Obstetrics and Gynecology - A. M. Hromova 2000

Breech presentation. Course of pregnancy and childbirth
Course and management of pregnancy in breech presentation

The course of labor in breech presentation has certain specific features, and there is also a high probability of various complications.

In breech presentation, it is essential to determine the management strategy from the moment the Diagnosis is established until term and to choose a rational method of delivery.

The management strategy upon diagnosis is as follows:

— up to 28 weeks, routine prenatal care is provided;

— at 29–33 weeks, the pregnant woman should be referred for correction of the fetal breech presentation to cephalic, using sets of gymnastic exercises developed by I.I. Hryshchenko, A.Ye. Shulishova, I.F. Dykan, and B.G. Kayo.

Gymnastic exercises not only help correct fetal breech presentation but also regulate uterine tone and spontaneous activity.

The main elements of corrective gymnastics according to I.I. Hryshchenko and A.Ye. Shulishova are as follows:

1. Tilting the pregnant woman's torso toward the fetal spine.

2. Flexion of the lower extremities at the knee and hip joints with simultaneous flexion of the torso toward the fetal position.

3. Arching the back while supported against a wall bars.

4. Arching the back in a knee-elbow position.

5. Flexing the lower extremities while lying on the back, bringing the knees to the abdomen, and semi-rotating the pelvis with bent legs toward the fetal position.

Corrective gymnastics according to I.F. Dykan.

Lying on a couch, the pregnant woman turns from one side to the other 3–4 times consecutively, remaining in each position for 10 min. The exercise routine should be repeated 3–4 times a day for 7–10 days. After the fetus has turned, it should be secured with a maternity belt.

B.G. Kayo recommends elevating the lower extremity corresponding to the fetal position and extending the straightened lower extremity backward, combining these movements with deep abdominal breathing.

External prophylactic cephalic version in breech presentation according to B.A. Arkhangelsky.

Performed exclusively in a hospital Setting at 34–36 weeks of gestation. Before the Procedure, the bowels and bladder must be emptied. The version should be performed very carefully, without The Use of narcotics. The rules for external prophylactic version are as follows: the buttocks are displaced toward the spine, the spine toward the HEAD, and the head toward the fetal abdominal wall, ensuring that the final result is an anterior view of cephalic presentation.

External cephalic version is more effective under the following conditions:

1. If the pelvic part has not engaged in the pelvic inlet.

2. With a normal volume of Amniotic Fluid.

3. Anterior fetal position.

4. Absence of obesity in the patient.

Throughout the procedure, fetal Heart rate monitoring is performed, and ultrasound control is recommended.

Some specialists have abandoned external prophylactic version due to A large number of contraindications and a high complication rate.

A pregnant woman with a breech presentation should be hospitalized at 38 weeks for labor preparation.

In an effort to reduce perinatal morbidity and mortality, determining the appropriate management and delivery tactics for women with breech presentations is a crucial priority in modern obstetrics.

Pregnancy may be terminated by:

1. Delivery per vias naturalis.

2. Cesarean Section.

When choosing the delivery method for breech presentations, the following factors are taken into account: gestational age, parity, type of breech presentation, fetal head attitude, estimated fetal weight, fetal condition, cervical ripeness, pelvic dimensions, and the response to labor induction.

Indications for cesarean section in breech presentations include:

- anatomically narrow pelvis;

- macrosomia (fetal weight of 3600 g or more);

- low birth weight (<2000 g);

- complicated obstetric history (stillbirth, labor dystocia, etc.);

- history of Infertility;

- primipara aged over 30 years;

- Post-term Pregnancy;

- Placenta Previa or premature placental abruption;

- uterine scar;

- Fetal Hypoxia;

- placental insufficiency;

- hyperextension of the fetal head;

- severe Preeclampsia (Late gestosis);

- unfavorable cervical score at 40 weeks of gestation or more;

- failure to respond to labor induction.