FETAL MALPOSITION

During pregnancy, babies move around constantly, but where they end up immediately
prior to childbirth is extremely important. If a baby fails to turn so that the head is
downward, the result could be fetal distress, neurological problems or death .

Significance

1. It is estimated that 3 to 4 percent of all pregnancies result in breech births.

Although most babies are delivered in a normal head-first position, vaginal
delivery from the breech position increases the baby's risk of physical, mental
and developmental abnormalities.

Types

2. Head-first (normal) and breech are two main types of fetal positions during
delivery. If a baby fails to turn his head down into the birth canal for delivery, the
result is a breech birth.

Identification

3. A variety of positions qualify as breech. In Frank breech, the baby enters the birth
canal buttocks first. In footling breech, which can be single or double, one or both
of the baby's feet are positioned to be delivered first from the birth canal.

Prevention/Solution

4. If impending birth is not immediate, doctors may employ external cephalic

version, a method of turning the baby so that the head is facing downward. Some
doctors (very few) will proceed with vaginal births for breech babies, but most
prefer to perform surgery to safely deliver the baby. Usually a C-section
(Caesarian) is performed to eliminate any risks that breech babies face in normal
vaginal births.

Considerations

5. Even a successful vaginal delivery of a breech baby can result in the baby's
having a misshapen head and an increased risk of developing "soft" neurological
disorders, such as Attention Deficit Disorder (ADD), hyperactivity and dyslexia.

MATERNAL PELVIS IS DIVIDED INTO QUADRANTS

• (a) Right and left side, viewed as the mother would.

•(b) Anterior and posterior. This is a line cutting the pelvis in the middle from side to
side. The top half is anterior and the bottom half is posterior.
 •(c) The quadrants never change, but sometimes it is confusing because the student or
physician's viewpoint changes.

SPECIFIC POINTS ON THE FETUS

a) Cephalic or head presentation.

•1 Occiput (O). This refers to the Y sutures on the top of
the head.
•2 Brow or fronto (F). This refers to the diamond sutures or anterior fontanel on the
head.
•3 Face or chin presentation (M). This refers to the mentum or chin.
(b) Breech or butt presentation.
•1 Sacrum or coccyx (S). This is the point of reference.
•2 Breech birth is associated with a higher perinatal mortality.
(c) Shoulder presentation.
•1 This would be seen with a transverse lie.
•2. Scapula (Sc) or its upper tip, the acromion (A) would be used for the point of
reference.
CODING OF POSITIONS
(a) Coding simplifies explaining the various positions.

1 The first letter of the code tells which side of the pelvis the fetus reference point is on
(R for right, L for left).

2 The second letter tells what reference point on the fetus is being used (Occiput-O,
Fronto-F, Mentum-M, Breech-S, Shoulder-Sc or A).

3 The last letter tells which half of the pelvis thereference point is in (anterior-A,
posterior-P, transverseor in the middle-T).

OBSERVATIONS ABOUT POSITIONS

A. LOA and ROA positions are the most common and permit relatively easy delivery.

B. LOP and ROP positions usually indicate labor maybe longer and harder, and the
mother

will experiEnce severe backache.

● An occiput in the posterior quadrant means that you will feel lumpy fetal parts, arms
and legs . If delivered in thatposition, the infant will come outlooking up.
●An occiput in the anterior quadrant means that you will feel a more smooth back. If
delivered in that position, the infant will come out looking down at the floor.