What is the presentation of the fetus and what does it affect?

The term "fetal presentation" refers to the position of the developing baby inside the womb during pregnancy. The area of the baby’s body that is positioned to emerge first during delivery is referred to as this. It is crucial to comprehend how the fetus presents itself because it can affect the kind of birth a mother will experience.

The most typical presentation—and typically the safest for a natural birth—is head-first. A more difficult delivery may result from the baby being positioned differently, such as feet-first or bottom-first, on occasion.

Understanding the fetus’s presentation aids medical professionals and expectant parents in planning for the safest delivery scenario, including vaginal delivery or, if necessary, cesarean delivery.

Term	Description
Fetal presentation	The way the baby is positioned in the womb before birth, usually head down.
Types of presentation	The most common is head-first, but babies can also be breech (feet or bottom first) or sideways.
Importance	The position of the baby affects the type of delivery, with head-first being the easiest for vaginal birth.
Delivery method	If the baby is in breech or sideways position, a cesarean section may be needed for a safe delivery.

What is it?

Pregnancy causes the baby to move around in the mother’s womb on multiple occasions. Throughout the first two trimesters, the fetus has ample room inside the uterus to roll around, tumble, and assume different positions. There is no diagnostic value to the information presented about the fetus at these stages; it is merely stated as fact. However, everything changes during the third trimester.

There is not much space for the baby to move around, and by the 35th week of pregnancy, the baby has taken up a permanent position in the uterus, making a coup extremely unlikely. It is crucial to know whether the baby is in the right or wrong position during the last third of pregnancy. This determines the delivery strategy to be used as well as the likelihood of complications for the mother and her child.

When we talk about presentations, it’s critical to know precisely what we mean. Let’s attempt to clarify the terminology. The position of the majority of the fetus in relation to the entrance of the uterus into the pelvic region is known as fetal presentation. The infant can be positioned obliquely across the uterus or turned towards the exit by the head or buttocks.

The relationship between the baby’s body’s longitudinal axis and the uterine cavity’s axis is the fetus’s position. The baby may be placed obliquely, transversely, or longitudinally. It is believed that a longitudinal position is the norm. The fetus’s position is determined by how close its back is to either the left or right uterine wall. The relationship between the back and the front or back wall of the uterus is thought to determine the type of position. The way a baby’s arms, legs, and head relate to its own body is known as its limb position.

The position of the baby is determined by all these factors, which are always considered when determining whether a woman will give birth naturally, naturally with stimulation, or by cesarean section. Any of the specified parameters can deviate from the norm, but the presentation is typically the deciding factor.

Types

There are various ways that a baby may present themselves, depending on which part of their body is closest to the entrance of the uterus into the small pelvis, which marks the start of their journey at birth.

Breech

The bottom or legs of the baby are facing the exit in roughly 4–6% of pregnant women. The baby is in a position in the uterus where its buttocks are pointed toward the exit when it is in a complete breech presentation. Another name for it is breech. When one or both of the baby’s legs "look" toward the exit, it’s referred to as a foot presentation. A mixed (combined or incomplete) breech presentation is one in which the legs and buttocks are positioned next to the exit.

Additionally, there is a knee presentation, where the baby’s legs are next to the exit with their knees bent.

It is thought that breech presentation is pathological. Both the mother and the child may be in grave risk. The most prevalent is breech presentation, which has a better prognosis than foot presentation, particularly knee presentation.

There are a variety of reasons why a baby presents breech, and not all of them are clear-cut to medical professionals and scientists. It is thought that head up and bottom down positions are most frequently displayed by children whose mothers have diseases and abnormalities related to the uterine, appendage, or ovarian structures. Women who have had numerous abortions, uterine cavity curettage surgery, scarring on their uteruses, and numerous births are also vulnerable.

Breech presentation can result from a chromosomal disorder in the baby or from abnormalities in the structure of its central nervous system, such as brain absence, microcephaly or hydrocephalus, abnormalities in the vestibular apparatus’s structure and function, or congenital musculoskeletal system malformations. One of the twins is capable of sitting as well, and it is risky if the infant is lying closest to the exit when this happens.

Additional risk factors include low placenta previa, entanglement that obstructs the baby’s turn, oligohydramnios and polyhydramnios, and a short umbilical cord.

Cerebral

It is believed that a child’s cerebral presentation is correct and ideal for them by nature. The baby’s head is next to the opening into the woman’s tiny pelvis with it. There are various distinct forms of cephalic presentation based on the child’s position and type of position. This is known as an occipital cephalic presentation if the infant is facing out of the window. The first part of the head to conceive will be the back. Anterior parietal or temporal presentation occurs when the infant is oriented in a profile towards the exit.

Because of the wider dimension and the slightly harder head movement along the woman’s birth canal, labor is typically a little more challenging in this position.

The most hazardous presentation is frontal. The baby uses its forehead to "punch" its way through. When the baby’s face is turned toward the exit, the presentation is referred to as facial; the baby’s facial structures will emerge first. During labor, the occipital version of the cephalic presentation is thought to be safe for both the mother and the fetus. Other forms are essentially elongated forms of the cephalic presentation; they are very difficult to call normal. The cervical vertebrae could be harmed, for instance, if the baby passes through the birth canal with a facial presentation.

Moreover, a low cephalic presentation is possible. The baby presses its head against the exit to the small pelvis or partially exits into it too early when the stomach "drops," as they refer to it on the "finishing straight." This process usually takes place in the final month prior to delivery. Pregnancy and presentation are also regarded as pathological if the head drops sooner.

By weeks 32–33 of pregnancy, up to 95% of all babies are typically in a cephalic presentation.

Transverse

When the presenting part of the baby’s body is absent, both oblique and transverse positions of the baby’s body inside the uterus are regarded as pathological. This kind of presentation is uncommon; only 0.5-0.8% of pregnancies end in this kind of complication. It is also quite difficult to systematize the reasons for the baby’s location across the uterus or at an acute angle to the exit into the small pelvis. They don’t always make sense to explain in a rational and reasonable way.

The transverse position of the fetus is typically seen in women whose pregnancies are preceded by oligohydramnios or polyhydramnios. The baby has too much room to move in the first instance, and his motor skills are severely restricted in the second. After giving birth, women usually experience overstretched uterine ligaments and muscles, which lack the elasticity needed to hold the fetus in place, even during later stages of pregnancy, as the child continues to move the mother’s body around.

Because the nodes prevent the child from being positioned normally, women with uterine fibroids frequently have transversely located fetuses. It is frequently impossible to position the baby correctly in women whose pelvises are clinically narrow.

Diagnostics

Diagnosing the fetus’s presentation does not make sense up to 30-32 weeks. However, during a standard external examination at this point, an obstetrician-gynecologist can make judgments about what portion of the baby’s body is next to the uterine exit. The height of the uterine fundus typically exceeds or falls short of the normal value when the baby is positioned incorrectly in the mother’s womb (breech presentation).(with transverse presentation).

The baby’s transverse position causes the abdomen to appear asymmetrical and rugby ball-shaped. Just stand up to your full height in front of a mirror to easily determine this position on your own.

The mother’s navel is where the misplaced baby’s heartbeat is audible. There is no discernible dense round head when the lower uterus is palpated. When a baby is presented breech, it feels in the uterine fundus; when it presents transversely, it feels on either the right or left side.

To further clarify the information, the physician performs a vaginal examination. An ultrasound scan is an unquestionable way to confirm the diagnosis. In addition to establishing the precise location, posture, and presentation, it also establishes the fetus’s weight, height, and other factors that are essential for a more deliberate selection of the delivery mode.

Possible complications

Everyone is susceptible to difficulties during childbirth and pregnancy, even in cases where the baby appears to be positioned correctly at first. The most hazardous, though, are transverse and breech presentations.

The probability of an early birth is the primary risk associated with a breech presentation of the fetus. About thirty percent of pregnancies end in this way, with the baby positioned head up in the mother’s belly. Premature amniotic fluid rupture occurs frequently in these women; it is swift and often results in the baby’s body parts—limbs, legs, and umbilical cord loops—falling out of the water along with the baby. Any of these issues could result in severe harm, rendering the infant crippled from birth.

Women who present breech frequently experience weakness in their labor forces during the early stages of labor, and their contractions do not produce the desired effect—the cervix either does not open at all or opens very slowly. Risks during childbirth include the baby throwing back its head or arms, cervical spine, brain, and spinal cord injuries, placental abruption, and the beginning of acute hypoxia, which can cause the child to die or completely disrupt the nervous system.

The breech position of the fetus poses a risk to the laboring mother because it can cause severe pelvic injuries, uterine ruptures, massive bleeding, and perineum ruptures.

Breech presentation frequently coexists with placental diseases, fetal hypoxia, and umbilical cord entanglement. Breech babies frequently present with lower body weights, hypotrophy, metabolic abnormalities, congenital heart defects, gastrointestinal tract pathologies, and kidney problems. The rate of development of some brain structures slows down and becomes disrupted by the 34th week of pregnancy if the baby does not assume the proper position.

There shouldn’t be any issues during pregnancy or labor if the baby is in the cephalic presentation, with the back of the head facing the exit longitudinally. Other cephalic presentation options may make it more difficult for the head to move through the birth canal and prevent it from extending toward the mother’s sacrum, which may result in hypoxia and weaken the laboring muscles. Doctors use forceps in this situation if they think the child’s life is in danger. Given the high number of birth injuries that occur to children following the use of obstetric forceps, this raises a lot of questions.

With a frontal presentation, the prognosis is the worst. It raises the risk of cervix ruptures, uterine ruptures, fistula formation, and infant mortality. With the exception of frontal, almost all forms of cephalic presentation can be accommodated during a natural childbirth. The primary risk associated with low cephalic presentation is premature birth.

These births won’t always be complicated or challenging, but, just as the baby’s lungs occasionally don’t have enough time to develop, the baby’s nervous system might not have enough time to mature for an autonomous life outside the mother’s womb.

A transverse presentation poses a risk because it is unlikely to be possible to deliver a child naturally without significant deviations. Complete transverse correction is practically unaffected if the baby’s oblique position can still be corrected during labor, if it is still closer to the head.

Such births can result in serious injury to the baby’s spine, limbs, hip region, musculoskeletal system, brain, and spinal cord. These wounds typically involve more severe lesions that essentially render the child disabled; they hardly ever have the characteristics of a fracture or dislocation.

Children with transverse presentation frequently suffer from chronic hypoxia during pregnancy; prolonged oxygen deprivation causes irreversible brain damage as well as abnormalities in the development of the senses, including hearing and vision.

Expectant parents must comprehend the fetus’s presentation because it can affect the delivery process. Midwives and doctors can better plan for a safe delivery when they are aware of the baby’s position, whether it is head-down, breech, or transverse.

While the majority of newborns instinctively assume the ideal head-down position, some may continue to present differently, necessitating further care or interventions. You can better prepare for the day of delivery by keeping yourself informed and talking with your healthcare provider about your baby’s position.

Regardless of the presentation, the most crucial thing is to protect the mother’s and the baby’s health and safety. When given the right medical attention, most deliveries go well.

The baby’s position inside the womb during labor is referred to as the "presentation of the fetus," especially the portion of the body nearest to the birth canal. It may affect the course of the delivery; head-down is the most common and optimal position for a smooth delivery, but other presentations, such as breech, may necessitate special attention or even a cesarean section to protect the mother and child.

Video on the topic

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