Malpresentations

All presentations of the fetus other than vertex

Aetiology

• Prematurity

• Multiple pregnancy

• Abnormalities of the uterus - e.g. fibroids.

• Partial septate uterus

• Abnormal fetus

• Placenta praevia

• Primiparity

Breech presentation

• Breech presentation is the most common malpresentation

• Occurs when the the fetus presents 'bottom-down' in the uterus

Management

• All women in the UK with an uncomplicated breech pregnancy at term should be offered external cephalic version (ECV), provided there are no contra-indications

• The main decision is whether to attempt vaginal delivery or plan an elective caesarean section

Transverse lie

• Fetus is positioned with the head on one side of the pelvis and the buttocks in the other

Management

• Vaginal delivery is impossible - requires caesarean section unless it converts or is converted late in pregnancy