Obstetric rotation: External obstetric rotation of the fetus

This operation is carried out with the transverse, oblique position and pelvic presentation of the fetus in order to return the fruit to the head.

Sometimes the fetal position can be corrected in an oblique or transverse position without surgical intervention. To do this, you need to invest the woman on the other side, which is facing the head. With a breech presentation of a pregnant woman from 26 weeks of gestation, it is recommended that you exercise by Dikan: on a hard sofa or floor with an incomplete stomach, a woman must return three times a day for one hour every 10 minutes from one side to the other. In this case, the fruit often returns on its own. In those cases where the position of the fetus can not be corrected in this way, an external obstetric turn is indicated.

Conditions for the operation obstetric turn:

1. Pregnancy 34-36 weeks, live fetus.

2. Compliance and lack of tension of the abdominal wall and the walls of the uterus.

3. The normal size of the pelvis is pregnant.

4. Mobility of the fetus.

5. The consent of the pregnant woman.

Contraindications to surgery:

1. Complications of pregnancy by bleeding or threat of interruption.

2. Spontaneous miscarriage or premature birth in an anamnesis.

3. Polyhydramnios and water scarcity.

4. Multiparty.

5. Narrow pelvis, scars or vaginal tumors that do not allow spontaneous delivery.

6. Complications of pregnancy and extragenital pathology in the stage of excited compensation.

7. Scar on the uterus.

8. Anomalies in the development of the uterus and fetus.

The operation is performed only in the hospital after the bladder and bowel have been emptied. The woman is on a hard couch in a position on her back. Anesthesia is contraindicated. Suppose the introduction of 2ml no-shpah, 1 ml of a 1% solution of promedol or 1 ml of a 0.1% solution of atropine for 20-30 minutes. before surgery.

Technique of operation with an external turn

Sitting on the right side of the obstetrician puts his hands on the woman's stomach, so that one hand lies on the head, capturing it, and the second - on the sciatic end.

External preventive rotation is expedient to conduct according to BA Arkhangelsky. The direction of movement should be from the ischium to the side of the fetal back, from the back to the side of the head, from the head to the side of the breast, to the entrance to the pelvis. This technique allows you to prevent the formation of extensor presentations. Thus, with the breech presentation, the fruit should be rotated 180 °, with a rear view of the transverse position (when the frontal back is facing the bottom of the uterus) - by 90 °, with the front view of the transverse position (when the back is facing the entrance to the small pelvis) - by 270 ° to translate the fetus first into the gluteal, and then into the cephalic presentation. If at the time of the turn there is pain or tension of the uterus or abdominal wall, the manipulation should be stopped until the organ is completely relaxed. After the turn, listen to the fetal heartbeat. It may become somewhat more frequent, but after 1-2 minutes it should again return to normal. If the fetus is successfully rotated from a transverse or oblique position, bandaging with a lining on both sides of the abdomen of the rollers is shown to fix the fetus in a new position. Before giving birth, a woman is subject to systematic supervision.