Previa and drop handle under the head previa

The emergence of this complication may at any position of the fetus: longitudinal (brain and pelvic) and transverse. Practical matters is the presentation and drop handle under the head previa, as pelvic previa elongated handle does not prevent biomechanism of labor.
Previa brush and drop handle under the head previa meet in 0,04-1.6% and more often in the second position, which contributes to the deviation of the womb to the right. Finding a pen near the head unfavourable to the biomechanism of labor. The cause of this complication should be seen in the functional changes of the lower uterine segment (stretched or tone down), then the handle is slipping past the head at first to the pelvis, and then into the vagina. This is facilitated by the abundance of water, the small size of the fetus, the size and shape of the handles, reduced muscle tone fruit etc.
The biomechanism of labor at loss handles, of course, is broken, and birth delayed. Often there are anomalies inserting head (prednisolone, facial, zaznamenano). Particularly damaging to the loss front handles, easy uselease between the head and pubic joint; rear handle better.
In the absence of timely help may occur uterine rupture.
The prediction for the mother seriously, the fetus dies almost 25% of cases.
This complication in most cases (especially in the entire fertile waters) is recognized when vaginal examination.
When potoshopshi waters elimination of the presentation of the handle is achieved by changing the body position of the woman (you should place it on the side, opposite dropped the pen, with a small Rise of the foot end of the bed). The brush usually goes up to the bottom of the uterus. Then under the control of his hands, placed in the vagina, outer arm trying to insert a head at the entrance
In the pelvis and fix the position of the fetus bandaging belly. After that, the bed down. With a well-pronounced labor activity, smoothed the neck and throat opening in nulliparous on 2 fingers, and multiparous on 3 fingers reveal fetal bladder. Head, which entered into the entrance of the pelvis, prevents the loss of the handle.
When retired waters, but preserved mobility fruit recommended setting of the handle with the subsequent fixation head first, outer arm, and then bandaging belly with a towel. Fixing the head at the entrance to the pelvis may also be carried out with the application of skin-head forceps with cargo.
To strengthen the uterus apply the appropriate medications. In case of impossibility of setting dropped out of the handle at the recently departed waters used metrals or obstetric turn on foot (under General anesthesia).
When the head located in the pelvic cavity, maintenance, delivery conservative, until the indication to the end of the delivery (forceps delivery). If the dead fetus produce perforation head with subsequent kranichsee.
When the transverse position loss handle it occurs in 50% of births.