What does the transverse position of the fetus mean during pregnancy?

A key factor in the delivery process is the baby’s position in the womb. As pregnancy goes on, most babies learn to lie head-down, but occasionally the baby might be lying sideways across the womb. The transverse position is what’s called for this.

Expectant parents can better prepare for potential medical interventions by being aware of what a transverse position entails. Although less common, this position might need extra care as the deadline draws near.

This post will describe the causes of transverse positions, how to spot them, and what to do to make sure a delivery goes smoothly.

What is it?

A transverse position is spoken of when the baby is in the uterus across. If you mentally draw a line along the baby"s spine, then with an oblique presentation it will intersect with the axis of the uterus at a right angle. In this way, the baby"s thigh and elbow can be facing the exit from the uterus. The head will be located on one side, and the bottom – on the opposite. There are several options for the transverse position. If the baby is facing the mother"s anterior abdominal wall, then we are talking about a transverse face presentation, if the baby is turned forward with his back, then a transverse fetal position with a dorsal presentation is diagnosed. In all cases, transverse or oblique transverse presentation (if the baby"s axis creates not a straight line, but an acute angle when intersecting with the central axis of the uterus) are considered a pathology of pregnancy.

This pathology is rare. Less than 1% of pregnant women experience a transverse position of the baby in the womb. In 97% of pregnant women, babies are located in the cephalic presentation, in 2-2.5% – in the breech. And only in 0.5-0.6% of cases do children take an unusual transverse presentation from the point of view of the laws of nature. Most often, this position of the fetus is characteristic of women who have given birth many times and often. During the first pregnancy, transverse presentation is isolated cases. Up to 34-35 weeks of pregnancy there is no talk of pathology, because the baby has a practical and theoretical opportunity to independently turn over in the uterus before childbirth, but after 35 weeks the turn becomes almost impossible, because there is no more free space for such wide movements in the uterus

Dangers and risks

This position has little effect on the course of pregnancy itself. However, it should be remembered that any incorrect position of the child in the uterus is a significant risk factor for premature birth. In the case of a transverse position, this happens in 40% of cases. A child who is born much earlier than the expected obstetric date cannot always adapt to a new environment. Thus, with immaturity of the lung tissue, problems with independent breathing may arise, acute respiratory failure may develop, and with a low weight of a child born prematurely, it will be difficult for the baby to retain heat. In the event of spontaneous labor, small parts of the child"s body and umbilical cord loops may fall out along with the outpouring of water. This is fraught with the death of the child, injuries, deformities, disability, development of severe complications from acute hypoxia. For a woman, such childbirth is dangerous to injuries of the pelvic bones, ruptures of the perineum, neck and body of the uterus, vagina, plentiful bleeding. In severe cases, everything can end in death of both the child and the woman in labor.

Rapid spontaneous births frequently result in the child’s shoulder being "injected" into the small pelvis, causing the fetus to develop in an advanced transverse position that makes it impossible for the child to birth independently. The most frequent cause of uterine rupture is a neglected transverse position. The child’s position is regarded as transitional if it is oblique. It is theoretically possible for it to change to either the longitudinal or transverse orientation during childbirth. Of course, nobody is going to wait for the baby to turn; the stakes are too great.

Because of this, it is advised that women with transverse presentations give birth surgically by cesarean section, which minimizes the risk of severe birth trauma or hypoxia. The procedure will also ensure that the expectant mother’s pelvis and perineum do not sustain fractures or ruptures.

Causes

Most often, babies who can easily and freely move in the uterus even at later stages end up in the transverse position. Such motor activity is facilitated by polyhydramnios. If the amount of amniotic fluid is higher than normal, the baby may well take this position and “get stuck” in it. Also, active movements at later stages are facilitated by weak and overstretched walls of the uterus. Weakness and some flabbiness of smooth muscles are typical of women who give birth a lot and often. As strange as it may sound, but the transverse position is also facilitated by low motor activity, or rather, the inability of the child to move. Such a condition is typical of oligohydramnios. Large hypertrophied children also experience difficulties with movements and turns.

Because a woman carrying multiples runs the risk of having one or both transversely present at the same time, every fetus’s position and condition are closely monitored during the entire multiple pregnancy.

The baby can take a transverse position as the only comfortable one if the woman has an almost constant increased tone of the uterus during pregnancy, and also has tumors or other neoplasms in the lower uterine segment. The establishment of a normal cephalic presentation due to this becomes unacceptable for the child. In addition, transverse or oblique presentation is often observed during pregnancy in women with congenital abnormal features of the main reproductive organ – a saddle-shaped or bicornuate uterus. Quite often the placenta interferes with the baby if it is located low or if it is completely or partially presented. When the entrance to the small pelvis is blocked by something, the baby cannot get into the correct position – cephalic presentation. A woman with a clinically narrow pelvis can also have a baby positioned across the womb. Sometimes the reason for the incorrect positioning of the baby is not in maternal factors, but in the baby itself. So, with hydrocephalus (dropsy of the brain) or anencephaly (absence of the brain), the baby does not take the cephalic position, but remains either sitting in a breech presentation or lying across the uterine cavity.

Diagnostics

A transverse presentation can be determined by an obstetrician-gynecologist during an external examination of the pregnant woman, as well as during a vaginal examination. Usually, the height of the fundus of the uterus, which is measured at each scheduled appointment at the clinic, is below the norm with a transverse position, and the pregnant woman"s tummy even visually looks like a torpedo melon. During palpation, the position of the fetus is determined by the location of the head – this is the hardest and most mobile part of the child"s body. In case of cephalic presentation, it is felt in the lower abdomen, above the pubis, in case of breech presentation – near the bottom of the uterus (in the upper abdomen), in case of transverse presentation, the head is either on the right or left side of the expectant mother. The baby"s heartbeat is determined near the navel of the expectant mother. A vaginal examination allows you to exclude the presentation of the head or bottom. Then the expectant mother is recommended to undergo an ultrasound. Only ultrasound scanning allows you to get the most accurate data on what position the baby is lying in, what are the features of its position, what part of the body is located at the exit to the small pelvis, and also to estimate the baby"s weight. All this data is needed so that the doctor can more carefully assess the risks and choose the correct tactics for childbirth, in which neither the mother nor the child will suffer.

What to do?

If a woman has transverse presentation at 24-25 weeks of pregnancy, as well as earlier or later than this period, there is no need to panic. Up until the 35th week, the baby has time to turn over. The expectant mother needs to try with all her might to help her baby take the correct position in the uterine cavity. For this, special gymnastics is recommended, in which each exercise is designed in such a way as to maximally relax the muscles of the uterus, giving the baby the opportunity to turn over. The set of exercises includes the sets of exercises by Dikan, Shuleshova, Grishchenko. There are also other sets developed by gynecologists specifically for women who need help in turning the baby. It should be noted that with a positive attitude and daily exercises, the effectiveness of gymnastics reaches about 70-75%. This is the percentage of babies who still move from an unstable transverse or oblique position to a cephalic one.

For fetal turning, gymnastics is not advised for everyone. Therefore, women with conditions affecting the heart, blood vessels, kidneys, or liver are not allowed to exercise. Another contraindication is having one or more scars from prior cesarean sections or other surgeries on the uterus.

If a pregnant woman has edema, signs of gestosis, a threat of miscarriage, bloody discharge, placenta previa or low location, gymnastics cannot be done. It is advisable to do gymnastics for those for whom it is not contraindicated from 30 to 36 weeks of pregnancy. If the baby stubbornly refuses to take a different position, doctors may suggest an obstetric turn according to Arkhangelsky. It is done in a hospital setting under ultrasound control. The baby is turned manually. But such an intervention is quite dangerous, it can provoke a rupture of the fetal membranes, the outpouring of amniotic fluid, the onset of premature labor, as well as injury to the fetus. That is why doctors themselves rarely decide on an obstetric turn. I would like to separately emphasize the importance of a positive attitude of the pregnant woman. Many experts claim that methods of persuading the baby, gentle persuasion in combination with corrective gymnastics give amazing results.

The likelihood of an autonomous turn over near delivery will rise dramatically if the expectant mother maintains a positive outlook and a peaceful, harmonious demeanor.

With transverse presentation, it is important to prevent premature birth. That is why a woman should be extremely careful – do not lift weights, do not jump, do not make sharp bends of the body. Sex should be done with caution, because orgasm and even normal sexual arousal in a woman cause short-term spasms of the smooth muscles of the uterus. If at the same time as transverse presentation, a low position or placenta previa is diagnosed, then it is recommended to completely abstain from sex, as well as from masturbation. Stress should be avoided. Additionally, a woman should only lie on her side, completely repeating the position of her baby. How to do this correctly, the doctor will tell you after the ultrasound, since he will see the exact position of the body and body parts of the child. You cannot miss scheduled visits to the doctor at the antenatal clinic. Most likely, the attending doctor will offer early hospitalization – at 36-37 weeks of pregnancy, and this will be the only reasonable decision to avoid unwanted complications. You should not refuse it under any circumstances.

In the event that, in spite of every safety measure, a woman experiences an early onset of labor, consistent, excruciating contractions, and her waters burst, it’s critical to position herself horizontally to keep the baby’s breech arm from slipping out of the genital slit. You then need to dial an ambulance right away.

The woman will receive emergency care, and after being brought to the hospital, there’s a 99 percent chance that she will have an emergency cesarean section.

The baby is not lying head-down in the womb during pregnancy; rather, it is lying sideways in the transverse position of the fetus. Because of this, a natural birth may be risky or difficult because the baby’s shoulders would emerge first. It is frequently discovered during routine check-ups, and if the baby remains in this position closer to the due date, doctors may advise a cesarean section or offer strategies to help the baby move into a better position before delivery.

Is it possible to give birth on your own?

Childbirth with transverse presentation can be dangerous, we talked about this above. With this position of the baby, in 99% of cases a cesarean section is performed. It is better if it is performed before the onset of spontaneous labor, which is why early hospitalization in the maternity hospital is recommended. Absolute indications for surgery are post-term pregnancy in transverse or oblique presentation, fetal hypoxia, as well as the presence of scars on the uterus. If a pregnant woman was taken to the maternity hospital in an emergency with the discharge of water, doctors will definitely make sure that the baby"s body parts have not fallen out. If prolapse is detected, it is prohibited to put the arm or umbilical cord back in.

If by the time of hospitalization the woman"s cervix is ​​fully dilated, doctors can try to turn the baby on its leg, in order to then extract it legs first. But they will not always do this, but only if the baby is very premature, weighs little, and also in the case of a twin pregnancy, if one of the babies is lying across. If the anhydrous period (the time that has passed since the waters broke) is prolonged, then the probability of infection of the uterine cavity and the development of fetal hypoxia increases. The critical time is considered to be 12 hours. If a woman is brought by ambulance after a long anhydrous period, a cesarean section will be performed in any case, regardless of the degree of dilation of the cervix.

For a woman, receiving treatment too late puts her life in danger because sepsis sets in. In these cases, a hysterectomy—the complete removal of the uterus—must frequently be done following a cesarean section. It is impossible for a woman to become a mother.

A planned cesarean section at 37–38 or 38–39 weeks of pregnancy seems like a more sensible course of action given the high risks. The procedure takes about forty minutes, and the woman can get up after ten to twelve hours. As with natural childbirth, the expectant mother will be able to look at her child right away and the baby will be put to the breast right away thanks to modern anesthetic techniques that allow her to be conscious throughout the baby’s extraction and not feel pain.

When a baby is sideways in the womb during pregnancy, it is said to be in the transverse position. Although less common than other positions, if left untreated prior to labor, it can cause difficulties during delivery.

Physicians keep a close eye on this position, particularly as the deadline draws near. Although head-down positioning occurs spontaneously in many cases, medical interventions such as external cephalic version or cesarean section may be advised if this does not occur.

In order to guarantee a safe and healthy delivery for both mother and child, it is crucial for expectant mothers to remain informed and communicate any concerns to their healthcare provider.

Video on the topic

Obscrew and transverse presentation of the fetus | How to turn the baby? Obstetrician-gynecologist

External obstetric version by the hands of the head physician of the ShchPTs Pasternak A. Yu. 🔥

INCORRECT POSITION OF THE FETUUS DURING PREGNANCY | Are there any chances to give birth yourself

At what stage does the baby turn upside down? Breech presentation of the fetus