fetal malposition

Fetal malposition,
either occiput posterior or transverse (OT), leads to greater risk of cesarean delivery, prolonged labor, and increased perinatal morbidity. Historically, there is a known association between epidural use and malposition that was assumed to be due to the increased discomfort of laboring with a fetus in the occiput posterior position. However, evidence now suggests that the epidural itself may contribute to fetal malposition by impacting the probability of internal rotation. Fetal malposition may be impacted by manual rotation. Manual rotation has been associated with greater rates of delivering in the occiput anterior position and lower rates of cesarean delivery.

In normal labour, the fetal head presents with the occiput in lateral position in early stages of labour followed by anterior rotation in advanced labour. Malpositions of fetal head result when the occiput persists in a lateral or posterior position while malpresentations occur due to extension of the fetal head causing brow or face to present. Malpresentations of fetal head are usually diagnosed in labour and are associated with difficult labour and increased risk of operative intervention. Regular systematic clinical examinations to monitor progress of labour and fetal wellbeing are necessary once the diagnosis is confirmed. Although vaginal delivery is possible in many cases, caesarean section becomes necessary when the malposition or malpresentation persists and labour fails to progress.