What’s the Difference Between Fetal Malposition and Malpresentation?

Differentiating Between Fetal Position and Presentation

While fetal malposition and fetal malpresentation may sound like they are the same, each has different characteristics. One thing they have in common is that when not appropriately addressed during the labor and delivery process, it can increase the risk of a birth injury. Here’s what you need to know.

What is Fetal Malposition?

When the baby is in the womb, its position refers to how the baby is facing the mother’s spine. Fetal malposition happens when the baby is not ideally positioned for labor in cephalic presentation. Cephalic presentation means the fetus is positioned head-down, facing the mother’s back, with its chin tucked to its chest and the back of the head ready to move towards the pelvis.

Some examples of fetal malposition are:

• Occiput Posterior Position – the baby’s head is down, but it faces the mother’s front instead of her back. This is identified as OP presentation. There are subcategories of this when the fetal head is to the left or the right (LOP, ROP). This position is known to slow or stop transit the fetus’ progress through the birth canal.
• Transverse Position (Abnormal Lie) – the baby is sideways or when the shoulders or back are over the mother’s cervix and the fetal head is not in the pelvis or engaged. This is also called the shoulder, or oblique, position. If labor begins in this setting, there is an increased risk of uterine rupture and fetal compromise if not addressed.

What is Fetal Malpresentation?

When a baby is in the womb, presentation refers to the baby’s body that leads out of the birth canal. Fetal malpresentation means that a baby may lead with a part other than the head engaged in the mother’s pelvis.

Types of fetal malpresentation:

• Breech presentation – when a baby’s bottom or feet are in a position to come out first instead of the head.
• Transverse/oblique lie – occurs when the baby’s shoulder or side presents down instead of the baby’s head.
• Face or brow presentation – when a baby’s head is partially extended, its neck, brow, or face will be present first.
• Compound presentation – when a baby’s hand or leg is presented next to the baby’s head or bottom.

Breech presentation is the most common type of fetal malpresentation and, in most cases, is discovered before labor via a prenatal examination and ultrasound. In many instances, fetal malpresentation unresolved prior to delivery may require an assisted delivery with the use of forceps or vacuum extraction. A doctor may order a cesarean section if the fetus is in distress.

What Causes Fetal Malpresentation?

While many times the cause of fetal malpresentation may be unknown, there are several risk factors that may increase the likelihood that an infant will be in malpresentation. 

Fetal malpresentation may be caused by:

• Uterine abnormalities 
• Fibroids or pelvic tumors
• Premature delivery
• Placenta praevia
• Inflammation of the pelvis
• Septate uterus
• Multiple pregnancy
• Malformation of the fetus

Malpresentation can be diagnosed prior to delivery, but it remains undiscovered until delivery a significant percentage of the time. If an infant presents with malpresentation before delivery, an obstetrician may attempt to turn the baby manually. If the malpresentation is not detected prior to delivery, it may be necessary to deliver via cesarean section.

A failure to diagnose fetal malpresentation can result in serious complications during labor and delivery, including signs of fetal distress, cord prolapse, swelling, skull fracture, and jaundice.

How is Malpresentation Diagnosed and Managed?

Early diagnosis of fetal malpresentation is critical to allow patients multiple options before delivery. Malpresentation is most often diagnosed via an abdominal or vaginal examination. The diagnosis is generally confirmed via ultrasound. 

Regular prenatal care is vital to detecting fetal malpresentation prior to birth. An infant may change presentation and position throughout the pregnancy, but it is much less likely after 37 weeks gestation. 

After 37 weeks, if an obstetrician suspects fetal malpresentation, they may recommend an external cephalic version. During this procedure, the obstetrician attempts to manually turn the baby into the correct presentation. If the baby remains in malpresentation during delivery resulting in a prolonged labor, the doctor may recommend a C-section to prevent further harm.

Complications from Fetal Malposition or Malpresentation

When a baby is in fetal malposition or malpresentation, the use of forceps or vacuum extraction may be necessary. When used properly, these tools can deliver a baby safely, however in some cases, too much pressure on the baby’s head can lead to fractures, nerve damage, or brain damage.

Has Your Baby Suffered a Birth Injury? We Can Help.

When medical professionals don’t act quickly when a baby is at risk of an injury due to fetal position, the result can be devastating or a fatal birth injury. Learning your baby has suffered a birth injury is difficult news.

You have the right to hold the responsible parties accountable for their negligent medical care. Our experienced attorneys at The Beasley Firm, LLC have decades of experience representing mothers and their babies who’ve suffered a birth injury. We’ve secured record-breaking settlements and verdicts on behalf of our clients, and we want to help you too.