a fruit also development of premature birth meets premature izlity amniotic waters. If the cross provision of a fruit is accompanied by prelying of a placenta, perhaps massive bleeding.
The prompt otkhozhdeniye of waters quite often leads to sharp restriction of mobility of a fruit, a plechik vkolachivaniye in a basin entrance, to loss outside of parts of a fruit (the handle, an umbilical cord) and to development, the so-called, started cross provision of a fruit.
At loss of parts of a fruit there can be an ascending infection to development of a horioamnionit, the poured peritonitis, sepsis. The long waterless interval proceeding 12 and more hours leads to a sharp hypoxia or asphyxia of a fruit. The started cross provision of a fruit against the background of the accruing patrimonial activity threatens with a rupture of a uterus.
In rare instances at the cross provision of a fruit at the time of delivery can occur in head or pelvic prelying or the birth of the baby a dual trunk. Such result of childbirth is an exception and is possible in case of strong contractions, deep prematurity of a fruit or at a dead fruit.
Tactics of conducting childbirth at the cross provision of a fruit
On term up to 34–35 weeks of a gestation the slanting or cross provision of a fruit is considered unstable as can independently change on longitudinal. When diagnosing cross provision of a fruit full gynecologic inspection of the pregnant woman for identification of the reasons of anomaly, the choice of tactics of further conducting pregnancy and a way of a rodorazresheniye is required.
On the term of 30-34 weeks of pregnancy the corrective gymnastics promoting a fruit turn in head prelying can be appointed. Special sets of exercises are shown in the absence of signs of threat of termination of pregnancy, a hem on a uterus, myomas, bloody allocations, dekompensirovanny heart diseases at the pregnant woman etc. and are carried out under control of the obstetrician-gynecologist observing the woman. Also at the cross provision of a fruit of the pregnant woman more time on one side, corresponding to the defined position is recommended to lie.
After 35-36 weeks of a gestation the fruit accepts a stable arrangement therefore when saving the cross provision the pregnant woman is hospitalized in maternity hospital for definition of tactics of a rodorazresheniye.
The technique of external turn on a head - changes of cross provision of a fruit with external receptions the present is practically not used. It is connected with small efficiency of turn as at not removed causes the fruit often adopts again the cross provision. In some cases the external turn can end with serious consequences: otsloyky placenta, rupture of a uterus, fruit hypoxia.
As optimum method of a rodorazresheniye of patients with the cross provision of a fruit serves planned Cesarean section. Absolute indications to an operational rodorazresheniye is perenoshenny pregnancy, the fact of existence of prelying of a placenta, premature otkhozhdeniye of amniotic waters, hems on a uterus, development of a hypoxia of a fruit. At the started cross provision of a fruit with loss of its handle or an umbilical cord, reposition of the dropped-out parts is inadmissible.
In case of full disclosure of a neck of a uterus, the defined live fruit and its mobility carrying out turn of a fruit on a leg and its subsequent extraction is possible. However the forecast in this case is less favorable for a fruit. Turn on a leg and natural childbirth are justified at prematurity or childbirth by twins when one fruit holds cross position.
In a situation of the long waterless interval which was complicated by development of infectious process, and viability of a fruit after Cesarean section the hysterectomy (removal of a uterus) and drainage of an abdominal cavity is made. At a dead fruit plodorazrushayushchy operation of an embriotomiya is carried out.