OBSTETRICS : TRANSVERSE FETAL POSITION (SITUS TRANSVERSUS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Polyhydramnios, multiple pregnancy, narrow pelvis, malformations of the uterus (a uterus bicornis), saggy flabby stomach.
During pregnancy when the transverse position of the fetus do not show any significant symptoms. During childbirth, if not timely provided obstetric care, transverse lie can go after the separation of water in a running transverse position and end with the death of the foetus and the mother of uterine rupture, bleeding, shock and infection. Spontaneous labor at the transverse position of the fetus is possible in very rare cases (very small materialmany fruit) by samosvat,
More often than transverse position of the fetus, there is an oblique position when the axis of the fetus is located obliquely relative to the axis of the uterus. The oblique position of the fetus often in the last months of pregnancy or early postpartum itself into longitudinal position (campomoro). If oblique position remains sustainable, pregnancy and childbirth when this complication will not differ from those in the transverse position of the fetus.
The position of the fetus in the lateral position is determined by the location of heads: head left to the first position, to the right is the second position. Vaginal examination during labor can be specified, along with the degree of opening, the direction of the back - anteriorly or posteriorly, fell into the vagina pen and exactly what is the right or left. The handle is also possible to determine the position of the head. For this we need the dropped pen make is supinated. The direction of the thumb handle the fetus will point to the direction of the head. Examples: had the right handle and the fruit is either in the first position, the front, or in the second position,the rear view. Had his left arm - the fruit is either in the first position and the rear, or in the second position and the front view. The location of the fetal head can be set by internal research, if you go up on the handle, and to determine the axilla. Head is in the direction of the closed part of the basin. The backrest is determined by the blade. Dropped the handle of the fetus should be distinguished from the legs. Identification points that would help to clarify the diagnosis may be:
Running transverse fetal position detected by the prescription of separation of water, the presence of a prolapsed vagina handles and the loss of the fruit of his mobility in the uterus as a result of water flowing, dense coverage of the fruit of the walls of the uterus and is firmly of valtellinese into the entrance of the pelvis swollen to the shoulder of the fruit. A study should be carried out extremely carefully under deep anesthesia mothers.
Prevention of complications transverse position of the fetus is possible with early hospitalization of these pregnant - not later than 3 weeks before the expected delivery date. Preventive measure may be in a hospital environment external rotation of the fetus and the translation of the last of the transverse position in the longitudinal. External rotation is made at 34 - 36 weeks of pregnancy. Pregnant after that should be monitored in the hospital all remaining before delivery time.
In early labor with entire water - serene, standing on the side on which is located below a large part of the fruit. Upon reaching the fully open you can try to make an external version from transverse to longitudinal position of the fetus and to dissect the fetal bladder to secure the longitudinal position of the fetus. If external rotation of the fetus could not produce when available full opening of the combined external-internal rotation of the leg and extraction of the fetus. When premature or early discharge of water and the absence or insufficient degree of opening should: if my water broke or enter Merarites, to maintain the balance of water, wait until the opening and to rotate the fruit on the stem, followed by extraction; or in the absence of signs of infection in the mother and live term fetus to perform a caesarean section. The first option gives the worst results for the child (increased mortality) and a greater incidence of infection in the mother. The second option suffers from the drawbacks associated with caesarean section, and is used mainly in older first-time mothers and childless, with a moderate degree of narrowing of the pelvis, etc., In these cases, the decision for cesarean section is best taken in late pregnancy or early postpartum and operation to produce at the very beginning of labor activity in preserved waters (better outcomes for mother and fetus). Turn the fetus on the leg when there is insufficient opening of the throat leads to a large loss of children, and should be avoided, especially in the presence of a living fetus. When long retired waters, the loss of mobility of the fetus in the uterus, close fit around the cervix of the fruit that fell into the vagina the handle of the fetus - the signs launched the transverse position of the fetus, odoratissima vaginal surgery is unacceptable. In these cases, embryotomy.