What is the status of the fetus in the breech position?

The article was professionally consulted by Specialist Doctor I Le Hong Lien - Department of Obstetrics and Gynecology - Vinmec Central Park International General Hospital. Doctor Lien has over 10 years of experience as a radiologist in the Department of Ultrasound at the leading hospital in the field of obstetrics and gynecology in the South - Tu Du Hospital.

The favorable position will help the birth process go smoothly. However, not all pregnant women are lucky to have a favorable pregnancy. The breech fetus, the shoulder fetus are the fetuses that put pregnant women at high risk of cesarean section.

The breech position is a longitudinal position, in which the buttocks of the fetus are presented in front of the waist above the mother's pelvis, the head of the fetus is at the bottom of the uterus, and the back is on the mother's abdomen. The position of the fetus in the breech position is determined based on the position of the buttocks and legs of the fetus.
The fetus in the breech position can still give birth in the lower birth canal, but it is more prone to getting stuck in the back of the head. Therefore, if not diagnosed early and handled well, it can increase the risk of complications for the mother and increase the mortality rate for the fetus.

The breech fetus is divided into 3 types:
Full breech fetus: The baby's bottom will be facing down the birth canal, the knees will be bent into a sitting position with the legs crossed. Incomplete breech position - breech type: The baby's bottom will be facing down the birth canal, the legs are stretched straight in front of the baby, the feet are close together. Incomplete breech position - foot pattern: One or both of your baby's legs will point down the birth canal.

Incomplete breech position – the leg style can increase the risk of cord prolapse, which puts pressure on the navel and limits blood flow to the fetus. In case the fetus is completely breech and incomplete, pregnant women can still give birth naturally but must be supported by doctors and medical staff with high expertise and skills.
From week 32-34, pregnant women should go for an ultrasound to determine the position of the buttocks. If detected early, the doctor can influence to conduct fetal rotation. If by the end of the pregnancy the baby is still in the breech position, the doctor will try to apply procedures to turn the fetus again.

Shoulder baby is a condition in which the fetus lies horizontally in the uterus. For the shoulder fetus, the head pole and rump pole are not always parallel, but one pole will be in the pelvic fossa and the other pole will be in the lower ribs.
During labor, the shoulders will appear in front of the upper waist. The landmark of the shoulder will be the thin shoulder part. Shoulder fetuses cannot give birth vaginally if the fetus is alive at full term, so there will be no delivery mechanism.

Horizontal pregnancy can occur due to the following reasons:
Because the mother has given birth many times, causing the uterus to dilate, it is difficult for the fetus to turn and fix its head in the pelvis. Due to the mother's ovarian tumor, uterine malformation, uterine septum, uterine fibroids, etc., causing the fetus to be compressed, the fetus cannot turn its head. The baby's head is too big. The umbilical cord is so short that the fetus cannot turn its head or only rotates halfway. The umbilical cord is too long or the umbilical cord wraps around the neck also hinder the rotation of the fetus. The amniotic fluid is so low that the fetus cannot turn its head. Too much amniotic fluid also makes the fetus unable to fix the position. Low placental attachment interferes with fetal adjustment, especially in the last months of pregnancy.

In the case of a horizontal position, a normal birth will be very difficult because the fetus cannot pass through the pelvis.
Pregnant women are forced to give birth by cesarean section to ensure the lives of both mother and baby.
Shoulder baby is one of the most dangerous forms of pregnancy, very likely to have complications during labor.

Pregnant women with a shoulder-to-shoulder fetus must have a caesarean section, but cannot give birth naturally. In addition, pregnant women also need regular checkups for early diagnosis to prevent dangerous complications. For the shoulder fetus, the doctor can handle it in two ways:
External fetal rotation: This is done when the fetus is more than 35 weeks old, the amniotic membrane is intact and it is possible to give birth normally. However, this method can cause many complications such as premature labor, placental abruption, and rupture of membranes, so it is not currently applied. Intra-uterine rotation: This method is applicable to cases where the cervix has been opened and the uterus is not scarred. To perform a laparoscopic procedure, the doctor will insert his hand into the uterine cavity to rotate the fetus into the breech position. However, despite turning into a breech position, a vaginal birth is still very difficult. Therefore, for the case of the fetus on the shoulder, cesarean section is still the safest method for both mother and baby.
For more information, please contact the hospitals and clinics of Vinmec Health system nationwide