Pregnant mommy finally survived the unstable period of embryo implantation in the first three months. Unexpectedly, during the second and third pregnancy tests, the baby was moved to the "head and feet" in the mother's stomach, which was clinically called "fetal malposition"! Is there any hope for mommy who wants to give birth naturally to help her baby turn the tide? Curious? How to deal with the ancient and modern medical association? Don't panic, let the Chinese and western experts in this unit answer for you!
Reveal the secret! The proportion of fetal malposition is 16 ~ 28 weeks: about 25% of infants have breech malposition (head, foot and fetal malposition). 32 weeks: About 7% of babies have incorrect breech position. 37 weeks: only about 3% ~ 4% of babies have incorrect breech position. Generally speaking, when a woman gives birth, the part of the fetal head closest to the cervix is called the fetal presentation, also known as fetal position. But usually before 28 weeks of pregnancy, the baby is still floating in the amniotic fluid, so the position of the fetus may change at any time. However, the closer to the 32 ~ 37 weeks before labor, the baby's head will generally turn down and be born in a normal fetal position, that is, head, feet and feet, until mommy gives birth.
However, some babies with "abnormal fetal position" showed many abnormal fetal positions for various reasons, which made it difficult to give birth naturally at this time and even caused dystocia to ancient women. However, modern surgical medical technology is developed, and there are ways to break through the difficulties of production in any fetal position, so pregnant mommy should not panic!
Lin Kou Chang Gung's novels of assistant professor-level attending physician in obstetrics and gynecology, under normal circumstances, the fetal head can pass, and the body will pass, especially the fetal head accounts for the largest proportion of the body, and the fetal head is hard. Therefore, the fetus usually comes out first, so in a word, as long as the head is down, it is still a normal fetal position. On the contrary, if the fetal breech position is not correct before delivery, whether the baby's feet, hands or buttocks are exposed first, it is a fetal position.
Dr. Xiao Wensheng pointed out that under normal circumstances, when giving birth, the mother can judge whether to choose caesarean section finally according to the fetal presentation; Among the types of fetal malposition, only "breech straight leg type" can be delivered directly and naturally through artificial delivery, but other types are very dangerous in production, so at present, doctors all adopt "caesarean section" to deliver babies.
1. Baby's head position If the baby's head position is downward, that is, close to the cervix, it is basically a normal fetal position. However, if you distinguish the baby's face, it can be divided into four types: occipital anterior position, occipital posterior position, frontal position and facial position.
Dr. Xiao Wensheng said that the above-mentioned "occipital anterior position" is still a normal fetal position and can be delivered naturally, but it is difficult to produce "occipital posterior position and frontal position". If it is a "face position", that is, when the baby's face is facing the cervix, or when the baby's face is looking at mommy's stomach, it is necessary to have a caesarean section.
2. The hip position is incorrect. Dr. Xiao said that when the mother is in labor, the baby's "hip down, head up" is the fetal position, and it is appropriate to choose caesarean section at this time. This type of breech position can be divided into the following four types: complete type, straight leg type, incomplete one foot type and incomplete two feet type.
(1) Complete pose: The baby's head and feet are the same, but the baby's legs bend and squat at the same time, which is a posture similar to "squatting", called "Complete pose". (2) Straight leg posture: The baby's thigh joint is bent, but the calf joint is straight, which is called "straight leg posture". (3) One-legged incomplete pose: A baby with the same head and feet can be classified as an incomplete pose if one leg is straight and the other leg is kneeling. If the baby sticks out of the birth canal with one foot first, it belongs to the one-legged incomplete type. (4) Bipedal type: when the baby's feet are extended to the birth canal, it is bipedal type. 3. Oblique position and transverse position When the baby is about to be born, no matter whether the head and face are up, down or front, once the fetal body is in an oblique or transverse position, it is the baby's unstable dynamic fetal position. Dr. Xiao pointed out that at this time, it usually depends on the baby's own decision, and most of the time, mommy has frequent contractions, and sometimes the baby will suddenly reverse from the oblique position to the head position, so there is a chance for natural delivery. But if the baby has been lying in the horizontal position (lying in the uterus), then it must be a caesarean section.
Placenta previa in the high-risk group with malposition (1).
Dr. Xiao said that although the absolute relationship between placenta previa and fetal malposition has not been confirmed, the incidence rate is indeed the highest. The so-called placenta previa generally means that the placenta grows at or covers the cervix, which will lead to the danger and difficulty of delivery, such as accidental bleeding of pregnant mommy, fetal distress and cardiac arrest when umbilical cord falls off, and premature delivery that requires emergency caesarean section.
(2) Multiple (twin) pregnancy When a woman is pregnant with twins, it is often because the two babies have small space in the uterus, so sometimes one of them will have abnormal fetal position. But this is not absolute. Some twins have normal fetal positions, but the proportion of twin fetal positions is high.
(3) Too much or too little amniotic fluid When there is too much amniotic fluid in the uterus, the baby has a large space to turn over in the stomach, so it is easy to have a baby's fetal position. In addition, including oligohydramnios, there is little room for the fetus to rotate in the uterus. Once the baby's fetal position is not correct, the probability of naturally turning positive will be low.
(4) Pregnant mothers with high parity and abnormal uterus usually have a higher risk of abnormal fetal position. In addition, when the pregnant mother's uterus structure is congenital abnormal, if there are problems such as bicornuate uterus and uterine diaphragm, it is easy to cause the baby's growth space to be blocked, and it is more prone to abnormal fetal position.
(5) Older pregnant women are more likely to have breech position. Due to the deterioration of pelvic and ligament functions, the elasticity of soft birth canal tissue is weakened, and the uterine contractility is relatively poor. If the fetal position is abnormal, it is more likely to cause prolonged labor and dystocia, so most elderly pregnant women choose caesarean section.
Abnormal fetal position is difficult to examine symptoms simply from the appearance of pregnant women's stomachs, and it will also affect the health of the fetus. Dr. Xiao Wensheng pointed out that if you want to confirm whether there is fetal malposition, you must pass ultrasound examination to know. Especially pregnant women in high-risk groups should pay more attention to prenatal examination, especially pregnant women with placenta previa. If frequent fetal movements are found, the baby's feet often kick the cervix, which will lead to placental bleeding. At this time, emergency medical treatment is needed.
Correction of ancient and modern fetal transfer 1. Modern "knee-chest cross" and "knee-chest cross" are postures that pregnant women practice specifically to correct fetal malposition. After 7 or 8 months (28 ~ 32 weeks) of pregnancy, it is a good way to help the baby recover to normal fetal position by doing it once every morning and evening for about 5 ~ 10 minutes each time.
◎ The correct method is as follows
(1) Take a kneeling position, with your head tilted to one side, your hands flexed and attached to the ground on both sides of your chest, and your legs are shoulder width apart. (2) Keep the chest and shoulders as close to the ground as possible. (3) Bend your knees and keep your thighs perpendicular to the ground. Dr. Xiao Wensheng pointed out that not every baby with abnormal fetal position can be corrected by mommy's "knee-chest transverse position", but usually at least about 60% of babies will start practicing at 28 weeks, and then the baby will gradually turn positive automatically. However, if it is impossible to give birth naturally, even after discussion with obstetricians and gynecologists, it is considered that pregnant mommy is in danger of giving birth naturally, and it is more appropriate for mommy to give birth safely by caesarean section.
2. Gao Mingli, an attending physician in the Department of Obstetrics and Gynecology, Chang Gung, Linkou, said that "fetal external rotation" has a high risk, especially when the fetus is pushed to the neck, amniotic fluid rupture, premature delivery, placental abruption, etc. are easy to involve medical disputes, so this method is no longer used now.
The doctor * * * said that unless a very small number of pregnant women are high-risk groups for caesarean section, such as allergic to anesthetics and blood coagulation dysfunction, it is possible to wait until 36 weeks to determine that the baby's fetal position has not turned positive. After evaluation by an experienced doctor, it is possible to carry out "carcass external rotation". But the safety of modern caesarean section is usually very high, and few pregnant mothers are willing to take risks.
When Detective Gao Ming was pregnant with a second child, it happened that the baby was breech. Therefore, she adopted the ancient doctor's method of facing the abnormal fetal position of pregnant women recorded in Chinese medical classics, and used moxa stick moxibustion (fumigation) at the Yin point to make the fetal position of the baby turn positive, but frequent contractions and fetal movements will occur, because the moxibustion machine can't turn clearly, and pregnant women are prone to medical disputes once they are born prematurely, so it is rarely used in clinic now.
As far as foreign clinical research is concerned, it has been reported that moxibustion at fetal position Yin point has certain curative effect, but there are also reports that there is little difference, so its clinical mechanism is still unclear. For the sake of safety, it is not recommended for pregnant women to do it themselves to avoid danger.
Dr. Xiao Wensheng reminded that if the pregnant mommy's fetal position is not correct, don't worry. After all, it happened in clinic. The night before the baby gave birth, the fetal position suddenly turned positive. Gaoming investigators also advocate that pregnant women should not use the secret recipe of fetal transfer by themselves if they have abnormal fetal position, but should respond in the right way under the guidance of doctors and welcome their newborns in the safest way.
Xiao Education: Graduated from Faculty of Medicine of Chang Gung University, Master of Molecular Medicine from Taiwan Province Provincial University, Doctor of Fetal Medicine from University College London, UK Experience: Chief Physician of Obstetrics and Gynecology at Chang Gung Hospital in Linkou, Researcher Physician of Obstetrics and Gynecology at Chang Gung Hospital in Linkou, Observer of King's College Hospital in England. Current position: Assistant Professor-level attending physician of gynecology at Chang Gung, Linkou.
Gao Ming's educational background: Department of Traditional Chinese Medicine, China Medical University Experience: Attending physician of TCM Obstetrics and Gynecology, Affiliated Hospital of China Medical University, Problem-oriented clinical lecturer of China Medical University, attending physician of Chiayi Chang Gung Hospital, and currently attending physician of TCM Obstetrics and Gynecology.
Interview Author/Yu Consulting/Assistant Professor-level Attending Physician of Gynecology, Chang Gung, Linkou Xiao Linkou Attending Physician of Gynecology and Obstetrics, Chang Gung, Chinese Medicine Gao Ming Detective Photography/Lao Mai Photography Comb/Lin Yuxi Illustration/Road Model//Beautiful Mommy