Malpositions and malpresentations of the foetal head

The normal way for a baby to deliver is by the vertex with the occiput lying anteriorly. With a cephalic presentation, if the occiput is not lateral in early labour or anterior in advanced labour then a malposition exists. If the leading pole of the foetus is anything other than the vertex, a malpresentation exists. Malpositions of the vertex and malpresentations of the foetal head usually present in labour and while birth can proceed normally, a more difficult labour is common and operative delivery is more likely, with attendant risks to both the mother and the baby. This article will describe these conditions, the clinical features associated with them and how to recognise and manage them.