Malposition / Presentation

Question 1

Define malposition

Answer 1

Incorrect positioning of the vertex so includes; occipital posterior (OP) positions or a slight deflection of the head

Question 2

Define malpresentation

Answer 2

The presenting part is not the vertex so includes; face, brow, shoulder and compound presentations and transverse lie.

Question 3

Is breech considered a malpresentation

Answer 3

Yes

Question 4

Maternal factors for malposition/ malpresentation

Answer 4

• uterine abnormalities
• pelvic mass (fibroids)
• pelvic shape (androidal)
• drug or alcohol abuse
• multiparity

Question 5

Fetal factors for malposition/ malpresentation

Answer 5

• IUGR
• IUGD
• Congenital abnormalities (anacephaly)

Question 6

Maternal fetal factors for malposition/ malpresentation

Answer 6

• Preterm delivery
• placental position
• multiple fetuses
• prev history of malposition

Question 7

How can you diagnose OP position?

Answer 7

• feel limbs on palpating
• high FHR
• dip in the umbilicus area
• fetal head usually high
• maternal back / sacral pain
• USS

Question 8

Name 5 complications of the OP position

Answer 8

• increased pain especially in the back
• prolonged latent phase
• deep transverse arrest
• prolonged 1st and 2nd stage
• increased moulding and caput
• premature urges to push
• increased chance of trauma to vaginal tract
• increased chance of an instrumental delivery

Question 9

What can help the baby turn?

Answer 9

• Early diagnosis
• Knee chest
• Left lateral with elevated right leg
• Upright positions