Abnormal fetal

presentation
and position
Presented by:
Hazel Anne Continedo
Leomar Lavina
 Table of contents

Diagnostic
Introduction 01 04 Tests

Suggestive
Signs 02 05 Management

Risk Factors 03 06 Prognosis

01
Introduction
Definition of terms:
• Presentation - refers to the fetal anatomic part which is the first part
to proceed into and through the pelvic inlet 3
• Fetal lie - describes the relationship between the long axis of the fetus
and the long axis of the mother.
• Fetal position - describes the orientation of the fetal presenting part
relative to the pelvis of the mother (Occiput, Mentum, Sacrum).
• Fetal presenting part - refers to the part of the fetus that is the first
to proceed into and through the pelvic inlet.
• Occiput – the back of the head or skull.
• Malpresentation - any position other than the vertex/cephalic.
• Malposition – any position other than the occipitoanterior.
• Normal Presentation – Vertex
• Normal Position – Occipitoanterior
 Abnormal fetal
presentation and
position
Normally, the position of a fetus is facing
rearward (toward the woman’s back) with
the face and body angled to one side and the
neck flexed, and presentation is head first.

An abnormal position is facing forward, and

abnormal presentations include the face,
brow, breech, and shoulder.
Fetal
position
RISK FACTORS

• More than one pregnancy (Multipara, Grand

multipara)
• More than one fetus
• Polyhydramnios or Oligohydramnios
• Abnormal Uterine Shape
• Placenta Previa
• Preterm
 RISK FACTORS
• Breech 3 in 100
• Face 1 in 500
• Brow 1 in 1000
• Shoulder 1 in 300
Signs suggestive of malpresentation

● Pendulous abdomen
● PROM
● Delay in the descent of the presenting part
during labour
● Vaginal examination or ultrasonography are
more conclusive
MALPOSITIONS: OCCIPITO POSTERIOR
(OP)
Causes : Dx:
• Big baby P/A
• Contracted pelvis • Back not in flank
• Head deep in the pelvis
• Flat sacrum • Small head
• Pelvic tumor • Limb anterior
• Placenta Previa
P/V
• Fontanelle
ENGAGING DIAMETER:
• Suboccipito frontal in a deflexed head is 10.5cm
• Occipito frontal diameter in a head which is further flexed is 11.5cm
ENGAGING DIAMETERS
MALPOSITIONS
 Management
OCCIPITO POSTERIOR

 WAIT
Spontaneous rotation (majority of OP); delivered as OA (Occipito Anterior)

 DELAY
Manual Rotation
Instrumental Delivery:
Forceps
Ventouse(vacuum cup)

 C Section
Management
FACE PRESENTATION
- an abnormal form of cephalic presentation where the presenting part is
mentum.
• Primary – present before the onset of labor (rare)

• Secondary – caused by extension during labor (e.g. Left Mento Anterior is

a result of extension of Right Occipito Posterior)
 ENGAGING DIAMETER:
The engaging diameter is submento-bregmatic 9.5cm
MALPOSITIONS
Face Presentation
Etiology :

MATERNAL
• Contracted pelvis
• Oblique of uterus
• Multiparity and pendulous abdomen

FETAL
• Anencephaly and iniencephaly
• Tumor of neck like congenital goiter
• Spasm of sternocleidomastoid muscle
 Diagnosis
• Abdominal Examination:
• In Mentoanterior, back is felt with difficulty as it is posterior
and limbs are felt anteriorly.
• Cephalic prominence is on the same side as the baby's back.

Vaginal Examination
• Chin, Mouth, Nose, and malar eminence are felt.
• In mentoanterior, chin is in one anterior quadrant and
forehead is in the opposite posterior quadrant.
Management

MENTO ANTERIOR
• Delivery face to pubes
• Forcep delivery

MENTO POSTERIOR
• Cesarean Section
BROW PRESENTATION
•The least common among cephalic presentation and most unfavorable.
•The attitude is one of partial extension, the presenting part being the area between
the anterior fontanelle (bregma) above the glabella and orbital ridges below .
.
 ENGAGING DIAMETER:
The engaging diameter is mento-vertical 13.5 cm, which is
the largest of the fetal head
 Brow Presentation
Possible Etiology :

• Bicornuate uterus
• Septate uterus
• Polyhydramnios/Oligohydramnios
• Large fetal head
• Congenital abnormalities
• Neck tumor

Abdominal examination
• High mobile head, which feels large from side to side.
• Cephalic prominence is the occiput and on the same side as the back and the
groove between the cephalic prominence and the back is less prominent than
in face presentation
Abdominal Examination

• High mobile head, which feels large from side to side.

• Cephalic prominence is the occiput and on the same
side as the back and the groove between the cephalic
prominence and the back is less prominent than in face
presentation

Vaginal Examination
• Anterior fontanelle (bregma) is felt at one end and root
of nose (nasion) and orbit ridges at the other end of an
oblique or transverse diameter.
• Sometimes, the nose and mouth are palpable, but not
the chin.
 Management
Spontaneous Correction can occur
• Flexion can be delivered as vertex presentation
• Extension can be delivered as face presentation

• BROW PRESENTATION has to be delivered by C Section

TRANSVERSE
LIE

•Most dangerous especially

in multiparous woman
because this has a large
uterus with poor tone
Causes MANAGEMENT:
• Lax abdomen
• Admission – if multiparous pt. at 36
• Multiparity which causes atonic
weeks
uterus • ECV (External Cephalic Version)
• Placenta previa
P/A • Cesarean section
• Uterus seems to be small
• Enlarged transversely
• Fetus lying across
P/V
• Shoulder, elbow, hand, and cord
can be felt.

• Can be confirmed by ultrasound

 •Most common malpresentation
BREECH •3-4% of term pregnancies
PRESENTATION •Becomes a problem if the baby is not cephalic by 37
weeks
Types of
Breech
 FLEXED BREECH
(complete)

 EXTENDED BREECH (frank)

• Most common

 FOOTLING BREECH
• Least common
 Breech Presentation
Causes : • Fetal neuromuscular condition
• Oligo hydramnios
MATERNAL • Polyhydrmanios
• Fibriods
• Congenital uterine abnormalities
• Uterine surgery

FETUS
• Multiple gestation
• Prematurity
• Placenta previa
• Anencephaly oy Hydrocephalus
 Management
• Confirm gestation week
• If breech is clinically suspected at/after 36 weeks, confirm by ultrasound
• Ultrasound scan to confirm:
1. Breech and type
2. Amniotic fluid index (AFI), fetal anomalies, pelvic tumor

Mode of Delivery
• External Cephalic Retroversion (ECV)
• Cesarean Section
• Vaginal breech delivery
Management
Vaginal Breech Delivery
Diagnosic tests
Several methods can be used to diagnose fetal presentation and position

 Abdominal palpation: Leopold’s maneuvers

 Vaginal examination
 Sonography/ultrasound
 Auscultation
Prognosis
The total rate of malposition and malpresentation was 4.8%. Most women
(87.3%) delivered by cesarean section, 25% of the neonates were admitted to
the neonatal intensive care unit, where 69.3% of these infants stayed for seven
days. There were three early neonatal deaths (1.0%), all of them were in
occipito-posterior, or occipito-transverse position and were delivered
abdominally. Among occipito-posterior and occipito-transverse deliveries,
2.2% ended with the death of the fetus (P = 0.360). An Apgar score of 7 was
recorded after 5 minutes for 97.7% of the infants. Around 11% of the women
had postpartum hemorrhage.