Management of malposition and malpresentation in labour

A malpresentation is diagnosed when any other part except the vertex of the fetal head is presented to the maternal pelvis. A malposition is diagnosed in any other position of the fetal head except an occipito-anterior (OA) flexed vertex. Both malpresentation and malposition are associated with prolonged or obstructed labour and associated fetal and maternal morbidity and potential mortality if not managed in labour effectively. The most common fetal malpresentation in longitudinal lie is breech presentation which can be further subdivided into subtypes. Other malpresentations in longitudinal lie include face, brow and compound. The fetus in non-longitudinal lie may include oblique and transverse with shoulder, arm or cord presentations. Malpositions include occipito-posterior (OP) and occipito-transverse (OT) with degrees of deflexion and asynclitism. This practical review considers the potential fetal abnormal presentations and positions, their risk factors and how these should be managed during labour, including approaches to vaginal breech delivery and assisted vaginal birth for malposition.