Malpresentation and malposition

While the large majority of fetuses are head down with a flexed head and in the occiput anterior position and vertex presentation, there are others which either do not present head down or do not present in the optimal position. When there is a noncephalic, nonvertex presentation, it is considered as malpresentation. When the fetus is rotated in the transverse or posterior position, it is considered as malposition. This chapter explores the epidemiology and outcomes related to the malpresentations and malpositions as well as potential modes of management. Breech is the common type of fetal malpresentation, and can be categorized based on the relationship between the lower extremities and the buttocks of the fetus. Fetal malpresentation, particularly shoulder or footling presentation, is the strongest risk factors for cord prolapse. For those who have challenges when diagnosing malposition with a vaginal exam, ultrasound is a useful adjunct.