Child position

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Drawing of the fetus in the womb by Leonardo da Vinci , approx. 1510–1512

In obstetrics, the child's position is the position of the fruit in the uterus . It is described in four terms: position, stance, posture and attitude. These terms are important for understanding the mechanics of labor .

Position (situs)

Depictions of child positions in a late antique Latin adaptation of the gynecology of Soranos of Ephesus . The images in this copy, made around 900, probably originally go back to drawings by Sorano. Bruxelles, Bibliothèque Royale, 3714, fol. 28r

According to the strict definition, the concept of position may only be used to describe the relationship between the longitudinal axis of the child and the longitudinal axis of the birth canal. Correct is the lengthways or straight position (99% at the time of birth), thus the

Only that count as an irregularity (deviation from the norm)

An irregular situation is called a situation anomaly .

The diagnosis of the situation is made with the 2nd Leopold handle .

The type of the preceding part in the longitudinal position is defined by the term pole setting . The diagnosis is made with the 3rd and 4th Leopold handles and a vaginal examination. The predominance of the cranial position (96% of all births) is due to the fact that the head fits best into the lower uterine segment or the pelvic entrance . The breech positions occur with a frequency of 3% as irregularities in the pole setting.

Position

The position results from the relationship between the child's back and the inner wall of the uterus. The pose expresses whether the child's back is on the mother's left or right side. The diagnosis is made with the 2nd Leopold handle. A distinction is made here

  • First position : back left (from the perspective of the pregnant woman)
    • Ia position : back left in front
    • Ib position : back left behind
  • Second position : back right (from the perspective of the pregnant woman)
    • IIa position : back right in front
    • IIb position : back right back

In the skull position, the first position is twice as common as the second position.

Attitude (habitus)

According to the gynecologist Ernst Bumm , the posture indicates "how the child is holding himself". It describes the relationship between the child's parts. There is a posture of the head, legs, and arms. Most importantly, the use of this term for the relationship between the head and the trunk as it passes through the birth canal. Normal and proper is the posture in which the head is bent low, i.e. with the chin on the chest, and passes the upper section of the birth canal. That is normal

  • anterior occipital position ( flexion , back anterior, flexion of the head onto the chest, normal position).

The diagnosis is made by vaginal examination, the position of the fontanelles indicates the posture. Any deviation from this head posture (extension, deflection) is illegal, i.e. a posture anomaly , these are:

Setting (presentation)

Attitude is the relationship of the previous part to the birth path. The section of the preceding part is “set” that the finger encounters in the guide line during the vaginal examination, i.e. H. the leading section is set. The adjustment of the head depends on its posture depending on the height :

  • Occipital setting (control center = small fontanel) (regular setting)

An illegal setting is also known as a setting anomaly , these are:

  • Vertex setting (control center = arrow seam)
  • Front head setting (control center = large fontanel)
  • Forehead adjustment (control center = large fontanel, forehead seam)
  • Face setting
  • high upright position (irregular setting in the pool entrance)
  • posterior occipital position (regular flexion, but irregular rotation of the occiput)
  • low transverse stand (irregularity of the setting in the pool exit)
  • Parietal bones adjustment (irregularity of the adjustment in the pelvic entrance)
  • Shoulder dystocia (irregular adjustment of the shoulder girdle depending on the height)

The breech position can result in:

  • the rump alone
  • the feet alone
  • the rump and the feet
  • the rump and a foot
  • one or both knees

The leading section of the preceding part, which is the lowest in the basin guide line, is called the control center . In practice, the various terms of position, posture, posture and attitude are summarized and, for example, one speaks of a first anterior occipital position (I.voHHL).

See also

literature

  • Christine Mändle, Sonja Opitz-Kreuter and Andrea Wehling: The midwife book: textbook of practical obstetrics. Schattauer, Stuttgart / New York 1997, ISBN 3-7945-1765-2 .
  • Klaus Diedrich u. a. (Ed.): Gynecology and Obstetrics . Springer-Verlag Berlin, Heidelberg, New York 2000, ISBN 3-540-65258-2 .
  • Pschyrembel Practical Obstetrics.
  • Martius midwifery textbook.

Web links