Malpresentation and malposition

Presentation and position are terms used to define the location of the baby in the mother’s womb. Presentation refers to the part of the baby’s body closest to the vagina which will emerge first during delivery. For a normal delivery the baby must present in a vertex or “head down” position. Position refers to the alignment of the baby’s head to the mother’s spinal cord. The back of the baby’s head should be aligned towards the mother’s spine. Any variations in the presentation and position of the baby are termed as mal-presentation and mal-positioning.

Common mal-presentations include breech presentation (buttocks down) and transverse position where the foetus presents sideways with the head and buttocks on either side of the pelvis. Common mal-positions include occiput posterior where the back of the head rotates towards the back of the pelvis, occiput transverse where the head is sideways, and face presentation where the baby’s face presents at delivery.

Mal-presentation or mal-positioning of the foetus may cause difficulty in delivery which may result in complications for the baby and mother. This condition is diagnosed with the help of a vaginal examination and palpation of the abdomen. Imaging tests can be used to confirm the diagnosis. Inappropriate or late diagnosis of this condition may cause prolonged or obstructed labour.

Mal-presentation and mal-positioning are usually managed by performing a C-section delivery. The general condition of the mother and the foetus such as vital signs, foetal heart rate, and colour of the amniotic fluid are evaluated prior to performing the C-section.

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