How is it Diagnosed?
Malpresentations in obstetrics refer to any fetal position that is not vertex (head-first) at
the time of labor. Common malpresentations include breech, transverse lie, and face or
brow presentations. Diagnosis is essential for safe delivery planning.
Initial evaluation includes clinical abdominal examination (Leopold’s maneuvers) to
palpate fetal parts. In breech presentations, the head is felt in the uterine fundus, while
in transverse lie, the fetus lies sideways across the uterus. Pelvic examination during
labor may reveal a non-vertex presenting part such as the buttocks or face.
Ultrasound is the gold standard for accurate diagnosis. It confirms fetal presentation,
position, attitude, and estimated fetal weight. It also evaluates placental location,
amniotic fluid volume, and possible anomalies.
Cardiotocography (CTG) may be used to assess fetal well-being in cases of
malpresentation. In some cases, MRI may be employed to clarify complex presentations,
especially with suspected fetal anomalies or uterine malformations.
Timely diagnosis is crucial as malpresentations often necessitate cesarean delivery to
avoid complications like cord prolapse, obstructed labor, or fetal distress. External
cephalic version (ECV) may be attempted in breech presentations before term in
selected cases.