Breech delivery - is a condition in which a child in the womb before birth is not the head and the pelvis down. At the same time one or both of his legs can be bent; often breech both legs extended. It is associated with increased risk of birth defects and death of the mother and child during childbirth. Currently, however, the mortality associated with breech reduced. The most secure when it is considered a caesarean section, but there is a high probability of having a healthy baby naturally.

At 28 weeks' gestation, breech presentation occurs in approximately 28% of children; on the day of birth - at 3-4%.

Risk factors

The following factors increase the chance of breech:

• Abnormalities of the uterus (e.g., the uterus or mat bicornuate septum), and tumors of the uterus
• Placenta previa
• Anomalies in the structure of the pelvis
• Maternal smoking
• Diabetes
• Fetal malformations Fetal development - week after week   (e.g., hydrocephalus)
• Polycyesis
• Polyhydramnios or oligohydramnios
• Low birth weight (prematurity or intrauterine growth retardation)
• Breech during previous pregnancies.
• Mechanical risk factors for breech is approximately 7-15%.

Up to 32-35 weeks of pregnancy, breech presentation diagnosed in most cases has no clinical significance.

Treatment

In uncomplicated breech women are advised to undergo the procedure, called external version on the head (ECV) - if there are no contraindications.

• ECV reduces the chance of breech during childbirth, and hence the need to carry out a caesarean section. At the same time, after successful ECV obstetric interventions during labor is required more frequently than in spontaneous cephalic presentation.
• ECV is successful in 30-80% of cases. It depends generally on the presence of various underlying diseases and abnormalities in the mother.
• An unfavorable outcome in ECV rare. Among the related complications: placental abruption, uterine rupture and haemorrhage in the mother and / or fetus. However, the risk of fetal death due to complications such ECV is increased only slightly.
• ECV is invited to do by 36 weeks of gestation has not previously parous women, and at 37 weeks - those who have had to bear. Sometimes when doing the procedure term pregnancy, and even at an early stage of labor.
• Contraindications to the ECV (eg, the presence of other indications for cesarean delivery, antepartum haemorrhage during the last week, abnormalities in the results of cardiotocography (CTG), anomalies in the structure of the uterus, rupture of membranes) are found, on average, 4% of women with pelvic previa.
• Spontaneous reversion to breech presentation after successful ECV is observed in less than 5% of cases.
• Before the procedure the doctor should inform the patient that sometimes passes ECV painful; at the request of the woman need to interrupt the process. In severe pain during ECV complains about 5% of patients.
• Tocolysis (the use of drugs that reduce the tone of the uterus) increases the likelihood of success of ECV. It can be used if the procedure without drugs fails.

Childbirth

One of the most important decisions for women with breech and her doctor - to carry out a caesarean section or try to give birth naturally. It is necessary to consider the following:

• Planned caesarean section reduces the risk of fetal death, and also the likelihood of serious complications associated with birth injuries Birth injuries - than they threaten your child? .
• Conventional breech presentation, as a rule, does not have a significant impact on child health in the long term.
• Since caesarean section is a slight increase in the risk of serious birth complications, compared with vaginal delivery.
• After caesarean section increases the likelihood that you will need a Caesarean section and in subsequent pregnancies.

Tribestan and pregnancy are incompatible because of the hormonal effects of the drug on the body - during pregnancy is not always useful excess female hormone estrogen. Besides the impact on tribestana woman's body has not been studied, and no one knows exactly how this medication affects as its body, and the body of the fetus.

How does Tribulus

Tribestan - it is herbal, which includes an extract of the aerial parts of Tribulus terrestris. This plant contains steroidal saponins furostanol type, which is the main representative of protodioscin. In the body, protodioscin decomposes to form the active metabolite - dehydroepiandrosterone, which has a medicinal effect. Other active furostanol saponins that are part of Tribulus terrestris extract, enhance the effect of protodioscin.

Tribestan has tonic effect and stimulates some of the functions of the reproductive system. Women timulyatsii consequence of this is the increased secretion of pituitary follicle-stimulating hormone (FSH), and ovaries - estradiol Estradiol, the most important hormone   (one of the estrogens).

Under the influence of FSH accelerated maturation of the egg in the ovary, and estrogen contribute to the widening of the mucous membrane (proliferation) of the uterus - is the first stage of preparation of the uterus for pregnancy. The second step is the beginning of the suppression of cell proliferation and secretion - mucosa cells release substances necessary for the implementation of the uterine wall of a fertilized egg. Phase secretion occurs under the influence of the female hormone progesterone.

If pregnancy occurs, progesterone secretion is increased many times over, as this hormone is a major hormone of pregnancy.

Possible actions tribestana during pregnancy

As is clear from the mechanism of action tribestana, this drug increases the secretion of estrogen. But a large number of female hormones estrogen will always inhibit the secretion of another female sex hormone - progesterone, and this is very dangerous during pregnancy.

Progesterone is vital during pregnancy. Its main function is to keep the pregnancy, especially in the early stages. He warns of uterine smooth muscle contraction and thus prevents miscarriage. If progesterone Progesterone - norm and pathology   produced enough, miscarriage Miscarriage - why you lose the most precious thing?   provided. Today obstetricians antenatal closely monitoring the content of progesterone in the blood of pregnant women and in the case of reducing its level prescribed synthetic analogs of the hormone.

Thus, the expected impact tribestana on the body of a pregnant woman can not be positive - a pregnancy may end in miscarriage Miscarriage - can you protect yourself from it? . But Tribulus - a herbal drug, so it operates smoothly and is less effective than the drugs of chemical origin. Therefore random tribesana reception (for example, if a woman did not know that there was a conception) most likely will not affect the state of pregnancy.

As Tribestan effects on the fetus

Action tribestana on the fetus has not been studied, so no one knows whether this drug to overcome the placental barrier and into the body of the child. Laboratory studies in animals did not reveal any adverse effects of the drug on the fetus. Nevertheless, the absence of clinical trials are not can confidently say that the reception tribestana will not toxic or mutagenic effects on the developing fetus.

What side effects have tribestana

Tribestan generally well tolerated by patients, the side effects are known only nausea and allergic reactions. But we all know that during pregnancy the body's response to a particular drug may be unpredictable.

Particularly dangerous in this respect allergic reactions - may occur in a minor violation (for example as an itchy rash of different nature), and may - in the form of severe disorders - anaphylactic shock syndrome, Stevens - Johnson or Lyell.

Manufacturers also recommend taking Tribulus with severe diseases of the cardiovascular system and kidneys. A pregnant woman these systems work with high load, and therefore there is a danger to women.

Tribestan not allowed to use during pregnancy. At the same time, the reception of small doses of the drug at the beginning of pregnancy is not the cause for the interruption. With proper monitoring in the antenatal clinic is no threat of miscarriage or fetal abnormality is not, as an obstetrician-gynecologist in a timely manner to identify all violations and take appropriate action.

Galina Romanenko