Pathology of pregnancy. Breech presentation fetus

The presentation of the fetus can be determined already at the 28th week of pregnancy, however, it is not a fact that the baby will quietly wait for the moment of its release in the very position in which the gynecologist recorded it for the first time.

The swirling little one would never agree that she needs to sit quietly, especially when there is a lot of water around and there is still enough space to make some fun in it.

True, every day there is less and less space for free swimming, and by the 37th week there is almost no space left at all. And if by this time your baby did not have time to turn in the position necessary for easy childbirth (head down), then the doctors will call your situation breech presentation and will begin to look for the most comfortable way out for you and the baby.

Reasons for incorrect presentation

According to Professor E. Chernukha (obstetric department of the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences), the main reason for the formation of a breech presentation of the fetus is a decrease in the tone and excitability of the uterus, which, in turn, reduce its ability to reduce and correct the position of the fetus.

There are specific risk factors that can trigger a breech presentation:

• polyhydramnios and premature pregnancy. In the first case, the baby has the opportunity not to restrain himself in opportunities, tumbling and turning over - too much amniotic fluid contributes to this very much. In the second, the due date comes so quickly and unexpectedly that the baby simply does not have time to "orientate" and turn over as it should.
• oligohydramnios and malformations of the uterus. Here, on the contrary, the possibilities of the fetus are so limited that if he is happy to accept the classic presentation, he cannot, he is inactive.
• placenta previa, tumors in the lower segment of the uterus, narrow pelvis of the mother, some malformations of the fetus.

Legs, knees, buttocks

Breech presentation is different and has several types.

There are purely gluteal and mixed gluteal. The first type is when the baby is located at the entrance to the small pelvis with his butt, and his legs, straightened at the knees, are kept parallel to his body. The second is when the legs are bent in both the hip and knee joints, and the fetus is presented by the buttocks and legs.

The baby can be presented with one or both legs.

The fetus is presented with bent knees.

Breech presentation occurs in only 3-5% of pregnancies. Most often - purely gluteal (67%), less often mixed gluteal (21%), even less often foot (13%) - these are the official statistics of the Russian Academy of Medical Sciences.

Is this a pathology or not?

Rather yes. Although breech presentation can occur naturally, the complication rate in such cases is much higher than in breech presentation. Obstetricians and women in labor are afraid of birth injuries and fetal pathologies, such as asphyxia.

Features of the life of the fetus with breech presentation

In common language, the baby can live with a breech presentation, but it is not very convenient. In this case, the fetal heart rate is increased, and the tone of the sympathetic segment of the nervous system is probably increased. Reduced physical activity, in contrast to babies in the classic presentation, a child who turns to the exit with his butt can only twist a little with his legs and arms. The general tone of the fetus is reduced, as evidenced by the extension of the baby's head.

Preventive measures

To the vital question: is it possible to prevent breech presentation, there is an affirmative answer.

Therefore, for the management of childbirth, the role of the attending physician is important, who will take into account all risk factors, identify pathology in a timely manner and help not just with advice, but will actively take on the correction of the situation.

• Lots or low water.

Diagnostics

Usually, a gynecologist can diagnose the pelvic location of the fetus without much difficulty during a routine examination of a pregnant woman. In very rare cases, it can be difficult for a doctor to palpate: when a woman is obese, she has an increased uterine tone, with multiple pregnancies or anencephaly, etc.

This diagnosis is made already before the 30th week of pregnancy. The doctor examines the belly of the pregnant woman and at the bottom he probes the soft volumetric part of the fetus - the buttocks, and at the top of the mother’s belly, you can feel the head. The heartbeat with this position of the baby is heard at the level of the navel or slightly higher.

Also used for the diagnosis of ultrasound, radiography, amnioscopy and electrocardiography of the fetus. It is very important with this diagnosis to establish the exact nature of presentation, the amount and color of amniotic fluid, the presence of entanglement and presentation of the umbilical cord, the size of the fetus, the location of the head.

The location of the fetal head is very important in this case. It happens that she is bent:

1. slightly unbent,
2. moderately unbent,
3. excessively unbent.

Before giving birth, it is very important to carry out the entire diagnostic cycle in order to establish preferences in the choice of the type of delivery. But if there are no contraindications, it is better to perform an external inversion of the fetus on the head.

Outward rotation of the fetus

Many women decide to perform an external rotation of the fetus from the breech presentation to the cephalic presentation. This method has fewer potential complications than a cesarean section or vaginal breech delivery. This is what the WHO Reproductive Health Library says - read. In this case, you need to choose an experienced and good specialist in this field. But there are such contraindications:

• Hypertonicity of the uterus.
• Threatened termination or premature birth.
• The woman was diagnosed with infertility before pregnancy.
• Late gestosis.
• Placenta previa or uterine development pathology.
• Little or polyhydramnios.
• The child's back is located "posterior" or "anterior".
• The placenta is on the anterior wall of the uterus.
• Arterial hypertension.

This article contains information of a general nature only and is not intended to replace the advice of a qualified professional.

Exercises to help you get in the right position

You should start doing gymnastics from the 30th week of pregnancy. In this case, there is still a lot of space in the uterus and it will not be very difficult for the baby to make a coup.

In my opinion, the exercises are not effective for this particular purpose. It is known that the frequency of fetal overturns when performing this gymnastics is the same as that of women who do not practice it. Therefore, doing exercises or not is a personal matter for every pregnant woman. Just in case, here are some of the most common ones that I managed to find on the Internet.

1. The woman lies on her side on a hard surface and rolls over on her other side every ten minutes. At the same time, the legs are bent at the hip joints and knees. It is advisable to do about 4 complete overturns. You need to lie on each side for about 10 minutes. You need to do this exercise for 7-10 days 3 times a day before meals.
2. Lie on a hard surface and place a pillow or rolled blanket under the pelvis so that the pelvis is 30-40 cm higher than shoulder level. You also want the knees, pelvis and shoulders to form a straight line. You need to do the exercise during the week before meals several times a day for 15 minutes. Quite often, the child turns over after the first day of such gymnastics.
3. Standing in the knee-elbow position is also considered quite effective. Take this position, relax your abdomen and perineum as much as possible. This exercise also relieves uterine hypertonicity and helps with back pain, so you can do it regularly.
4. Lessons in the pool and sleep on the side where the child's back is displaced also contribute to the inversion of the fetus.

Do you have any questions? You can ask them on the FORUM

Breech presentation 36 weeks

If at 36 weeks the fetus is in breech presentation, then this is not scary.

During the last week of pregnancy, the doctor will often check the position of the fetus. He probes the lower part of the uterus to see if the baby is positioned correctly. The largest part of the baby's body is the head, so all difficulties during childbirth are associated with its passage through the birth canal.

The arms and legs, together with the calf, are still small, so they pass easily. The best position for the baby is to be with the head down. True, sometimes things may be different, and the baby may have a different position. So if at 36 weeks the fetus has a leg in the lower part, then this is a breech presentation.

In this case, a cesarean section is very often prescribed, because the baby has already taken a position and may not change it. Although there is still time before giving birth, there are cases when the child turns over at the last moment, taking the correct position.

Types of breech presentation

In general, the breech presentation is divided into several types. The first is the gluteal, when the baby is at the entrance just with the buttocks, and the arms and legs are extended along the body. Although it happens that at the entrance to the pelvis, the buttocks and legs are together in a bent state. There is a foot presentation, both complete and incomplete.

The first option is both legs slightly bent at the knees. The second is when one leg is in an extended state, and the other is bent at the knee joint and is located higher.

Of course, a fetus of 35, 36 weeks can change its position, so you need to wait. If, at a later date, the baby does not change its position, then artificial childbirth can be prescribed so as not to harm the baby.

The onset of breech presentation

It is believed that the cause of breech presentation is a decrease in uterine tone. This as a result leads to a decrease in her ability to contract, while correcting the position of the baby.

Most often this happens because the fetus is very mobile with polyhydramnios and premature pregnancy. In addition, it may occur due to the fact that the pelvis is very narrow or the placenta previa.

Of course, a breech presentation of the fetus at 36 weeks does not mean that it will necessarily be a cesarean section. Often, with this position, the baby is born safely without any complications.

With a breech presentation, the course of pregnancy is no different from a cephalic presentation. The only thing can be assigned to do special exercises that contribute to the fact that the fetus in the last stages itself will turn over to the desired position.

Continued on the next. page

Breech presentation of the fetus

During its development, the baby, which is in the mother's tummy, turns over several times. And after 22-23 weeks of pregnancy, the baby, as a rule, takes a head-down position - and it is this position of the fetus that is considered optimal for subsequent births. The fetal head is the largest part of its body in diameter, and therefore it is with its passage during delivery that the greatest difficulties are associated. After the baby's head passes through the birth canal, the rest of his body "by inertia" follows almost imperceptibly. If the baby is located in the mother's tummy vertically, that is, with the head down, in most cases this position does not bring any difficulties. But it also happens that the fetus takes a transverse position in the womb: legs or buttocks down. In this case, we are talking about breech presentation during pregnancy, which is diagnosed, as a rule, by 28 weeks during the next visit to the antenatal clinic. It should also be mentioned that the breech presentation found at this time does not necessarily persist until delivery - the baby can change position up to 36 weeks. In addition, there are a number of measures that can help "flip" the fetus, thereby giving it a head position.

Causes of breech presentation of the fetus

Breech presentation of the fetus during pregnancy can be due to several factors. One of the main reasons doctors call a decrease in the tone and excitability of the uterus. Also, the causes of breech presentation are called polyhydramnios, oligohydramnios and abnormalities of the uterus, placenta previa, and some fetal malformations. Breech presentation can be breech, leg, mixed, knee - each of them is easily diagnosed by the doctor during a routine examination, after which an ultrasound confirmation will be required. Breech presentation is considered not quite a normal position for both the baby and the mother - although it does not carry any direct big threats.

Although natural childbirth with a breech presentation of the fetus is possible, nevertheless, a caesarean section is often the indication for delivery. If childbirth proceeds in a natural way, constant and enhanced medical supervision is necessary - breech delivery is much more often accompanied by complications.

Signs of a breech presentation of the fetus

Physically, if there is a breech presentation of the fetus, the woman does not feel this pathology in any way. She is not worried about any pain symptoms or feelings of discomfort, which can clearly signal the "wrong" position of the baby in the uterus.

Breech presentation can only be determined by examinations. So, with breech presentation, experts note a higher standing of the bottom of the uterus above the pubis, which does not correspond to the gestational age. The fetal heartbeat is heard more clearly in the navel area or slightly above it on the right or left (depending on the position of the fetus).

Read also 35th week 37th week

36th week of pregnancy: fetal development, weight, movement

At the 36th week of pregnancy, the fetal length is 47 cm, the average weight is 2800 g, the head diameter is 87.7 mm, the chest diameter is 91.8 mm, and the tummy is 94.8 mm. We indicate the average values ​​of the height and weight of the fetus, the exact values ​​are largely determined by the heredity and developmental conditions of the child.

By 36 weeks of gestation, the fetus has accumulated a sufficient amount of subcutaneous fat and now looks quite plump. The skin is pink and velvety. It is practically devoid of vellus hair and is only in places covered with oily primordial lubricant. The hairs on the head have become a little longer, the eyebrows and eyelashes are clearly visible. Nails on both hands and feet already cover the nail beds. The cartilage that forms the auricles has become noticeably denser, all the curls and grooves of the outer ear have already been formed.

The increased growth of the fetus led to the fact that it became cramped in the uterine cavity. Movements were sharply limited. Thrusts and blows are still clearly felt by the mother. The number of movements is, on average, 1 time in 10 minutes. The fetus has taken its "legal" position, and this presentation will now persist until the end of pregnancy. The presenting end, the head or pelvis of the fetus, begins to descend into the pelvic cavity.

At 36 weeks, the internal organs are well developed. The vasomotor and respiratory centers in the brain are already fully functional. The heart beats at a rate of 140 beats per minute, its sounds became clear and well distinguishable through an obstetric stethoscope. The lungs contain a sufficient amount of surfactant. If born, the child will be able to survive on its own, without the support of the mother's body and special medical care.

By the 36th week, the placenta begins to fade slowly, but in most cases it is still coping with its functions. Its thickness is 35.59 mm. With premature aging of the placenta and the development of placental insufficiency due to a violation of the flow of nutrients, the fetus lags behind in development and growth. Oxygen starvation affects cardiac activity and the functions of all organs of the fetus. Deep disturbance of the feto-placental circulation can lead to the death of the child.

36th week of pregnancy: a woman's feelings

At the thirty-sixth week of bearing a child, a woman already knows for sure that pregnancy is not just a pleasant expectation - it is hard work, and the health of the child and herself will depend on how well this work is done. The expectant mother has already become overweight, it is difficult for her even to move, not to mention doing housework. Helplessness begins to irritate her, so the woman wants even more for the birth to come faster. She listens to how her stomach pulls, and subconsciously waits for contractions.

In anticipation of childbirth, the pregnant woman becomes irritable and a little moody. The upcoming test worries her, whether she will have enough strength, whether everything will be all right with the child, whether she will be able to take care of him immediately after birth. Do not worry, pregnancy and childbirth are a natural process in which doctors intervene only in order to correct the mistakes of nature. No one has ever remained pregnant forever, all mothers had to go through this, and some even immediately decide on a second child, which means that everything is not so scary. Think about whether nature, whose main goal is evolution, could create such an obstacle that would be impossible for the average woman to pass. What would then be the point of reproduction?

Now, at the end of your pregnancy, you should pull yourself together and stay calm, brushing aside gloomy thoughts and stopping the storytellers of all sorts of "horror stories." If you have insomnia, take valerian or motherwort. Ask your husband to give you a light stroking massage. Organize your sleeping space properly and ventilate the room before bed. Sleep and rest more while cultivating positive thoughts and emotions. Your main task is to come to childbirth as strong and rested as possible.

At the 36th week of pregnancy, even women who do not suffer from late toxicosis notice edema in the legs caused by impaired blood outflow due to compression of the pelvic veins by an enlarged uterus. How to understand that this is not gestosis? If swelling appears towards the end of the day, after prolonged standing or sitting, most likely, the swelling is not associated with pathology. To be sure, lie on the couch with your feet on the pillow, thereby giving them an elevated position. Edema, which is a manifestation of toxicosis, will never disappear, it can only slightly decrease, but the pastiness caused by blood stagnation will disappear without a trace.

Fetal movements at the 36th week of pregnancy are felt well, although the total number of movements audible and inaudible by a woman by the end of pregnancy is reduced by almost 2 times. The child is in very cramped conditions, it becomes more and more difficult for him to move. Nevertheless, an attentive mother, in 12 hours, as before, should count at least 10 movements.

Unpleasant manifestations of pregnancy, such as muscle spasms in the arms and legs, heaviness in the lower back, pain in the pubis and hip joints, still continue to bother the woman. Some people have hemorrhoids worsening. Hemorrhoidal nodules falling out of the anus are injured, itchy, and sometimes cause light bleeding. Do not hesitate to tell your doctor about the existing problem, he will recommend a medicine suitable for pregnant women.

36th week of pregnancy: discharge from the genital tract

What discharge from the genital tract should make you see a doctor?

Bloody discharge, regardless of intensity, especially if, in addition to this, the stomach hurts - these are symptoms of abruption of a normally located placenta, which are the reason for calling the ambulance team.

Fluid discharge from the genital tract that resembles slightly yellowish or whitish water may be amniotic fluid. Regardless of the amount of discharge, even if you doubt that it is water, you should go to the maternity hospital to clarify the diagnosis.

Leucorrhoea, cheesy in nature, containing an admixture of cloudy mucus or pus is a sign of an infection in the vagina and a reason for an extraordinary visit to a doctor.

36th week of pregnancy: nutrition of a pregnant woman

A woman's nutrition at the 36th week of pregnancy should be less caloric than in the second trimester. The diet should be formulated taking into account the reduction in energy consumption, as a result of reduced physical activity. At the same time, nutrition should be complete in terms of the composition of nutrients and the content of essential micronutrients and vitamins.

Caloric intake should be limited by reducing the intake of simple carbohydrates and animal fats. Even a slight weight gain seems huge to you, a reduced diet during pregnancy is strictly prohibited. You will have to take care of your figure after childbirth. If the fetus during the period of active growth will experience a lack of nutrients, it is possible that it will be further delayed in development and reduced viability, which will affect during childbirth and in the early neonatal period.

The products you choose for your table should be as safe as possible. Strictly monitor their expiration date, check the composition, store and handle correctly. In the spring, do not buy early vegetables and herbs on the market, they contain a lot of nitrates. Do not abuse exotic products brought from far away and stored for a long time. This will avoid poisoning.

Eat fractionally, in small portions. Drink only purified water in an amount of about 1 liter per day, the rest of the need for liquid will be satisfied by the first courses and fruits. Arrange fasting days for yourself about 1 time per week, freeing your body of excess fluid. Do not eat at night, especially fatty, sour, spicy foods and products from shortcrust and pastry. If you wish, you can drink a glass of milk or sweet fruit jelly.

36th week of pregnancy: preparing for childbirth

Are your training contractions stronger? Don't worry: this is not childbirth yet and these contractions are perfectly safe. Braxton Hicks contractions differ from labor contractions in that they do not get stronger and stop quickly. You will understand when the real contractions begin: they will initially occur at regular intervals, and gradually the interval between them will begin to decrease, and the contractions themselves will become stronger. In addition to preparing yourself mentally for childbirth, you can help yourself by preparing your crotch for a baby. Every day, massage the perineum and the part of the vagina adjacent to the labia with vegetable oil (ideally one that contains a lot of vitamin E, such as olive oil).

At 36 weeks of gestation, the baby is growing rapidly and has a fully formed skeleton. Sometimes the mother may even be in pain when the baby rests his head, spine or leg against the wall of the uterus and presses on the bladder. On the this photo the doctor evaluates the lower limbs of the baby. Against the background of the dark shadow of the amniotic waters, the lower leg, surrounding muscles, foot and toes are clearly visible. The shin bones are clearly visible in the form of light stripes, they are already very dense. The arch of the foot and the heel bone are well visualized. The baby's legs are very similar to the limbs of an adult, and also have nail plates.

Interesting details: not only your baby has grown in the past eight months. Your uterus has increased significantly in size: before pregnancy, it weighed 40 grams, and now it is about 800.

Pregnancy is gradually reaching the home stretch. Anxiety and fears about future childbirth appear. Back pain, increased belly and weight make you feel uncomfortable. But everything outweighs the joyful expectation of the baby. Future mothers come up with a name, prepare a dowry for a newborn.

Pregnancy 28 weeks is how many months, how many months are left before delivery? The third trimester is the most intense in terms of experiences. the appearance of colostrum, absent-mindedness and clumsiness of a woman is not a cause for concern. and confidence in a happy outcome of childbirth will help to overcome discomfort.

Fetus at 28 weeks

The third trimester of pregnancy has come. It's time to visit the antenatal clinic more often. The baby takes up almost all the space in the mother's belly. It becomes more and more difficult for a woman to endure pregnancy. 28 weeks - the child's weight is already about 1 kg; his height is about 35 cm. These are average figures. Individual features may vary. Both weight and height may be slightly more or less.

If the pregnancy is 28 weeks, what happens to the baby? The brain begins to actively develop. Up to this point, it has been smooth. After 28 weeks, convolutions begin to form in it. The heart beats at a frequency of 150 beats per minute.

The baby's lungs are still weak, underdeveloped. However, at this time, the child is quite capable of surviving with medical help... Of course, babies are also nursed at an earlier date. But it is from the 3rd trimester that the child is legally considered a newborn.

How many months is 28 weeks gestation? Considering that the obstetric month is 28 days, then the 7th month begins. The child's features become clearer, the cheeks are rounded. He starts yawning more often. Hair builds up pigment and begins to darken.

Location of the fetus

The kid already knows how to hear, he begins to distinguish the voices of his parents. Opens eyes and emotionally reacts to what he likes or dislikes. If the pregnancy is 28 weeks, what happens to the fetus? When will it roll over to the correct position?

There are only 3 types of presentation of the fetus:

1. Head. The baby is head down, close to the cervix.
2. Transverse. The fetus is located across the mother's abdomen.
3. Pelvic. The child is head up, the legs of the fetus, buttocks are adjacent to the cervix.

Up to 3 doesn't really matter. The child's activity increases, he regularly moves and may be in any of the three presentations. If the pregnancy has reached 28-29 weeks, then the fetus is in the most convenient position for childbirth. Most often it is a cephalic presentation. It is optimal for childbirth.

During childbirth, the buttocks and legs of the child appear first. It may be difficult to remove the head, because this is the largest part of the body. Therefore, the prospect of a cesarean section is possible.

With a transverse presentation, the child will not be able to be born independently, without medical help. It is during this period, when the pregnancy is 28-29 weeks, that the official diagnosis of fetal presentation is made. Nevertheless, you should not worry ahead of time. It also happens that just before childbirth, the child is in a cephalic presentation.

Wiggling baby

Third trimester, pregnancy 28 weeks - how many months are left until delivery? If the baby is not requested ahead of time, then the expectant mother has 3 more obstetric months left. This is an opportunity to set yourself up for a positive outcome of the case, collect the bag in the hospital, prepare the necessary documents. If suddenly there is a need to suddenly leave for the maternity ward, all things will already be collected.

At the 7th month of pregnancy, fetal movements are most active. They must occur at least 10 times in one hour. Here you should be careful when counting. Because the baby can sleep during the day. And at night, waking up, start your motor activity, stirring.

It should not be forgotten that the belly at 28 weeks of gestation is quite large. Sometimes he turns to stone - this means that the uterus is in good shape and preparing for future contractions. The child also grows and there is not enough space for him in the mother's tummy. Therefore, the movements may not be as frequent.

During the day or night rest, the uterus relaxes, the activity of the baby increases. Therefore, when counting, you can find at least 4 perturbations in 1 hour of mom's rest.

Attention should be paid to fetal movements. If the movements are less than expected, you should tell the doctor about it.

Analyzes at 28 weeks

The time to go on maternity leave starts at 27-28 weeks of pregnancy, and from that moment on, you need to visit your gynecologist more often. Ultrasound scans are often not done at this time. During the appointment, the doctor listens to the woman's pressure and weight in the chart, measures the circumference of the abdomen and pelvis. You should still take the standard tests during pregnancy - urine, blood. But there are some other indicators, the values ​​of which need to be found out in the 3rd trimester.

Blood tests to be taken:

• for sugar;
• for antibodies.

Diabetes mellitus can occur during pregnancy. Therefore, blood sugar indicators are so necessary. So that anemia does not develop, the level of iron in the body is monitored.

An antibody test will reveal the Rh factor. As well as the presence or absence of Rh-conflict with the child, which can affect the outcome of childbirth. If necessary, a special medicine is administered to prevent the formation of antibodies to the child's blood in the mother's body.

Changes in the mother's body

Pregnancy 28 weeks - how many months have passed since the beginning of conception? For 7 months, the baby is developing in the mother's belly. The woman's forms are rounded. The belly becomes much larger. It is at this time that gynecologists are advised to wear a bandage.

The skin on the abdomen is more and more stretched, it begins to itch. Whitish streaks - stretch marks - can cover part of the abdomen. To prevent this, it is necessary to apply to the skin 1-2 times a day with special gels and creams. Even a simple oil or baby cream will help prevent stretch marks. In the morning and in the evening, the selected cosmetic should be rubbed clockwise into the abdomen.

Back pain, lower back pain begins at about 27-28 weeks of pregnancy. Increase in height, weight of the child, displacement of the center of gravity - these are the causes of these pains. It is necessary to distinguish between them. can lead to premature birth. With them, the tone of the uterus also increases. Sciatica pains are associated with an increase in the abdomen, softening of the supporting ligaments and joints.

Edema

The appearance of edema is a sign that it is time to think about weight control, time to adjust the diet, reduce fluid intake. It should be 1.5 liters per day. Liquid includes not only drinking, but also soups, and fruits, and milk.

Smoked, salted, fried, spicy foods cause thirst. Therefore, it is necessary to refuse such products. Attention should be paid to the amount of urine excreted per day. It should be more than the fluid consumed.

At 28 weeks, the fetus may be disturbed by intense edema and dropsy. Late gestosis is a serious complication, so you need to be careful about your health and nutrition.

Allocations

Light, milky shades of discharge are considered the norm. They should be homogeneous, have a slightly sour smell. If the discharge changes sharply, becomes yellow, gray, with clots of pus or mucus, you should immediately consult a doctor. If itching and a pungent odor appear, a series of tests must be carried out to detect an infection.

Watery discharge means leakage of amniotic fluid. They can be minor or profuse. In any case, watery discharge indicates a violation of the integrity of the fetal bladder. It is necessary to urgently consult a doctor.

If the pregnancy is 28 weeks - what happens with bleeding? This means presentation, detachment of the placenta. Be sure to call an ambulance in this case. Bloody discharge may be slight, smearing. Or profuse, with sharp pains. In any case, they disrupt the normal course of pregnancy and can lead to premature contractions and childbirth.

Health care

When the 28th week of pregnancy has arrived, the fetal movements are so active that they can hurt mommy. In this case, it is recommended to calm the baby down, stroke the belly or change the position of the body.

It becomes more and more difficult to walk, to bend over. However, weight gain in the last trimester is accelerating. Therefore, doctors advise not to engage in vigorous activity (especially if there are cramping pains), but to devote more time to leisurely walks. It is important to monitor the smoothness of movements, not to allow yourself to jump, tilt.

You should establish contact with the child - communicate more, stroking the belly. Sing songs, read fairy tales. The child does not yet understand the words, but he is well versed in the intonations of his parents. Therefore, it is better not to swear, not to raise your voice. Talk calmly, softly.

Nutrition

It is better to distribute food intake 5-6 times during the day. Preference should be given to small portions. A change in taste, the appearance of unpleasant sensations often accompany pregnancy. 28 weeks - what happens in the last trimester?

The appearance of heartburn is due to the fact that with an increase in the uterus, the diaphragm also rises. She presses on the stomach. Therefore, heartburn and nausea are perfectly acceptable.

A pregnant woman just needs to take foods containing calcium: cheese, cottage cheese, milk. The child's inert system continues to form, and calcium is necessary for both mother and baby. But it is better to limit the intake of potatoes, flour products, white rice - these products will contribute to fat accumulation in the woman's body. It is better to prefer cereals. For baking, use coarse flour.

Feelings of a woman

It is the 28th week of pregnancy. The movements of the baby are so noticeable that they cause inconvenience to the expectant mother. You need more rest. At this point, the legs should be kept at an elevation more often in order to prevent varicose veins.

It is important to monitor your posture. Back pain due to a misaligned center of gravity will continue until the end of pregnancy. To prevent spinal flexion, you must keep your back straight.

Veins appear on the chest more and more, colostrum appears. But a pregnant woman needs to remember that it is undesirable to squeeze out liquid from the glands. It is better to wash your breasts with cool water, wear special pads so as not to spoil your underwear.

Insomnia is possible in the last trimester. This is due to frequent urination, heartburn, thoughts of future childbirth. It is better not to dwell on anxious thoughts, not to take sedatives without a doctor's recommendation. Walking before bed, a peaceful mood, an evening shower will help you overcome night vigils.

Causes of premature birth

An improper lifestyle contributes to premature birth - smoking, alcohol, taking drugs. But even for women who have monitored their health throughout the pregnancy, some complications are possible (they, in turn, can lead to premature birth):

• Rubella disease during pregnancy.
• Genital infections.
• Immune incompatibility between parents and children.
• Inconsistency of the cervix.
• Polyhydramnios, fetal malformations.
• Detachment, placenta previa.

Childbirth at 28 weeks gestation

Timely measures taken can suspend the complications that have begun. To do this, you need to see a doctor or call the emergency team soon. The child at 28 weeks will survive only in special conditions that can be provided by the obstetric institution.

In some cases, a threat to the mother's life leads to the initiation of premature birth. The rupture of the fruit membranes and possible infection is also a reason for the start of artificial labor.

It does not matter whether it is a cesarean section or a natural birth, it is important to preserve the life and health of the mother and child. If the doctors made a decision about the operation or about artificial stimulation of activity, then the situation should be accepted without wrangling.

The postpartum period proceeds in most cases in the same way as in women who gave birth on time. Minor complications can keep the mother and baby in the hospital for some time.

By the 28th week of pregnancy, a woman's weight gain should be 9 kg. Slightly more or slightly less weight gain is allowed. However, it is necessary to monitor the increase, adjust the nutrition. It is bad if the weight is much more - this will affect the general well-being and the process of childbirth.

The raised diaphragm supports the abdomen and causes mild nausea. Therefore, it is better to sleep at this time on a high pillow. It will be most convenient to lie on the left side - it is this position that is optimal for the mother and child.

To avoid anxiety and fear of childbirth, you should add positive emotions to your life.

• Spend time with friends and relatives more often.
• Light scented candles.
• Read positive books, watch kind or funny films.
• Go to interesting exhibitions, concerts.
• Wear comfortable shoes, clothing.
• Play relaxation music.
• Choose a name for the child, talk to the baby.

Shortly before birth, the baby takes a certain position in the uterus. In most cases, it is placed head downwards - towards the exit from the uterus, and its back turns to the left. This is the correct, so-called cephalic presentation, which is most convenient for childbirth. This is how up to 90% of children are born.

Varieties of breech presentation

However, today we will talk about those cases when the legs or buttocks are the presenting part. Frequency pelvic adherence, according to various estimates, is within 3-5% of the total number of newborns. In 67% of such pregnancies, the baby sits with its buttocks in the mother's pelvic ring, his legs are bent at the hip joints, and his knees are straightened. Less common is a mixed breech presentation (20.0%), when the child enters the mother's pelvic ring not only with the buttocks, but also with the legs, more precisely, with the feet. The breech presentation also includes complete foot presentation when the baby's legs are slightly bent at the hip and knee joints; and mixed leg presentation, when one leg is almost straight and the other is bent at the hip joint; and knee presentation, when the baby is presented with bent knees.

Factors affecting breech presentation

There are certain conditions due to which the baby is in the wrong position. The following factors are distinguished:

• maternal (anomalies in the development of the uterus, limiting the mobility of the fetus and the possibility of turning its head down at the end of pregnancy; tumors of the uterus, a scar on the uterus, a narrow pelvis, preventing the establishment of the head at the entrance to the small pelvis; the uterus and the fetus are not sufficiently fixed, which also leaves the baby with room to maneuver ; numerous pregnancies and, as a consequence, weakness of the abdominal muscles; previous births in breech presentation);
• fruit (congenital anomalies fetal development; prematurity; neuromuscular and vestibular disorders of the fetus; multiple pregnancy, incorrect fetal position);
• placental (, high and low water, due to which the child moves freely, his head cannot fix in the mother's pelvic floor or, conversely, does not have the possibility of active movement, the entanglement and shortness of the umbilical cord, which also limit mobility).

At the same time, a child with an instinct for self-preservation takes the most convenient position for himself. Doctors do not disregard the hereditary factor: if the mother was born in a breech presentation, then there is a risk that her baby will take the same position.

Diagnostics of the breech presentation

Breech presentation of the fetus is diagnosed primarily by external obstetric and vaginal examination. At outdoor study a large, irregularly shaped, softish consistency, a sedentary part that is presented to the entrance to the pelvis is determined, while a large, round, solid, mobile, ballot part (fetal head) is determined in the bottom of the uterus. Characterized by a higher standing of the fundus of the uterus above the pubis, which does not correspond to the gestational age. The heartbeat is clearly heard at or above the navel. During vaginal examination with a purely breech presentation, a softish volumetric part is felt, on which the inguinal fold, sacrum and coccyx are determined. With a mixed breech and foot presentation, the feet of the fetus are determined.

Via Ultrasound it is possible to determine not only the breech presentation itself, but also its type. The position of the fetal head and the degree of its extension are assessed. Excessive extension is fraught with serious complications during childbirth: trauma to the cervical spinal cord, cerebellum and other injuries.

Coup attempt

Breech presentation, diagnosed before, should not cause concern, enough dynamic observation... The tactic is aimed at correcting the breech presentation to the cephalic presentation. There are conservative methods. For this purpose, corrective gymnastics, the efficiency of which is 75-85%. However, it cannot be used in case of fetal developmental abnormalities, the threat of termination of pregnancy, a scar on the uterus, infertility and miscarriage in anamnesis, gestosis, placenta previa, low or polyhydramnios, abnormalities in the development of the uterus, multiple pregnancies, a narrow pelvis, severe extragenital diseases. In addition to gymnastics, are used unconventional methods: acupuncture / acupressure, aromatherapy, homeopathy, as well as the power of suggestion, light and sound effects on the fetus from the outside, swimming.

If the breech presentation persists, an external prophylactic turning the fetus to the head proposed by B.L. Arkhangelsk, the efficiency of which ranges from 35 to 87%.

External preventive turn must be performed by a highly qualified doctor in stationary conditions, where, if necessary, a cesarean section can be performed and the necessary assistance provided to the newborn. After turning, it is necessary to consolidate the achieved result. For this, a certain the exercise, contributing to fixing the child's head in the desired position. However, if the baby, despite all the efforts made, did not turn over, you should not despair: even in this case, the opportunity remains spontaneous childbirth.

Choice of delivery method

A woman with a breech presentation of the fetus needs to go to the hospital for examination and the choice of rational tactics for the management of childbirth. Method of delivery is determined based on the number of births, the age of the mother, obstetric history, the readiness of the female body for childbirth, the size of the pelvis and other factors. Breech presentation of the fetus is not an absolute indication for cesarean section, however, in cases where it is combined with various complicating factors, the issue is decided in favor of operative delivery.

Indications for caesarean section routinely with full-term pregnancy, primiparous age is more than 30 years; severe form of nephropathy; extragenital diseases requiring the shutdown of attempts; pronounced violation of fat metabolism; narrowing the size of the pelvis; the estimated weight of the fetus is over 3600 g in primiparous and over 4000 g in multiparous; fetal malnutrition; signs of fetal hypoxia according to cardiotocography; violation of blood flow during dopplerometry; ; extension of the head of the 3rd degree according to ultrasound; unpreparedness of the birth canal during gestation; overburdening; foot presentation of the fetus; breech presentation of the first fetus in multiple pregnancies and other factors.

Childbirth is carried out through natural birth canal in good condition of the expectant mother and fetus, full-term pregnancy, normal pelvic size, average fetal size, with a bent or slightly unbent head, the presence of the birth canal readiness, with a purely breech or mixed breech presentation.

It is best if breech presentation fetal labor began spontaneously... In the first stage of childbirth, a woman in labor must comply with bed rest and lie on the side towards which the back of the fetus is facing in order to avoid complications (premature outpouring of water, loss of the fetal leg or umbilical cord loops). Childbirth is carried out under monitoring control for fetal heartbeat and uterine contractile activity. In the second stage of labor, it turns out obstetric care in the form of a benefit, the purpose of which is to preserve the articulation of the fetus (the legs are extended along the body and pressed to the chest by the arms of the fetus). First, the baby is born to the navel, then to the lower edge of the angle of the shoulder blades, then to the arms and shoulder girdle, and then to the head. When a child is born to the navel, its head presses the umbilical cord, and a lack of oxygen develops, therefore, no more than 5-10 minutes should pass before the full birth of the child, otherwise the consequences of oxygen starvation will be very negative. Also produced perineal incision to speed up the birth of the head and make it less traumatic.

Childbirth at foot presentation through the natural birth canal are carried out only in multiparous with good labor, readiness of the birth canal, full-term pregnancy, medium size (weight up to 3500 g) and good condition of the fetus, bent head, woman's refusal from caesarean section. In this case, the obstetric allowance is as follows: the external genitals are covered with a sterile napkin and the palm facing the vulva prevents the legs from falling out of the vagina prematurely. Holding the legs promotes the full disclosure of the uterine pharynx. The fetus, during the effort, seems to squat, while a mixed breech presentation is formed. The birth legs are resisted until the uterine pharynx is fully opened. After this, the fetus is usually born without difficulty.

The condition of children born in breech presentation through the natural birth canal requires special attention. Hypoxia, transferred during childbirth, can adversely affect the child's nervous system, a pathology such as dislocation of the hip joint is possible. A neonatologist and a resuscitator must be present at childbirth. With these precautions, babies born in this way do not differ in development from other babies.

Breech presentation is the position of the baby in the uterus with the buttocks or legs down... It is considered a certain deviation from the normal course of pregnancy and childbirth. Most often it can be due to the following reasons:

• Repeated childbirth
• Polyhydramnios
• Abnormalities of the uterus
• Fetal malformations
• Low location or placenta previa

There is a point of view that the formation of a breech presentation depends on the maturity of the fetal vestibular apparatus, therefore it is more often detected in a short period of pregnancy.

How and when can a diagnosis be made?

Up to 30 weeks of pregnancy, breech presentation is detected in 33-35% of cases. During this period, the fetus freely turns over in the uterus. By 33-34 weeks, the fetus begins to occupy a more definite position, and with full-term pregnancy, the frequency of this type of presentation is only 3-4%.

Typically, starting at 28 weeks of gestation, a breech presentation can be diagnosed with a doctor's examination and ultrasound.

When and how can the child turn into a cephalic presentation?

There are techniques that increase the likelihood of this turn, which usually occurs at 28-32 weeks. They can be started after 32-34 weeks of pregnancy, in consultation with your doctor. It is more efficient to use two or more techniques at the same time.

Special exercises

Turns. This is the simplest and most commonly recommended set of exercises. Lying on the couch, turn from side to side 3-4 times after 10 minutes. Do it 3 times a day. The rotation of the fetus usually occurs within the first week.

Using gravity

The intended effect of these exercises is that the force of gravity pushes and turns the head of the fetus against the fundus of the uterus, and the child himself unfolds into a cephalic presentation.

Tilt of the pelvis. It is performed on an empty stomach. You need to lie with your back on an inclined surface, raising your pelvis 20-30 cm above your head. In the absence of a dedicated exercise machine, you can use pillows folded on the floor in front of a low sofa.

Remain in this position for at least 5 minutes, but no more than 15 minutes. Do this exercise 2 times a day for 10 minutes for 2-3 weeks, starting at 32 weeks. Research shows that this method is effective 88-96% of the time.

Knee-elbow position. An alternative to the previous exercise. Get on your knees and elbows while your pelvis is above your head. Stay in this position for 15-20 minutes several times a day. Yoga. The classic shoulderstand pose is used.

Swimming pool. Handstand diving has been reported to be effective; the latter two approaches are quite exotic and require almost professional training.

Unconventional treatments

For successful fetal rotation with good results, acupuncture / acupressure (Bladder 67), homeopathy (pulsatilla), aromatherapy (Bougainvillea) can be used. Specialist help is needed when applying these methods.

Alternative techniques

Although there is no scientific evidence for the effectiveness of these techniques, their use is not harmful and even allows you to devote more time to your unborn child.

Suggestion. Use the power of suggestion, tell your child to turn. You can ask your partner to talk to your child.

Visualization. Visualize the baby's turn while deeply relaxing. Try to imagine not the process of turning, but the already turned child.

Light. Placing a light or music source directly above the bosom encourages the fetus to turn towards the light or sound. Place the flashlight near the crotch so the baby can turn towards the light.

Music. Place the headphones of the player with pleasant music under the clothes in the lower abdomen, this will encourage the child to move towards the music. This technique can be quite effective.

Water. There is evidence that when swimming or just being in the pool, the fetus turns. Subject to care, visiting the pool does not pose any particular problems.

How to keep the child in cephalic presentation after a successful turn?

Tailor pose. Promotes the advancement of the head deeper into the pelvic cavity. Sit on the floor with the soles of your feet close to each other. Press your knees as close to the floor as possible, and pull your feet towards you. Apply this position for 10-20 minutes 2 times a day before labor.

Timeframe 36-37 weeks - Consider an outside twist.

If you have enough amniotic fluid at 36-37 weeks, your obstetrician-gynecologist may suggest an external turn.

In the hands of an experienced physician, this technique is successful in 65-70% of cases. It is performed in a maternity hospital with monitor, ultrasound monitoring of the fetus and the introduction of drugs that relax the uterus. The greatest risk with external rotation is the possibility of placental abruption, however, due to ultrasound control, this rarely happens.

Is your unborn baby still in breech position?

You have exhausted all possibilities, and the baby is still in breech presentation. Even so, you can give birth to it yourself. Up to half of the births with this type of presentation pass through the natural birth canal. When deciding on a spontaneous delivery of a fetus in a breech presentation, several criteria are usually considered, although there are different opinions about their exact definition. A successful breech delivery is more likely if you have:

• The fetus is in a pure breech presentation (straightened legs are raised up)
• You have already had one or more vaginal births
• The fruit is not judged to be oversized
• No pelvic or uterine abnormalities

In some cases, with breech presentation, a cesarean section is preferable. Your doctor will help determine the best option.