malpresentations

Malpresentation is an obstetric term for fetal presentations that are not cephalic (head‑first) at labor. The most common non‑cephalic presentations are breech (buttocks or feet presenting first) and transverse lie; less common are oblique lie and facial or brow presentations. Compound presentations, where an extremity presents with the head, can also occur.

Incidence and risk factors: At term, non‑cephalic presentations occur in a minority of pregnancies; breech is seen in about 3–4% of term labors and is more common earlier in gestation. Risk factors include placenta previa, uterine anomalies or scars, multiple pregnancy, fetal growth restriction or polyhydramnios, fetal anomalies, and a contracted pelvis.

Diagnosis and version: Malpresentation is diagnosed by ultrasound, with clinical assessment supporting the finding. External cephalic version (ECV) at about 37 weeks can rotate a breech or other non‑cephalic presentation to cephalic in suitable cases; success rates vary, commonly around 40–60%. Contraindications include placenta previa, uterine scar, multiple pregnancy, ruptured membranes, or fetal distress.

Management: If malpresentation persists at term, delivery planning depends on presentation type and obstetric factors. Planned cesarean delivery is common for term breech in many settings, while vaginal breech birth may be considered in carefully selected cases with experienced clinicians and continuous monitoring.

Outcomes and complications: Malpresentation is associated with higher risks of labor complications such as cord prolapse, obstructed labor, and fetal distress, and may require emergency cesarean. With modern obstetric care, many pregnancies affected by malpresentation deliver safely, though prognosis varies by presentation and gestational age.