- Pelvic position - types
- Pelvic position - diagnosis
- Pelvic position - causes
- Dangers to the fetus in the pelvic position
- Perinatal management in the pelvic position
- The course of labor from the pelvic position through natural paths
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Gluteal delivery is the common name for longitudinal pelvic delivery. We talk about it when the front part is not the child's head, but its buttocks or lower limbs. Check what are the causes of the pelvic position, what risks may occur in such a pregnancy and whether vaginal delivery is possible.
Breeding in the pelvic positionof the fetus is popularly referred to as " gluteal delivery ", although it is imprecise. The gluteal position is one of the few positions that the fetus can assume in the pelvic position. The pelvic position of the fetus occurs in about 3-4% of deliveries. Usually, but not always, a pelvic pregnancy ends with a caesarean section.
Pelvic position - types
Depending on which part of the child's body is the leading part, we distinguish the following types of pelvic position:
- complete pelvic position(5-10% of cases), in which the child's legs are bent at the hips and knees, and the feet and buttocks are the leading part (the child looks as if in Turkish).
- gluteal position(50-70% of cases), in which the child's legs are bent at the hips and the feet are near the head (the child takes the position "folded in half" ). The buttocks are the leading part
- foot position(10-30%), in which the child's legs are completely straightened in all joints, and the feet are the leading part.
- knee position(approx. 1%), in which the child's legs are bent at the knees and one or both knees are the leading part
Pelvic position - diagnosis
The diagnosis of the pelvic position can be made by an experienced obstetrician-gynecologist. External examination using the so-called Leopold's grips may indicate the presence of a hard, round structure - the baby's head - in the fundus.
Auscultation of the abdomen with a stethoscope reveals the best audible fetal heartbeat in the area above the navel. The final confirmation of the diagnosis is an ultrasound scan (USG).
Pelvic position - causes
In the vast majority of pregnancies, the unborn child can turn freely around the end of the second trimester.
W IIIDuring the third trimester of pregnancy, the baby becomes larger and larger, and his movements are slowly limited by less and less free space.
It is natural for the baby's head to move towards the birth canal. In some cases, the baby positions itself in this way only in the last weeks before delivery.
After 35 weeks of pregnancy, every fourth child in the pelvic position turns to the head position before delivery.
It is estimated that in about 3-4% of pregnancies, the baby remains in the pelvic position at term.
The exact reasons for this fetal position remain unknown in most cases. A number of maternal and fetal factors are listed which may increase the risk of a pelvic position. These include:
- abnormalities in the structure of the mother's pelvis (e.g. too tight pelvis, tumors in the pelvic area)
- defects in the structure of the uterus (e.g. myomatosis, uterine septum)
- incorrect amount of amniotic fluid (both oligohydramnios, limiting the baby's movements, and polyhydramnios, giving him excessive space to change position)
- placenta previa, altering the internal shape of the uterus
- preterm labor (as mentioned earlier, the less advanced the pregnancy, the greater the fetal mobility - in the case of preterm labor, the baby may not be in the head position. Premature babies constitute 30% of newborns born from the pelvic position
- birth defects of the fetus, changing the shape of its head
- multiple pregnancy (in a twin pregnancy, in only 40% of cases both fetuses are in the cephalic position)
Dangers to the fetus in the pelvic position
Vaginal delivery of the fetus in the pelvic position carries a higher risk of complications compared to the head position. In such a birth, the largest part of the baby's body, i.e. the head, is born last. This poses a significant risk of both disorders of blood flow in the umbilical cord.
It happens that the child's head or shoulder, which is born at the end, puts a significant pressure on the umbilical cord, which reduces the amount of blood reaching the child's body, and consequently its hypoxia.
Delivery of the head and shoulders often requires support or assistance of qualified personnel and is associated with the risk of mechanical injuries. Perinatal injuries can affect both the bones of the skull and the structures of the central nervous system.
A relatively common neurological complication is paralysis of the shoulder plexus. In the event that childbirth takes placeprematurely, risks may also result from complications of prematurity.
Perinatal management in the pelvic position
External Fetal Rotation
External Fetal Rotation is a procedure to rotate a fetus from a pelvic to a head position by careful manipulation and pressure on specific areas of the mother's abdomen by an experienced operator. Studies show that this method reduces the frequency of a cesarean section without significantly increasing the risk of complications for the fetus.
External rotation is not particularly painful, although it can be unpleasant at times. It is performed under the conditions of full control and monitoring of the condition of the fetus. An attempt of external circulation can be made only around the date of the expected delivery, when the pregnancy is termed.
A successful external rotation enables vaginal delivery, while an unsuccessful rotation attempt usually results in a caesarean section. For this reason, rotation is performed only in facilities with appropriate facilities and the ability to quickly transport a pregnant woman to the operating room in the event of a Caesarean section.
Choosing the method of delivery
The choice of the method of delivery requires the consideration of many factors that may affect the prognosis. Currently, in developed countries, delivery of a fetus from a pelvic position is most often performed by caesarean section. In some situations it is possible to have this type of vaginal delivery. Factors that increase the chance of a successful vaginal delivery include:
- second or subsequent birth of the mother (in the case of primiparous women it is not certain that the anatomy of the pelvis will allow the baby to pass through the birth canal. There may be a situation where after the birth of the baby's legs and torso, the head would become wedged)
- appropriate pelvic width
- complete pelvic position of the fetus
- estimated fetal weight between 2,500 and 3,500 g
- appropriate gestational age (term pregnancy)
- normal uterine contractions and labor progress
- general well-being and no birth defects of the fetus
In practice, vaginal delivery can only be performed with the assistance of experienced personnel. It requires constant monitoring of the condition of the fetus and the availability of the operating room, if a cesarean section is necessary.
The course of labor from the pelvic position through natural paths
There are 3 variants of vaginal delivery:
- spontaneous delivery , i.e. fully independent, requiring no obstetrician intervention
- assisted deliverymanual , consisting in the spontaneous delivery of a newborn approximately up to the navel, followed by an obstetrician's intervention to safely extract the baby's shoulders and head. This is the most common variant of vaginal delivery
- total extraction of the fetus , which is a procedure involving the extraction of the entire newborn from the mother's womb. This is a relatively high-risk procedure that is currently used only when immediate removal of the second fetus (in the pelvic position) during the birth of twins.
Conducting a vaginal delivery requires the experience of an assistant obstetrician and strict adherence to certain rules.
You should strive to maintain the continuity of the membranes as long as possible, while the pressure should only start after the cervix is fully dilated. An incompletely open neck poses a risk of the child's head not being able to pass through and significant pressure on the umbilical cord. In many cases, the timing of head and shoulder delivery is supported by intravenous oxytocin, a hormone that causes uterine contractions.
Childbirth is carried out under constant monitoring using a cardiotocograph (KTG), a device that records the fetal heartbeat and uterine contractions.
About the author
Krzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.
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