Abnormal Fetal Lie - An Overview

What Is a Fetal Lie and Its Types?

The baby's position in the uterus is known as the fetal lie or presentation of the fetus. During pregnancy, the baby tends to move around in the uterus, a normal phenomenon. In the earlier stages of pregnancy, the baby is small enough to move around freely. But, when the baby gets larger, its movement becomes limited.

As the delivery day approaches, the baby starts to move into the position for birth. This position involves flipping over so that the baby's head is down and with the face towards the mother's back. The baby starts to move down in the uterus and prepares to go through the birth canal (cervix, vagina, and vulva) during childbirth.

1) Normal Fetal Lie- This position is ideal for labor and baby delivery. In this position, the baby is head-down with the chin tucked into its chest. The back of the head is positioned as it is ready to enter the pelvis. The baby is facing the mother's back. This position is called cephalic presentation, and most babies settle in this position at 32 weeks to 36 weeks of the pregnancy.

2) Abnormal Fetal Lie- Sometimes, the baby cannot get into the perfect cephalic presentation before birth. There are several positions that the baby can attain, and all these positions can render complications during childbirth. The different types of abnormal fetal lies are as follows-

1. Occiput or Cephalic Posterior Position- When the baby is positioned head down but facing the mother's abdomen. With the head in this position, the baby is looking up. This position is nicknamed sunny-side-up. This position can increase the chance of a long, painful delivery.

2. Frank Breech- In a frank breech, the baby's buttocks enter the birth canal, and the hips are flexed while the knees are extended. This position can cause an umbilical cord loop formation, and the baby can get injured during vaginal delivery.

3. Complete Breech- The baby is positioned with the buttocks in front, and both the hips and the knees are flexed. This position increases the risk of forming an umbilical cord loop and injuring the baby if delivered vaginally.

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4. Transverse Lie- The baby lies crosswise in the uterus such that the shoulder enters the pelvis first. A cesarean (C-section) delivery is used for babies in this position.

5. Footling Breech- The baby's feet are pointed toward the birth canal, which increases the chances of the umbilical cord coming down into the mouth of the womb, thereby cutting off the blood supply to the baby.

Does Abnormal Fetal Lie Pose Any Risk?

An abnormal fetal position or breech makes the baby's delivery very complicated. The baby is safe inside the mother's womb, and vaginal delivery is considered a safe form of childbirth. However, when the baby is in an abnormal fetal position, vaginal delivery can get complicated.

The reason is that the baby's head is larger than the bottom and feet, so there is a risk of head entrapment in the uterus. In this situation, it becomes difficult for the doctor to deliver the baby. Some babies in the breech position are in a hurry to come out during labor, thus making it more difficult for the doctor and the mother.

Sometimes, the doctor may recommend a cesarean birth (c-section) instead of vaginal birth. Cesarean birth is a surgical procedure in which an incision is made in the mother's abdomen, and the baby is delivered in an operating room. The risk involved is much less for the baby during this procedure than vaginal birth if the baby has an abnormal fetal lie.

What Is the Ideal Time for a Baby to Attain the Birth Position?

The baby drops down in the uterus and moves into the birth position, usually in the third trimester. This happens between weeks 32 and week 36 of the pregnancy. The doctor can check the baby's position by touching the mother's abdomen during regular appointments or with the help of an ultrasound.

Can a Doctor Modify or Turn the Baby in Abnormal Fetal Lie?

There are several ways that a doctor can try and turn the baby before beginning labor. These methods may or may not work, as sometimes, the baby turns back into the abnormal fetal position again. The success rate is very low, but if the mother wishes to avoid cesarean delivery, they can try them. The following techniques can be tried to encourage the baby to turn on its own-

1) External Cephalic Version (ECV)- It is a non-invasive way to turn the baby and improve the chance of having a vaginal birth. In this method, on the delivery table, nurses or helpers apply pressure through the abdominal wall to the uterus while trying to rotate the baby's head forward or backward.

2) Exercises- The exercises may or may not work, but they might encourage the baby to turn, avoiding a c-section delivery. The exercise involves yoga-like poses. The following two specific movements are recommended-

1. Getting on the hands and knees and then gently rocking in back and forth directions.

2. While laying on the back with knees bent and feet flat on the floor, pushing the hips up in the air (bridge pose).

3) Sound Therapy- Music, temperature changes, talking, and light could interest the baby in the womb.

• The mother can place headphones on the belly, towards the bottom, to see if this attracts the baby.

• Applying cold objects to the top of the abdomen where the baby's head is present might encourage the baby to move away and downward.

• A chiropractic technique (webster technique) can move the hips. This allows the uterus to relax. Relaxation can promote baby movement and help the baby to get into the best possible birth position.

What Factors Promote an Abnormal Fetal Lie?

• Premature delivery and early labor.

• Abnormal placental position.

• Multiple pregnancies.

• Anatomical defects in the uterus.

• Uterine fibroids.

Conclusion:

Knowing about abnormal fetal lies before delivery can add to the mother's anxiety surrounding childbirth. However, it can help doctors form an ideal labor and delivery birth plan. Most pregnant women do not have a c-section as a part of their birth plan. But the main goal is to safely deliver the baby and protect the mother's health.