INTRODUCTION

Near term or during labor the fetus generally assumes cephalic presentation
and a vertical lie. Approximately 5% of fetus fetuses do not; this is
considered a malpresentation
Left and right occipito-anterior are the only normal
presentations and positions.
Malposition: occipito-posterior.
Malpresentations: Anything except vertex as face, brow,
breech, shoulder, cord and complex presentations.
 Causes of Malpresentations and Malpositions

Defects in the powers:

Pendulous abdomen: laxity of the abdominal muscles.
Dextro-rotation of the uterus: rotation of the uterus
in anti-clock wise favours occipito-posterior in right
occipito-anterior position.
 Causes of Malpresentations and Malpositions

Defects in the passages:

•Contracted pelvis.
•Android pelvis.
•• Pelvic tumours.
•Uterine anomalies as bicornuate, septate or fibroid
•uterus.
•Placenta praevia.
 Causes of Malpresentations and Malpositions

Defects in the passenger:

•Preterm foetus.
•Intrauterine foetal death.
•Macrosomia.
•Multiple pregnancy
•Congenital anomalies as anencephaly and
•hydrocephalus.
•Polyhydramnios.
•• Coils of the cord around the neck favours face
•presentation
 Signs Suggestive of Malpresentations

•Pendulous abdomen.
•Nonengagement of the presenting part in the last 3-4
•weeks in primigravida.
•Premature rupture of membranes or its rupture early
•in labour.
•Delay in the descent of the presenting part during labour.
•Vaginal examination, X-ray or ultrasonography are
•more conclusive.