Gluteal presentation. Diagnostics

Breech presentations, like the main ones, are recognized due to external obstetric and internal examinations.

At external obstetric examination the following signs of pelvic presentation are observed:

1. High standing (under the xiphoid process) of the uterine fundus.

2. At the bottom of the uterus, a rounded, dense, dense part of the fetus is identified.

3. Above the entrance to the small pelvis, the wrong shape is palpated, soft, sometimes denser, most of the body, inactive.

4. Mobility of the presenting part above the entrance to the small pelvis at the end of pregnancy.

5. High (at the level of the navel or higher) the location of the best listening position of the fetal heart.

When conducting an external obstetric examination, it is necessary to try to identify possible extension of the fetal head. The end of labor in many ways depends on its degree.

It is necessary to distinguish 4 positions of the fetal head with pelvic presentations.

1. The head of the fetus is bent (the chin is pressed to the chest)

2. The head of the fetus is slightly unbent (the "military" posture) - the 1st degree of extension.

3. The head of the fetus is moderately unbent (cervico-occipital furrow not more than 90 °) - II degree of extension.

4. The head of the fetus is excessively unbent (cervico-occipital furrow more than 90 °) - III degree of extension.

The clinical sign of unbending the head is the discrepancy between the size of the head and the size of the fetus (the head seems bigger).

To clarify the presentation in childbirth, an internal obstetrical study is conducted, during which a soft, three-dimensional part of the fetus is determined on which it is possible to identify the sciatic bumps, the sacrum, and the foot of the fetus. In this case, it is necessary to distinguish the presenting leg from the handle of the fetus, focusing on the thumb that is left on the arm and orienting on the presence or absence of the calcaneal tubercle.

The most informative is ultrasound, which makes it possible to clarify the presentation, the size of the fetus, the location of the placenta, the degree of extension of the head.