does cephalic presentation mean labor is close

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Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Illustration of the head-down, face-up position

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Illustration of the frank breech position

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

Illustration of a complete breech presentation

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

Down, with the back facing the birth canal.
Sideways, with one shoulder pointing toward the birth canal.
Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

An attempt to deliver the baby in the breech position is not successful.
You do not want to try to have the baby delivered vaginally in the breech position.
An attempt to move the baby into a head-down position is not successful.
You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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What Is Cephalic Position?

The ideal fetal position for labor and delivery

Why It's Best

Risks of Other Positions

Determining Position
Turning a Fetus

The cephalic position is when a fetus is head down when it is ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery.

About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy . Your healthcare provider will monitor the fetus's position during the last weeks of gestation to ensure this has happened by week 36.

If the fetus is not in the cephalic position at that point, the provider may try to turn it. If this doesn't work, some—but not all—practitioners will attempt to deliver vaginally, while others will recommend a Cesarean (C-section).

Getty Images

Why Is the Cephalic Position Best?

During labor, contractions dilate the cervix so the fetus has adequate room to come through the birth canal. The cephalic position is the easiest and safest way for the baby to pass through the birth canal.

If the fetus is in a noncephalic position, delivery becomes more challenging. Different fetal positions have a range of difficulties and varying risks.

A small percentage of babies present in noncephalic positions. This can pose risks both to the fetus and the mother, and make labor and delivery more challenging. It can also influence the way in which someone can deliver.

A fetus may actually find itself in any of these positions throughout pregnancy, as the move about the uterus. But as they grow, there will be less room to tumble around and they will settle into a final position.

It is at this point that noncephalic positions can pose significant risks.

Cephalic Posterior

A fetus may also present in an occiput or cephalic posterior position. This means they are positioned head down, but they are facing the abdomen instead of the back.

This position is also nicknamed "sunny-side up."

Presenting this way increases the chance of a painful and prolonged delivery.

There are three different types of breech fetal positioning:

Frank breech: The legs are up with the feet near the head.
Footling breech: One or both legs is lowered over the cervix.
Complete breech: The fetus is bottom-first with knees bent.

A vaginal delivery is most times a safe way to deliver. But with breech positions, a vaginal delivery can be complicated.

When a baby is born in the breech position, the largest part—its head—is delivered last. This can result in them getting stuck in the birth canal (entrapped). This can cause injury or death.

The umbilical cord may also be damaged or slide down into the mouth of the womb, which can reduce or cut off the baby's oxygen supply.

Some providers are still comfortable performing a vaginal birth as long as the fetus is doing well. But breech is always a riskier delivery position compared with the cephalic position, and most cases require a C-section.

Likelihood of a Breech Baby

You are more likely to have a breech baby if you:

Go into early labor before you're full term
Have an abnormally shaped uterus, fibroids , or too much amniotic fluid
Are pregnant with multiples
Have placenta previa (when the placenta covers the cervix)

Transverse Lie

In transverse lie position, the fetus is presenting sideways across the uterus rather than vertically. They may be:

Down, with the back facing the birth canal
With one shoulder pointing toward the birth canal
Up, with the hands and feet facing the birth canal

If a transverse lie is not corrected before labor, a C-section will be required. This is typically the case.

Determining Fetal Position

Your healthcare provider can determine if your baby is in cephalic presentation by performing a physical exam and ultrasound.

In the final weeks of pregnancy, your healthcare provider will feel your lower abdomen with their hands to assess the positioning of the baby. This includes where the head, back, and buttocks lie

If your healthcare provider senses that the fetus is in a breech position, they can use ultrasound to confirm their suspicion.

Turning a Fetus So They Are in Cephalic Position

External cephalic version (ECV) is a common, noninvasive procedure to turn a breech baby into cephalic position while it's still in the uterus.

This is only considered if a healthcare provider monitors presentation progress in the last trimester and notices that a fetus is maintaining a noncephalic position as your delivery date approaches.

External Cephalic Version (ECV)

ECV involves the healthcare provider applying pressure to your stomach to turn the fetus from the outside. They will attempt to rotate the head forward or backward and lift the buttocks in an upward position. Sometimes, they use ultrasound to help guide the process.

The best time to perform ECV is about 37 weeks of pregnancy. Afterward, the fetal heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after having ECV done.

ECV has a 50% to 60% success rate. However, even if it does work, there is still a chance the fetus will return to the breech position before birth.

Natural Methods For Turning a Fetus

There are also natural methods that can help turn a fetus into cephalic position. There is no medical research that confirms their efficacy, however.

Changing your position: Sometimes a fetus will move when you get into certain positions. Two specific movements that your provider may recommend include: Getting on your hands and knees and gently rocking back and forth. Another you could try is pushing your hips up in the air while laying on your back with your knees bent and feet flat on the floor (bridge pose).
Playing stimulating sounds: Fetuses gravitate to sound. You may be successful at luring a fetus out of breech position by playing music or a recording of your voice near your lower abdomen.
Chiropractic care: A chiropractor can try the Webster technique. This is a specific chiropractic analysis and adjustment which enables chiropractors to establish balance in the pregnant person's pelvis and reduce undue stress to the uterus and supporting ligaments.
Acupuncture: This is a considerably safe way someone can try to turn a fetus. Some practitioners incorporate moxibustion—the burning of dried mugwort on certain areas of the body—because they believe it will enhance the chances of success.

A Word From Verywell

While most babies are born in cephalic position at delivery, this is not always the case. And while some fetuses can be turned, others may be more stubborn.

This may affect your labor and delivery wishes. Try to remember that having a healthy baby, and staying well yourself, are your ultimate priorities. That may mean diverting from your best laid plans.

Speaking to your healthcare provider about turning options and the safest route of delivery may help you adjust to this twist and feel better about how you will move ahead.

Glezerman M. Planned vaginal breech delivery: current status and the need to reconsider . Expert Rev Obstet Gynecol. 2012;7(2):159-166. doi:10.1586/eog.12.2

Cleveland Clinic. Fetal positions for birth .

MedlinePlus. Breech birth .

UT Southwestern Medical Center. Can you turn a breech baby around?

The American College of Obstetricians and Gynecologists. If your baby is breech .

Roecker CB. Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios . Journal of Chiropractic Medicine . 2013;12(2):74-78. doi:10.1016/j.jcm.2013.06.003

By Cherie Berkley, MS Berkley is a journalist with a certification in global health from Johns Hopkins University and a master's degree in journalism.

Your baby in the birth canal

Shoulder presentation; Malpresentations; Breech birth; Cephalic presentation; Fetal lie; Fetal attitude; Fetal descent; Fetal station; Cardinal movements; Labor-birth canal; Delivery-birth canal

During labor and delivery, your baby must pass through your pelvic bones to reach the vaginal opening. The goal is to find the easiest way out. Certain body positions give the baby a smaller shape, which makes it easier for your baby to get through this tight passage.

The best position for the baby to pass through the pelvis is with the head down and the body facing toward the mother's back. This position is called occiput anterior.

Childbirth is really a series of four stages that culminate in the actual birth and short period thereafter. For more specific information regarding emergency delivery see the information on childbirth, emergency delivery.

Emergency measures are indicated when childbirth is imminent and no health care professional is present. Indications of late labor include rupturing of the amniotic sac, dilation of the cervix, and appearance of the baby's head at the vaginal opening.

Cephalic (head first) presentation is considered normal, but a breech (feet or buttocks first) delivery can be very difficult, even dangerous for the mother and the baby.

In a normal pregnancy, the baby is positioned head down in the uterus.

The term fetal presentation refers to the part of your baby's body that is closest to the birth canal. In most full-term pregnancies, the baby is positioned head down, or cephalic, in the uterus.

Information

Certain terms are used to describe your baby's position and movement through the birth canal.

FETAL STATION

Fetal station refers to where the presenting part is in your pelvis.

The presenting part. The presenting part is the part of the baby that leads the way through the birth canal. Most often, it is the baby's head, but it can be a shoulder, the buttocks, or the feet.
Ischial spines. These are bone points on the mother's pelvis. Normally the ischial spines are the narrowest part of the pelvis.
0 station. This is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis.
If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5.

In first-time moms, the baby's head may engage by 36 weeks into the pregnancy. However, engagement may happen later in the pregnancy, or even during labor.

This refers to how the baby's spine lines up with the mother's spine. Your baby's spine is between their head and tailbone.

Your baby will most often settle into a position in the pelvis before labor begins.

If your baby's spine runs in the same direction (parallel) as your spine, the baby is said to be in a longitudinal lie. Nearly all babies are in a longitudinal lie.
If the baby is sideways (at a 90-degree angle to your spine), the baby is said to be in a transverse lie.

FETAL ATTITUDE

The fetal attitude describes the position of the parts of your baby's body.

The normal fetal attitude is commonly called the fetal position.

The head is tucked down to the chest.
The arms and legs are drawn in towards the center of the chest.

Abnormal fetal attitudes include a head that is tilted back, so the brow or the face presents first. Other body parts may be positioned behind the back. When this happens, the presenting part will be larger as it passes through the pelvis. This makes delivery more difficult.

DELIVERY PRESENTATION

Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.

The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation.

This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.
There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).

If your baby is in any position other than head down, your doctor may recommend a cesarean delivery.

Breech presentation is when the baby's bottom is down. Breech presentation occurs about 3% of the time. There are a few types of breech:

A complete breech is when the buttocks present first and both the hips and knees are flexed.
A frank breech is when the hips are flexed so the legs are straight and completely drawn up toward the chest.
Other breech positions occur when either the feet or knees present first.

The shoulder, arm, or trunk may present first if the fetus is in a transverse lie. This type of presentation occurs less than 1% of the time. Transverse lie is more common when you deliver before your due date, or have twins or triplets.

CARDINAL MOVEMENTS OF LABOR

As your baby passes through the birth canal, the baby's head will change positions. These changes are needed for your baby to fit and move through your pelvis. These movements of your baby's head are called cardinal movements of labor.

This is when the widest part of your baby's head has entered the pelvis.
Engagement tells your health care provider that your pelvis is large enough to allow the baby's head to move down (descend).
This is when your baby's head moves down (descends) further through your pelvis.
Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.
During descent, the baby's head is flexed down so that the chin touches the chest.
With the chin tucked, it is easier for the baby's head to pass through the pelvis.

Internal Rotation

As your baby's head descends further, the head will most often rotate so the back of the head is just below your pubic bone. This helps the head fit the shape of your pelvis.
Usually, the baby will be face down toward your spine.
Sometimes, the baby will rotate so it faces up toward the pubic bone.
As your baby's head rotates, extends, or flexes during labor, the body will stay in position with one shoulder down toward your spine and one shoulder up toward your belly.
As your baby reaches the opening of the vagina, usually the back of the head is in contact with your pubic bone.
At this point, the birth canal curves upward, and the baby's head must extend back. It rotates under and around the pubic bone.

External Rotation

As the baby's head is delivered, it will rotate a quarter turn to be in line with the body.
After the head is delivered, the top shoulder is delivered under the pubic bone.
After the shoulder, the rest of the body is usually delivered without a problem.

Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

Kilpatrick SJ, Garrison E, Fairbrother E. Normal labor and delivery. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 11.

Version Info

Last reviewed on: 11/10/2022

Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Common baby positions during pregnancy and labor

African American woman using Swiss Ball during labour.

As you near the end of your third trimester, your baby will settle into position for birth. By this time in your pregnancy, your baby is likely in one of three positions.

Cephalic presentation, occiput anterior

This is the best position for labor. Your baby is head-down, their face is turned toward your back, and their chin is tucked to their chest. This allows the back of your baby’s head to easily enter your pelvis when the time is right. Most babies settle into this position by week 36 of pregnancy.

Cephalic presentation, occiput posterior position

In this case, your baby is head-down, but their face is turned toward your bellybutton instead of your back. This is also called the “sunny side up” position. If your baby is positioned this way, your labor could be longer and more difficult. Don’t be alarmed if your baby is in this position at the start of your labor. Your baby can rotate their head throughout the birthing process and may naturally turn their head to face down.

Breech position

Breech can mean any position where your baby’s head isn’t pointed down toward your pelvis. Instead, your baby’s buttocks might be positioned to enter the birth canal first. Sometimes one or both of their feet might be pointed downward.

In certain cases, babies lie crosswise inside the uterus. This position makes it more likely that the baby’s shoulder will enter the pelvis first.

If your baby is breech and they can’t be turned in the uterus, you’ll likely need a cesarean birth, or C-section. Your clinician will let you know if this is a possibility.

Turning your baby

In many cases, it’s possible to get your baby to move into the right position for birth. This is called external cephalic version. A clinician will firmly press their hands on certain parts of your belly. Babies often adjust to a head-down position when this happens.

You can also help your baby turn by changing your own position. Try getting on your hands and knees and rocking back and forth. You can also try pushing your hips upward while you lie on your back with your knees bent and your feet flat on the floor. Be sure to ask your clinician before trying to turn your baby yourself.

Stimulating music or light can sometimes encourage your baby to turn. Try placing headphones toward the bottom of your belly to see if your baby will turn toward it. Shining a light into your belly can have the same effect.

This article has been created by a national group of Kaiser Permanente ob-gyns, certified nurse-midwives, pediatricians, lactation consultants and other specialists who came together to provide you with the best pregnancy, birth, postpartum, and newborn information.

Some of the content is used and adapted with permission of The Permanente Medical Group.

Third trimester
Gestation period 33 weeks

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

does cephalic presentation mean labor is close

Position and Presentation of the Fetus

Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed.

Variations in fetal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing forward, toward the mother's pubic bone) is less common than occiput anterior position (facing backward, toward the mother's spine).

Variations in Fetal Position and Presentation

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

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Normal Labor

Fetal Lie The relation of the fetal long axis to that of the mother is termed fetal lie and is either longitudinal or transverse . Occasionally, the fetal and the maternal axes may cross at a 45-degree angle, forming an oblique lie . This lie is unstable and becomes longitudinal or transverse during labor. A longitudinal lie is present in more than 99 percent of labors at term. Predisposing factors for transverse fetal position include multiparity, placenta previa, hydramnios, and uterine anomalies ( Chap. 23 , p. 468 ). Fetal Presentation The presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it. It typically can be felt through the cervix on vaginal examination. Accordingly, in longitudinal lies, the presenting part is either the fetal head or breech, creating cephalic and breech presentations , respectively. When the fetus lies with the long axis transversely, the shoulder is the presenting part. Table 22-1 describes the incidences of the various fetal presentations. TABLE 22-1. Fetal Presentation in 68,097 Singleton Pregnancies at Parkland Hospital Cephalic Presentation Such presentations are classified according to the relationship between the head and body of the fetus ( Fig. 22-1 ). Ordinarily, the head is flexed sharply so that the chin is in contact with the thorax. The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation . Much less commonly, the fetal neck may be sharply extended so that the occiput and back come in contact, and the face is foremost in the birth canal— face presentation ( Fig. 23-6 , p. 466 ). The fetal head may assume a position between these extremes, partially flexed in some cases, with the anterior (large) fontanel, or bregma, presenting— sinciput presentation —or partially extended in other cases, to have a brow presentation ( Fig. 23-8 , p. 468 ). These latter two presentations are usually transient. As labor progresses, sinciput and brow presentations almost always convert into vertex or face presentations by neck flexion or extension, respectively. Failure to do so can lead to dystocia, as discussed in Chapter 23 ( p. 455 ). Figure 22-1 Longitudinal lie. Cephalic presentation. Differences in attitude of the fetal body in (A) vertex, (B) sinciput, (C) brow, and (D) face presentations. Note changes in fetal attitude in relation to fetal vertex as the fetal head becomes less flexed. The term fetus usually presents with the vertex, most logically because the uterus is piriform or pear shaped. Although the fetal head at term is slightly larger than the breech, the entire podalic pole of the fetus—that is, the breech and its flexed extremities—is bulkier and more mobile than the cephalic pole. The cephalic pole is composed of the fetal head only. Until approximately 32 weeks, the amnionic cavity is large compared with the fetal mass, and the fetus is not crowded by the uterine walls. Subsequently, however, the ratio of amnionic fluid volume decreases relative to the increasing fetal mass. As a result, the uterine walls are apposed more closely to the fetal parts. If presenting by the breech, the fetus often changes polarity to make use of the roomier fundus for its bulkier and more mobile podalic pole. As discussed in Chapter 28 ( p. 559 ), the incidence of breech presentation decreases with gestational age. It approximates 25 percent at 28 weeks, 17 percent at 30 weeks, 11 percent at 32 weeks, and then decreases to approximately 3 percent at term. The high incidence of breech presentation in hydrocephalic fetuses is in accord with this theory, as the larger fetal cephalic pole requires more room than its podalic pole. Breech Presentation When the fetus presents as a breech, the three general configurations are frank, complete , and footling presentations and are described in Chapter 28 ( p. 559 ). Breech presentation may result from circumstances that prevent normal version from taking place. One example is a septum that protrudes into the uterine cavity ( Chap. 3 , p. 42 ). A peculiarity of fetal attitude, particularly extension of the vertebral column as seen in frank breeches, also may prevent the fetus from turning. If the placenta is implanted in the lower uterine segment, it may distort normal intrauterine anatomy and result in a breech presentation. Fetal Attitude or Posture In the later months of pregnancy, the fetus assumes a characteristic posture described as attitude or habitus as shown in Figure 22-1 . As a rule, the fetus forms an ovoid mass that corresponds roughly to the shape of the uterine cavity. The fetus becomes folded or bent upon itself in such a manner that the back becomes markedly convex; the head is sharply flexed so that the chin is almost in contact with the chest; the thighs are flexed over the abdomen; and the legs are bent at the knees. In all cephalic presentations, the arms are usually crossed over the thorax or become parallel to the sides. The umbilical cord lies in the space between them and the lower extremities. This characteristic posture results from the mode of fetal growth and its accommodation to the uterine cavity. Abnormal exceptions to this attitude occur as the fetal head becomes progressively more extended from the vertex to the face presentation (see Fig. 22-1 ). This results in a progressive change in fetal attitude from a convex (flexed) to a concave (extended) contour of the vertebral column. Fetal Position Position refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the birth canal. Accordingly, with each presentation there may be two positions—right or left. The fetal occiput, chin (mentum), and sacrum are the determining points in vertex, face, and breech presentations, respectively ( Figs. 22-2 to 22-6 ). Because the presenting part may be in either the left or right position, there are left and right occipital, left and right mental, and left and right sacral presentations. These are abbreviated as LO and RO, LM and RM, and LS and RS, respectively. FIGURE 22-2 Longitudinal lie. Vertex presentation. A. Left occiput anterior (LOA). B. Left occiput posterior (LOP). FIGURE 22-3 Longitudinal lie. Vertex presentation. A . Right occiput posterior (ROP). B . Right occiput transverse (ROT). FIGURE 22-4 Longitudinal lie. Vertex presentation. Right occiput anterior (ROA). FIGURE 22-5 Longitudinal lie. Face presentation. Left and right mentum anterior and right mentum posterior positions. FIGURE 22-6 Longitudinal lie. Breech presentation. Left sacrum posterior (LSP). Varieties of Presentations and Positions For still more accurate orientation, the relationship of a given portion of the presenting part to the anterior, transverse, or posterior portion of the maternal pelvis is considered. Because the presenting part in right or left positions may be directed anteriorly (A), transversely (T), or posteriorly (P), there are six varieties of each of the three presentations as shown in Figures 22-2 to 22-6 . Thus, in an occiput presentation, the presentation, position, and variety may be abbreviated in clockwise fashion as: Approximately two thirds of all vertex presentations are in the left occiput position, and one third in the right. In shoulder presentations, the acromion (scapula) is the portion of the fetus arbitrarily chosen for orientation with the maternal pelvis. One example of the terminology sometimes employed for this purpose is illustrated in Figure 22-7 . The acromion or back of the fetus may be directed either posteriorly or anteriorly and superiorly or inferiorly. Because it is impossible to differentiate exactly the several varieties of shoulder presentation by clinical examination and because such specific differentiation serves no practical purpose, it is customary to refer to all transverse lies simply as shoulder presentations . Another term used is transverse lie , with back up or back down , which is clinically important when deciding incision type for cesarean delivery ( Chap. 23 , p. 468 ). FIGURE 22-7 Transverse lie. Right acromiodorsoposterior (RADP). The shoulder of the fetus is to the mother’s right, and the back is posterior. Diagnosis of Fetal Presentation and Position Several methods can be used to diagnose fetal presentation and position. These include abdominal palpation, vaginal examination, auscultation, and, in certain doubtful cases, sonography. Rarely, plain radiographs, computed tomography, or magnetic resonance imaging may be used. Abdominal Palpation—Leopold Maneuvers Abdominal examination can be conducted systematically employing the four maneuvers described by Leopold in 1894 and shown in Figure 22-8 . The mother lies supine and comfortably positioned with her abdomen bared. These maneuvers may be difficult if not impossible to perform and interpret if the patient is obese, if there is excessive amnionic fluid, or if the placenta is anteriorly implanted. FIGURE 22-8 Leopold maneuvers (A–D) performed in a fetus with a longitudinal lie in the left occiput anterior position (LOA). The first maneuver permits identification of which fetal pole—that is, cephalic or podalic—occupies the uterine fundus. The breech gives the sensation of a large, nodular mass, whereas the head feels hard and round and is more mobile and ballottable. Performed after determination of fetal lie, the second maneuver is accomplished as the palms are placed on either side of the maternal abdomen, and gentle but deep pressure is exerted. On one side, a hard, resistant structure is felt—the back. On the other, numerous small, irregular, mobile parts are felt—the fetal extremities. By noting whether the back is directed anteriorly, transversely, or posteriorly, fetal orientation can be determined. The third maneuver is performed by grasping with the thumb and fingers of one hand the lower portion of the maternal abdomen just above the symphysis pubis. If the presenting part is not engaged, a movable mass will be felt, usually the head. The differentiation between head and breech is made as in the first maneuver. If the presenting part is deeply engaged, however, the findings from this maneuver are simply indicative that the lower fetal pole is in the pelvis, and details are then defined by the fourth maneuver. To perform the fourth maneuver, the examiner faces the mother’s feet and, with the tips of the first three fingers of each hand, exerts deep pressure in the direction of the axis of the pelvic inlet. In many instances, when the head has descended into the pelvis, the anterior shoulder may be differentiated readily by the third maneuver. Abdominal palpation can be performed throughout the latter months of pregnancy and during and between the contractions of labor. With experience, it is possible to estimate the size of the fetus. According to Lydon-Rochelle and colleagues (1993), experienced clinicians accurately identify fetal malpresentation using Leopold maneuvers with a high sensitivity—88 percent, specificity—94 percent, positive-predictive value—74 percent, and negative-predictive value—97 percent. Vaginal Examination Before labor, the diagnosis of fetal presentation and position by vaginal examination is often inconclusive because the presenting part must be palpated through a closed cervix and lower uterine segment. With the onset of labor and after cervical dilatation, vertex presentations and their positions are recognized by palpation of the various fetal sutures and fontanels. Face and breech presentations are identified by palpation of facial features and fetal sacrum, respectively. In attempting to determine presentation and position by vaginal examination, it is advisable to pursue a definite routine, comprising four movements. First, the examiner inserts two fingers into the vagina and the presenting part is found. Differentiation of vertex, face, and breech is then accomplished readily. Second, if the vertex is presenting, the fingers are directed posteriorly and then swept forward over the fetal head toward the maternal symphysis ( Fig. 22-9 ). During this movement, the fingers necessarily cross the sagittal suture and its linear course is delineated. Next, the positions of the two fontanels are ascertained. For this, fingers are passed to the most anterior extension of the sagittal suture, and the fontanel encountered there is examined and identified. Then, with a sweeping motion, the fingers pass along the suture to the other end of the head until the other fontanel is felt and differentiated ( Fig. 22-10 ). Last, the station, or extent to which the presenting part has descended into the pelvis, can also be established at this time ( p. 449 ). Using these maneuvers, the various sutures and fontanels are located readily ( Fig. 7-11 , p. 139 ). FIGURE 22-9 Locating the sagittal suture by vaginal examination. FIGURE 22-10 Differentiating the fontanels by vaginal examination. Sonography and Radiography Sonographic techniques can aid fetal position identification, especially in obese women or in women with rigid abdominal walls. Zahalka and associates (2005) compared digital examinations with transvaginal and transabdominal sonography for fetal head position determination during second-stage labor and reported that transvaginal sonography was superior. Occiput Anterior Presentation In most cases, the vertex enters the pelvis with the sagittal suture lying in the transverse pelvic diameter. The fetus enters the pelvis in the left occiput transverse (LOT) position in 40 percent of labors and in the right occiput transverse (ROT) position in 20 percent (Caldwell, 1934). In occiput anterior positions—LOA or ROA— the head either enters the pelvis with the occiput rotated 45 degrees anteriorly from the transverse position, or this rotation occurs subsequently. The mechanism of labor in all these presentations is usually similar. The positional changes of the presenting part required to navigate the pelvic canal constitute the mechanisms of labor . The cardinal movements of labor are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion ( Fig. 22-11 ). During labor, these movements not only are sequential but also show great temporal overlap. For example, as part of engagement, there is both flexion and descent of the head. It is impossible for the movements to be completed unless the presenting part descends simultaneously. Concomitantly, uterine contractions effect important modifications in fetal attitude, or habitus, especially after the head has descended into the pelvis. These changes consist principally of fetal straightening, with loss of dorsal convexity and closer application of the extremities to the body. As a result, the fetal ovoid is transformed into a cylinder, with the smallest possible cross section typically passing through the birth canal. Figure 22-11 Cardinal movements of labor and delivery from a left occiput anterior position. Engagement The mechanism by which the biparietal diameter—the greatest transverse diameter in an occiput presentation—passes through the pelvic inlet is designated engagement . The fetal head may engage during the last few weeks of pregnancy or not until after labor commencement. In many multiparous and some nulliparous women, the fetal head is freely movable above the pelvic inlet at labor onset. In this circumstance, the head is sometimes referred to as “floating.” A normal-sized head usually does not engage with its sagittal suture directed anteroposteriorly. Instead, the fetal head usually enters the pelvic inlet either transversely or obliquely. Segel and coworkers (2012) analyzed labor in 5341 nulliparous women and found that fetal head engagement before labor onset did not affect vaginal delivery rates in either spontaneous or induced labor. Asynclitism. The fetal head tends to accommodate to the transverse axis of the pelvic inlet, whereas the sagittal suture, while remaining parallel to that axis, may not lie exactly midway between the symphysis and the sacral promontory. The sagittal suture frequently is deflected either posteriorly toward the promontory or anteriorly toward the symphysis ( Fig. 22-12 ). Such lateral deflection to a more anterior or posterior position in the pelvis is called asynclitism . If the sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers, and the condition is called anterior asynclitism . If, however, the sagittal suture lies close to the symphysis, more of the posterior parietal bone will present, and the condition is called posterior asynclitism . With extreme posterior asynclitism, the posterior ear may be easily palpated. FIGURE 22-12 Synclitism and asynclitism. Moderate degrees of asynclitism are the rule in normal labor. However, if severe, the condition is a common reason for cephalopelvic disproportion even with an otherwise normal-sized pelvis. Successive shifting from posterior to anterior asynclitism aids descent. Descent This movement is the first requisite for birth of the newborn. In nulliparas, engagement may take place before the onset of labor, and further descent may not follow until the onset of the second stage. In multiparas, descent usually begins with engagement. Descent is brought about by one or more of four forces: (1) pressure of the amnionic fluid, (2) direct pressure of the fundus upon the breech with contractions, (3) bearing-down efforts of maternal abdominal muscles, and (4) extension and straightening of the fetal body. Flexion As soon as the descending head meets resistance, whether from the cervix, pelvic walls, or pelvic floor, it normally flexes. With this movement, the chin is brought into more intimate contact with the fetal thorax, and the appreciably shorter suboccipitobregmatic diameter is substituted for the longer occipitofrontal diameter ( Figs. 22-13 and 22-14 ). FIGURE 22-13 Lever action produces flexion of the head. Conversion from occipitofrontal to suboccipitobregmatic diameter typically reduces the anteroposterior diameter from nearly 12 to 9.5 cm. FIGURE 22-14 Four degrees of head flexion. The solid line represents the occipitomental diameter, whereas the broken line connects the center of the anterior fontanel with the posterior fontanel. A. Flexion poor. B. Flexion moderate. C. Flexion advanced. D. Flexion complete. Note that with complete flexion, the chin is on the chest. The suboccipitobregmatic diameter, the shortest anteroposterior diameter of the fetal head, is passing through the pelvic inlet. Internal Rotation This movement consists of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly from its original position or, less commonly, posteriorly toward the hollow of the sacrum ( Figs. 22-15 to 22-17 ). Internal rotation is essential for completion of labor, except when the fetus is unusually small. FIGURE 22-15 Mechanism of labor for the left occiput transverse position, lateral view. A. Engagement. B. After engagement, further descent. C. Descent and initial internal rotation. D. Rotation and extension. FIGURE 22-16 Mechanism of labor for left occiput anterior position. FIGURE 22-17 Mechanism of labor for right occiput posterior position showing anterior rotation. Calkins (1939) studied more than 5000 women in labor to ascertain the time of internal rotation. He concluded that in approximately two thirds, internal rotation is completed by the time the head reaches the pelvic floor; in about another fourth, internal rotation is completed shortly after the head reaches the pelvic floor; and in the remaining 5 percent, rotation does not take place. When the head fails to turn until reaching the pelvic floor, it typically rotates during the next one or two contractions in multiparas. In nulliparas, rotation usually occurs during the next three to five contractions. Extension After internal rotation, the sharply flexed head reaches the vulva and undergoes extension. If the sharply flexed head, on reaching the pelvic floor, did not extend but was driven farther downward, it would impinge on the posterior portion of the perineum and would eventually be forced through the perineal tissues. When the head presses on the pelvic floor, however, two forces come into play. The first force, exerted by the uterus, acts more posteriorly, and the second, supplied by the resistant pelvic floor and the symphysis, acts more anteriorly. The resultant vector is in the direction of the vulvar opening, thereby causing head extension. This brings the base of the occiput into direct contact with the inferior margin of the symphysis pubis (see Fig. 22-16 ). With progressive distention of the perineum and vaginal opening, an increasingly larger portion of the occiput gradually appears. The head is born as the occiput, bregma, forehead, nose, mouth, and finally the chin pass successively over the anterior margin of the perineum (see Fig. 22-17 ). Immediately after its delivery, the head drops downward so that the chin lies over the maternal anus. External Rotation The delivered head next undergoes restitution (see Fig. 22-11 ). If the occiput was originally directed toward the left, it rotates toward the left ischial tuberosity. If it was originally directed toward the right, the occiput rotates to the right. Restitution of the head to the oblique position is followed by external rotation completion to the transverse position. This movement corresponds to rotation of the fetal body and serves to bring its bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet. Thus, one shoulder is anterior behind the symphysis and the other is posterior. This movement apparently is brought about by the same pelvic factors that produced internal rotation of the head. Expulsion Almost immediately after external rotation, the anterior shoulder appears under the symphysis pubis, and the perineum soon becomes distended by the posterior shoulder. After delivery of the shoulders, the rest of the body quickly passes. Occiput Posterior Presentation In approximately 20 percent of labors, the fetus enters the pelvis in an occiput posterior (OP) position (Caldwell, 1934). The right occiput posterior (ROP) is slightly more common than the left (LOP). It appears likely from radiographic evidence that posterior positions are more often associated with a narrow forepelvis. They also are more commonly seen in association with anterior placentation (Gardberg, 1994a). In most occiput posterior presentations, the mechanism of labor is identical to that observed in the transverse and anterior varieties, except that the occiput has to internally rotate to the symphysis pubis through 135 degrees, instead of 90 and 45 degrees, respectively (see Fig. 22-17 ). Effective contractions, adequate head flexion, and average fetal size together permit most posteriorly positioned occiputs to rotate promptly as soon as they reach the pelvic floor, and labor is not lengthened appreciably. In perhaps 5 to 10 percent of cases, however, rotation may be incomplete or may not take place at all, especially if the fetus is large (Gardberg, 1994b). Poor contractions, faulty head flexion, or epidural analgesia, which diminishes abdominal muscular pushing and relaxes pelvic floor muscles, may predispose to incomplete rotation. If rotation is incomplete, transverse arrest may result. If no rotation toward the symphysis takes place, the occiput may remain in the direct occiput posterior position, a condition known as persistent occiput posterior . Both persistent occiput posterior and transverse arrest represent deviations from the normal mechanisms of labor and are considered further in Chapter 23 . Fetal Head Shape Changes Caput Succedaneum In vertex presentations, labor forces alter fetal head shape. In prolonged labors before complete cervical dilatation, the portion of the fetal scalp immediately over the cervical os becomes edematous ( Fig. 33-1 , p. 647 ). This swelling, known as the caput succedaneum , is shown in Figures 22-18 and 22-19 . It usually attains a thickness of only a few millimeters, but in prolonged labors it may be sufficiently extensive to prevent differentiation of the various sutures and fontanels. More commonly, the caput is formed when the head is in the lower portion of the birth canal and frequently only after the resistance of a rigid vaginal outlet is encountered. Because it develops over the most dependent area of the head, one may deduce the original fetal head position by noting the location of the caput succedaneum. FIGURE 22-18 Formation of caput succedaneum and head molding.

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Cephalic Presentation
Medicine and Healthcare
Obstetrics, Gynecology & Women'S Health

Management of Labour and Delivery – Questions

Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth in Get Through , 2014

For each clinical scenario below, choose the single most appropriate stage of labour from the above list of options. Each option may be used once, more than once or not at all. A 30-year-old para 3 woman was admitted at term with regular uterine activity at 5 cm cervical dilatation and 4 hours later she delivered a female neonate with APGARs 9, 10, 10 at 1, 5 and 10 minutes. Syntometrine injection was given immediately after delivery and placenta with membranes was delivered completely 20 minutes after the delivery of the baby by continuous cord traction.A 23-year-old para 3 woman was admitted after spontaneous rupture of membranes at 39 weeks’ gestation. She is contracting 4 in 10 minutes and pushing involuntarily. On vaginal examination the cervix was fully dilated, vertex was 2 cm below the spines in direct occipito-anterior position with minimal caput and moulding.A 30-year-old nulliparous woman was admitted at term with uterine contractions once in every 5 minutes. On examination, the fetus is in cephalic presentation with two fifths palpable per abdomen. The cervix is central, soft, fully effaced and 2 cm dilated with intact membranes.

Biometric Measurements and Normal Growth Parameters in a Child

Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child , 2021

In cephalic presentation, the intra-uterine fetal position is of universal flexion, which is carried by the child to the immediate post-partum period. The hips and knees are flexed. The lower legs are internally rotated. The feet are further internally rotated with respect to the lower legs. At times there is an external rotational contracture of the hip that tends to mask the true femoral rotational profile. The anatomy of the lower limbs changes significantly as the child grows. This is primarily in response to the development of motor abilities and the ability of the child to crawl, cruise, stand, walk, and finally run. These changes are seen right from the hip joints, the femoral neck, knees, and tibia to the feet.

DRCOG MCQs for Circuit A Questions

Una F. Coales in DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips , 2020

External cephalic version: Used to convert a breech presentation to cephalic presentation.Not contraindicated if there is a prior Caesarean section scar.Can cause premature labour.Contraindicated in hypertension.Can be performed after 33 weeks' gestation in a rhesus-negative mother.

Complex maternal congenital anomalies – a rare presentation and delivery through a supra-umbilical abdominal incision

Published in Journal of Obstetrics and Gynaecology , 2018

Samantha Bonner, Yara Mohammed

She had a spontaneous conception and booked at 9 weeks of gestation under consultant-led care. A scan confirmed the pregnancy was in the right uterus. She had no other significant medical history but did suffer from recurrent urinary tract infections and hence was on low-dose antibiotic prophylaxis. There was no sonographic evidence of hydronephrosis. Her body mass index (BMI) was 18 at the time of booking. Combined screening was low risk and she had a normal 20 week anomaly scan. She had serial growth scans which demonstrated a normal growth trajectory on a customised chart. The baby was consistently a cephalic presentation. She had multidisciplinary antenatal care, including specialist urologists, general surgeons, obstetricians and anaesthetists. An antenatal MRI scan had shown extensive adhesions over the lower segment of the uterus. She was extensively counselled regarding the mode of delivery and this was scheduled at 37 weeks of gestation to avoid the potential of spontaneous labour and an emergency Caesarean section.

Utilization of epidural volume extension technique for external cephalic version

Published in Baylor University Medical Center Proceedings , 2021

Hanna Hussey, James Damron, Mark F. Powell, Michelle Tubinis

Repeat ultrasound demonstrated breech presentation, normal amniotic fluid volume, and fetal head toward the maternal left abdomen. After 0.25 mg of intramuscular terbutaline injection, a forward roll was initiated by applying pressure from behind the fetal head toward the maternal left. Continuous progress was made and bedside ultrasound showed cephalic presentation. Immediately after successful ECV, the fetal heart rate was 70 beats/min but returned to baseline with conservative measures. Motor blockade regressed after approximately 1.5 hours. After 4 hours of fetal heart rate monitoring and tocometry, the patient was deemed stable for discharge. Follow-up discussion with the patient via phone call on postprocedure day 1 confirmed that she was not experiencing pain or concerning symptoms for neuraxial complications. She returned to the labor and delivery unit at 40 weeks’ gestation for elective induction of labor and had a successful vaginal delivery.

Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section

Aida Kalok, Shahril A. Zabil, Muhammad Abdul Jamil, Pei Shan Lim, Mohamad Nasir Shafiee, Nirmala Kampan, Shamsul Azhar Shah, Nor Azlin Mohamed Ismail

The inclusion criteria were pregnant women at 36 weeks of gestation or more with singleton foetus in cephalic presentation, who agreed for trial of vaginal delivery after one lower segment caesarean section. We excluded women with contraindication for vaginal birth, or who declined trial of vaginal delivery from this study. Previous antenatal history was noted and recorded during the 36-week assessment, including year and indication for previous caesarean section. Recurrent indications involved were cephalopelvic disproportion and obstructed labour. While non-recurrent indications were foetal distress and malpresentation. Past operative notes were checked for any operative complications such as extended uterine tear, organ injury and post-partum haemorrhage. Information regarding current pregnancy including pre-existing medical disorder was recorded. Estimated foetal weight based on ultrasound scan at 36 weeks of gestation was used in this study.

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Your baby in the birth canal

The best position for the baby to pass through the pelvis is with the head down and the body facing toward the mother's back. This position is called occiput anterior.

Alternative Names

Shoulder presentation; Malpresentations; Breech birth; Cephalic presentation; Fetal lie; Fetal attitude; Fetal descent; Fetal station; Cardinal movements; Labor-birth canal; Delivery-birth canal

Information

Certain terms are used to describe your baby's position and movement through the birth canal.

FETAL STATION

Fetal station refers to where the presenting part is in your pelvis.

The presenting part. The presenting part is the part of the baby that leads the way through the birth canal. Most often, it is the baby's head, but it can be a shoulder, the buttocks, or the feet.
Ischial spines. These are bone points on the mother's pelvis. Normally the ischial spines are the narrowest part of the pelvis.
0 station. This is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis.
If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5.

In first-time moms, the baby's head may engage by 36 weeks into the pregnancy. However, engagement may happen later in the pregnancy, or even during labor.

This refers to how the baby's spine lines up with the mother's spine. Your baby's spine is between their head and tailbone.

Your baby will most often settle into a position in the pelvis before labor begins.

If your baby's spine runs in the same direction (parallel) as your spine, the baby is said to be in a longitudinal lie. Nearly all babies are in a longitudinal lie.
If the baby is sideways (at a 90-degree angle to your spine), the baby is said to be in a transverse lie.

FETAL ATTITUDE

The fetal attitude describes the position of the parts of your baby's body.

The normal fetal attitude is commonly called the fetal position.

The head is tucked down to the chest.
The arms and legs are drawn in towards the center of the chest.

DELIVERY PRESENTATION

Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.

The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation.

This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.
There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).

If your baby is in any position other than head down, your doctor may recommend a cesarean delivery.

Breech presentation is when the baby's bottom is down. Breech presentation occurs about 3% of the time. There are a few types of breech:

A complete breech is when the buttocks present first and both the hips and knees are flexed.
A frank breech is when the hips are flexed so the legs are straight and completely drawn up toward the chest.
Other breech positions occur when either the feet or knees present first.

CARDINAL MOVEMENTS OF LABOR

This is when the widest part of your baby's head has entered the pelvis.
Engagement tells your health care provider that your pelvis is large enough to allow the baby's head to move down (descend).
This is when your baby's head moves down (descends) further through your pelvis.
Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.
During descent, the baby's head is flexed down so that the chin touches the chest.
With the chin tucked, it is easier for the baby's head to pass through the pelvis.

Internal Rotation

As your baby's head descends further, the head will most often rotate so the back of the head is just below your pubic bone. This helps the head fit the shape of your pelvis.
Usually, the baby will be face down toward your spine.
Sometimes, the baby will rotate so it faces up toward the pubic bone.
As your baby's head rotates, extends, or flexes during labor, the body will stay in position with one shoulder down toward your spine and one shoulder up toward your belly.
As your baby reaches the opening of the vagina, usually the back of the head is in contact with your pubic bone.
At this point, the birth canal curves upward, and the baby's head must extend back. It rotates under and around the pubic bone.

External Rotation

As the baby's head is delivered, it will rotate a quarter turn to be in line with the body.
After the head is delivered, the top shoulder is delivered under the pubic bone.
After the shoulder, the rest of the body is usually delivered without a problem.

Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

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Health Conditions

Signs That Your Baby Has Turned Into a Head-Down Position

As you get closer to your due date, they’ll likely settle into a head-down position to prepare for birth. You might be able to tell based on where you feel their head and movements.

Your baby kicks, squirms, and flips all day (and night!). But what exactly are they doing in there?

Toward the end of pregnancy, your baby will likely get into a head-down position so that they can begin their descent into the birth canal. The exact timing of when your baby hits this position is individual. And some babies prefer other positions, like breech (head up) or transverse (side lying).

Regardless, you can look out for signs that your baby has moved head down. Here’s more about when your baby will move head down, what the options are if they stay head up or in another position, and what to feel for when trying to determine your baby’s position at home.

When it generally occurs

Most babies tend to shimmy their way into a cephalic (head-first) presentation before birth.

Your baby may move all over the place in the first and second trimesters. Their position may change wildly early on in the third trimester as well. At 28 weeks, around 25% of babies are breech (head up), but this drops significantly later in pregnancy.

If you’re in your third trimester, you may notice your baby staying put in a head-down position. Your uterus grows to accommodate their size — but there’s only so much room. As time passes, your baby gets bigger and starts to run out of space to move into different positions.

Learn more about what to expect during the third trimester .

Types of head-down positions

Being head down is just half of the equation when it comes to birth. There’s also the matter of which way your baby is facing.

Why does this make a difference? It comes down to geometry. Your baby’s head must fit through the pelvis on its way into the vaginal canal for delivery. Some positions make this journey easier than others, especially considering how different parts of your baby’s skull are wider and narrower than others.

There are two positions your baby might be in:

Occiput anterior: This position is the most common. It means that your baby is head down with their back against your stomach and their chin tucked into their chest.
Occiput posterior: This position means that your baby is head down but facing the opposite direction. In this position, your baby’s back is at your back.

Anterior is considered the ideal position for an uncomplicated vaginal delivery. When your baby’s chin is tucked, it helps the narrowest part of their head go through the birth canal. Posterior presentation can sometimes mean a longer or more complicated delivery.

If your baby is posterior even in early labor, they may still turn throughout the process as contractions move them around in the womb. Some babies completely spin to an anterior position during labor while others are born posterior.

Signs and symptoms that it has happened

You may not experience any signs that your baby has flipped into a head-down position, and there’s no easy way to tell just by looking at your bump.

Fortunately, your doctor or midwife is trained to feel for your baby’s position using what are called Leopold’s maneuvers. With this technique, they will feel for what part of your baby is presenting in the pelvis, then for your baby’s back, and what part of your baby is in your fundus (up high, near your rib cage).

They can also use an ultrasound to confirm your baby’s position.

Additionally, your doctor will feel around for your baby’s cephalic prominence, which simply means which way your baby is facing.

With a head-down presentation:

baby’s head would be in your pelvis
baby’s back position would depend on whether baby is anterior/posterior, but generally baby will have either their back to your belly (anterior) or your back (posterior)
baby’s bottom/legs would be in your fundus

But how can you figure out your baby’s position at home? Pay close attention to the shapes in your belly, as well as the different movements you feel.

Your baby may be head down if you can:

feel their head low down in your belly
feel their bottom or legs above your belly button
feel larger movements (bottom or legs) higher up toward your rib cage
feel smaller movements (hands or elbows) low down in your pelvis
feel hiccups on the lower part of your belly, meaning that their chest is likely lower than their legs

Belly mapping

It can be difficult to read the different lumps and bumps you feel on your stomach. But with practice, you may start to understand what you’re feeling.

You could even try belly mapping, a process to estimate baby’s position. It was created by Gaily Tully, certified professional midwife and author of SpinningBabies.com .

To use this technique, wait until you are at least 30 weeks pregnant. Lie down in bed or on the couch, and use a washable marker or finger paint to gently mark where you feel your baby’s head (it feels like a small bowling ball). The arms and hands are likely near the head, and their tiny movements give them away.

Then feel for the back, butt, and legs, as well as larger movements. Lightly draw or paint your baby on your stomach to help you visualize how they’re lying.

Options for babies that aren’t yet head down

If you’re in late pregnancy and have concerns about your baby’s positioning, ask your doctor about it at your next prenatal appointment. There are several options for delivery if your baby is in breech or another position.

Wait-and-see approach

Your baby’s position isn’t usually a concern until you reach the third trimester Before that point, the fluid in the uterus gives your baby plenty of space to move around. As you get closer to delivery, they start to run out of space to change position.

Your doctor can monitor your baby’s position at your prenatal appointments by feeling your belly for where their head, back, and buttocks are. To confirm, you may also have an ultrasound or pelvic exam.

External cephalic version (ECV)

External cephalic version (ECV) is a procedure during which your doctor tries to move your baby into a head-down position to increase your chance of a vaginal birth. This is done in a setting in which baby can be monitored and you can have an emergency cesarean section (C-section) if needed.

The success rate of this procedure is around 58% . While that’s not a guarantee, ECV may be worth a try if delivering vaginally is important to you.

It’s also worth noting that some babies that are flipped return to a breech position. You can have a repeat ECV, but space runs out the closer you get to birth, so it may be more difficult the second time.

Cesarean delivery (C-section)

A C-section is another option for delivering babies who aren’t head down. It is a surgery that you may schedule ahead of time (if you know your baby isn’t head down) or that can be performed in the event you go into labor naturally.

Most babies who are breech are born C-section. While this surgery is routine, it involves some risks, including:

postpartum hemorrhage
blood clots
issues with future pregnancies, like a risk of placenta previa or uterine rupture

Vaginal birth

Some people are still able to have a vaginal birth even if their babies are breech. This possibility is determined on a case-by-case basis and involves a review of your medical history and weighing benefits and risks.

If you choose to go this route, you’ll need to follow any specific guidelines set up by your hospital or birth center. Your doctor will monitor you closely, and if they have concerns about you or your baby’s health, they may recommend immediately switching to a C-section.

The bottom line

Your baby moves a lot throughout your pregnancy. As you get closer to your due date, they’ll likely settle into a head-down position as they get ready for birth.

If you have concerns about your baby’s position, don’t hesitate to bring them up at your next prenatal appointment. Your doctor is also keeping tabs on whether baby is head down and can help guide you with options for repositioning or an alternate birth plan, if necessary.

3rd Trimester

How we reviewed this article:

Gray CJ, et al. (2022). Breech presentation. https://www.ncbi.nlm.nih.gov/books/NBK448063/
Makajeva J, et al. (2023). Delivery, face and brow presentation. https://www.ncbi.nlm.nih.gov/books/NBK567727/
Shanahan MM, et al. (2023). External cephalic version. https://www.ncbi.nlm.nih.gov/books/NBK482475/

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Obstetric and Newborn Care I

10.02 key terms related to fetal positions.

a. “Lie” of an Infant.

Lie refers to the position of the spinal column of the fetus in relation to the spinal column of the mother. There are two types of lie, longitudinal and transverse. Longitudinal indicates that the baby is lying lengthwise in the uterus, with its head or buttocks down. Transverse indicates that the baby is lying crosswise in the uterus.

b. Presentation/Presenting Part.

Presentation refers to that part of the fetus that is coming through (or attempting to come through) the pelvis first.

(1) Types of presentations (see figure 10-1). The vertex or cephalic (head), breech, and shoulder are the three types of presentations. In vertex or cephalic, the head comes down first. In breech, the feet or buttocks comes down first, and last–in shoulder, the arm or shoulder comes down first. This is usually referred to as a transverse lie.

Figure 10-1. Typical types of presentations.

(2) Percentages of presentations.

(a) Head first is the most common-96 percent.

(b) Breech is the next most common-3.5 percent.

(3) Specific presentation may be evaluated by several ways.

(a) Abdominal palpation-this is not always accurate.

(b) Vaginal exam–this may give a good indication but not infallible.

(d) X-ray–this confirms the presentation, but is used only as a last resort due to possible harm to the fetus as a result of exposure to radiation.

c. Attitude.

This is the degree of flexion of the fetus body parts (body, head, and extremities) to each other. Flexion is resistance to the descent of the fetus down the birth canal, which causes the head to flex or bend so that the chin approaches the chest.

(1) Types of attitude (see figure 10-2).

Figure 10-2. Types of attitudes. A--Complete flexion. B-- Moderate flexion. C--Poor flexion. D--Hyperextension

(a) Complete flexion. This is normal attitude in cephalic presentation. With cephalic, there is complete flexion at the head when the fetus “chin is on his chest.” This allows the smallest cephalic diameter to enter the pelvis, which gives the fewest mechanical problems with descent and delivery.

(b) Moderate flexion or military attitude. In cephalic presentation, the fetus head is only partially flexed or not flexed. It gives the appearance of a military person at attention. A larger diameter of the head would be coming through the passageway.

(c) Poor flexion or marked extension. In reference to the fetus head, it is extended or bent backwards. This would be called a brow presentation. It is difficult to deliver because the widest diameter of the head enters the pelvis first. This type of cephalic presentation may require a C/Section if the attitude cannot be changed.

(d) Hyperextended. In reference to the cephalic position, the fetus head is extended all the way back. This allows a face or chin to present first in the pelvis. If there is adequate room in the pelvis, the fetus may be delivered vaginally.

(2) Areas to look at for flexion.

(a) Head-discussed in previous paragraph, 10-2c(1).

(b) Thighs-flexed on the abdomen.

(d) Arches of the feet-rested on the anterior surface of the legs.

(e) Arms-crossed over the thorax.

(3) Attitude of general flexion. This is when all of the above areas are flexed appropriately as described.

d. Station.

This refers to the depth that the presenting part has descended into the pelvis in relation to the ischial spines of the mother’s pelvis. Measurement of the station is as follows:

(1) The degree of advancement of the presenting part through the pelvis is measured in centimeters.

(2) The ischial spines is the dividing line between plus and minus stations.

(3) Above the ischial spines is referred to as -1 to -5, the numbers going higher as the presenting part gets higher in the pelvis (see figure10-3).

(4) The ischial spines is zero (0) station.

(5) Below the ischial spines is referred to +1 to +5, indicating the lower the presenting part advances.

e. Engagement.

This refers to the entrance of the presenting part of the fetus into the true pelvis or the largest diameter of the presenting part into the true pelvis. In relation to the head, the fetus is said to be engaged when it reaches the midpelvis or at a zero (0) station. Once the fetus is engaged, it (fetus) does not go back up. Prior to engagement occurring, the fetus is said to be “floating” or ballottable.

f. Position.

This is the relationship between a predetermined point of reference or direction on the presenting part of the fetus to the pelvis of the mother.

(1) The 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.

NOTE: Remember that when you are describing the quadrants, view them as the mother would.

(2) 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.

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.

(3) 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 the reference point is in (anterior-A, posterior-P, transverse or in the middle-T).

(b) Each presenting part has the possibility of six positions. They are normally recognized for each position–using “occiput” as the reference point.

1 Left occiput anterior (LOA).

2 Left occiput posterior (LOP).

3 Left occiput transverse (LOT).

4 Right occiput anterior (ROA).

5. Right occiput posterior (ROP).

6 Right occiput transverse (ROT).

1 Occiput at sacrum (O.S.) or occiput at posterior (O.P.).

2 Occiput at pubis (O.P.) or occiput at anterior (O.A.).

(4) Types of breech presentations (see figure10-4).

(a) Complete or full breech. This involves flexion of the fetus legs. It looks like the fetus is sitting in a tailor fashion. The buttocks and feet appear at the vaginal opening almost simultaneously.

A–Complete. B–Frank. C–Incomplete.

(b) Frank and single breech. The fetus thighs are flexed on his abdomen. His legs are against his trunk and feet are in his face (foot-in-mouth posture). This is the most common and easiest breech presentation to deliver.

(c) Incomplete breech. The fetus feet or knees will appear first. His feet are labeled single or double footing, depending on whether 1 or 2 feet appear first.

(5) Observations about positions (see figure 10-5).

(a) LOA and ROA positions are the most common and permit relatively easy delivery.

(b) LOP and ROP positions usually indicate labor may be longer and harder, and the mother will experience severe backache.

Figure 10-5. Examples of fetal vertex presentations in relation to quadrant of maternal pelvis.

1 Breech. This will be upper R or L quad, above the umbilicus.

2 Vertex. This will be lower R or L quad, below the umbilicus.

(d) An occiput in the posterior quadrant means that you will feel lumpy fetal parts, arms and legs (see figure 10-5 A). If delivered in that position, the infant will come out looking up.

(e) An occiput in the anterior quadrant means that you will feel a more smooth back (see figure 10-5 B). If delivered in that position, the infant will come out looking down at the floor.

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Your baby in the birth canal

The best position for the baby to pass through the pelvis is with the head down and the body facing toward the mother's back. This position is called occiput anterior.

Information

Certain terms are used to describe your baby's position and movement through the birth canal.

FETAL STATION

Fetal station refers to where the presenting part is in your pelvis.

The presenting part. The presenting part is the part of the baby that leads the way through the birth canal. Most often, it is the baby's head, but it can be a shoulder, the buttocks, or the feet.
Ischial spines. These are bone points on the mother's pelvis. Normally the ischial spines are the narrowest part of the pelvis.
0 station. This is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis.
If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5.

In first-time moms, the baby's head may engage by 36 weeks into the pregnancy. However, engagement may happen later in the pregnancy, or even during labor.

This refers to how the baby's spine lines up with the mother's spine. Your baby's spine is between their head and tailbone.

Your baby will most often settle into a position in the pelvis before labor begins.

If your baby's spine runs in the same direction (parallel) as your spine, the baby is said to be in a longitudinal lie. Nearly all babies are in a longitudinal lie.
If the baby is sideways (at a 90-degree angle to your spine), the baby is said to be in a transverse lie.

FETAL ATTITUDE

The fetal attitude describes the position of the parts of your baby's body.

The normal fetal attitude is commonly called the fetal position.

The head is tucked down to the chest.
The arms and legs are drawn in towards the center of the chest.

DELIVERY PRESENTATION

Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.

The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation.

This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.
There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).

If your baby is in any position other than head down, your doctor may recommend a cesarean delivery.

Breech presentation is when the baby's bottom is down. Breech presentation occurs about 3% of the time. There are a few types of breech:

A complete breech is when the buttocks present first and both the hips and knees are flexed.
A frank breech is when the hips are flexed so the legs are straight and completely drawn up toward the chest.
Other breech positions occur when either the feet or knees present first.

CARDINAL MOVEMENTS OF LABOR

This is when the widest part of your baby's head has entered the pelvis.
Engagement tells your health care provider that your pelvis is large enough to allow the baby's head to move down (descend).
This is when your baby's head moves down (descends) further through your pelvis.
Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.
During descent, the baby's head is flexed down so that the chin touches the chest.
With the chin tucked, it is easier for the baby's head to pass through the pelvis.

Internal Rotation

As your baby's head descends further, the head will most often rotate so the back of the head is just below your pubic bone. This helps the head fit the shape of your pelvis.
Usually, the baby will be face down toward your spine.
Sometimes, the baby will rotate so it faces up toward the pubic bone.
As your baby's head rotates, extends, or flexes during labor, the body will stay in position with one shoulder down toward your spine and one shoulder up toward your belly.
As your baby reaches the opening of the vagina, usually the back of the head is in contact with your pubic bone.
At this point, the birth canal curves upward, and the baby's head must extend back. It rotates under and around the pubic bone.

External Rotation

As the baby's head is delivered, it will rotate a quarter turn to be in line with the body.
After the head is delivered, the top shoulder is delivered under the pubic bone.
After the shoulder, the rest of the body is usually delivered without a problem.

Alternative Names

Shoulder presentation; Malpresentations; Breech birth; Cephalic presentation; Fetal lie; Fetal attitude; Fetal descent; Fetal station; Cardinal movements; Labor-birth canal; Delivery-birth canal

Barth WH. Malpresentations and malposition. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

Review Date 11/10/2022

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Chapter 15: Abnormal Cephalic Presentations

Roxanna Mohammed; Darine El-Chaâr

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Malpresentations.

TRANSVERSE POSITIONS OF THE OCCIPUT
POSTERIOR POSITIONS OF THE OCCIPUT
BROW PRESENTATIONS
MEDIAN VERTEX PRESENTATIONS: MILITARY ATTITUDE
FACE PRESENTATION
SELECTED READING
Full Chapter
Supplementary Content

The fetus enters the pelvis in a cephalic presentation approximately 95 to 96 percent of the time. In these cephalic presentations, the occiput may be in the persistent transverse or posterior positions. In about 3 to 4 percent of pregnancies, there is a breech-presenting fetus (see Chapter 25 ). In the remaining 1 percent, the fetus may be either in a transverse or oblique lie (see Chapter 26 ), or the head may be extended with the face or brow presenting.

Predisposing Factors

Maternal and uterine factors.

Contracted pelvis: This is the most common and important factor

Pendulous maternal abdomen: If the uterus and fetus are allowed to fall forward, there may be difficulty in engagement

Neoplasms: Uterine fibromyomas or ovarian cysts can block the entry to the pelvis

Uterine anomalies: In a bicornuate uterus, the nonpregnant horn may obstruct labor in the pregnant one

Abnormalities of placental size or location: Conditions such as placenta previa are associated with unfavorable positions of the fetus

High parity

Fetal Factors

Errors in fetal polarity, such as breech presentation and transverse lie

Abnormal internal rotation: The occiput rotates posteriorly or fails to rotate at all

Fetal attitude: Extension in place of normal flexion

Multiple pregnancy

Fetal anomalies, including hydrocephaly and anencephaly

Polyhydramnios: An excessive amount of amniotic fluid allows the fetus freedom of activity, and he or she may assume abnormal positions

Prematurity

Placenta and Membranes

Placenta previa

Cornual implantation

Premature rupture of membranes

Effects of Malpresentations

Effects on labor.

The less symmetrical adaptation of the presenting part to the cervix and to the pelvis plays a part in reducing the efficiency of labor.

The incidence of fetopelvic disproportion is higher

Inefficient uterine action is common. The contractions tend to be weak and irregular

Prolonged labor is seen frequently

Pathologic retraction rings can develop, and rupture of the lower uterine segment may be the end result

The cervix often dilates slowly and incompletely

The presenting part stays high

Premature rupture of the membranes occurs often

The need for operative delivery is increased

Effects on the Mother

Because greater uterine and intra-abdominal muscular effort is required and because labor is often prolonged, maternal exhaustion is common

There is more stretching of the perineum and soft parts, and there are more lacerations

Bleeding is more profuse, originating from:

Tears of the uterus, cervix, and vagina

Uterine atony from prolonged labor

There is a greater incidence of infection. This is caused by:

Early rupture of the membranes

Excessive blood loss

Tissue damage

Frequent rectal and vaginal examinations

Prolonged labor

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COMMENTS

Cephalic Position: Understanding Your Baby's Presentation at Birth
Cephalic occiput posterior. Your baby is head down with their face turned toward your belly. This can make delivery a bit harder because the head is wider this way and more likely to get stuck ...
Fetal presentation before birth
Frank breech. When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head.
Cephalic Position During Labor: Purpose, Risks, and More
The cephalic position is when a fetus is head down when it is ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery. About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy.
Your Guide to Fetal Positions before Childbirth
Head Down, Facing Up (Cephalic, Occiput Posterior Presentation) In this position, baby is still head down towards the cervix, but is facing its mama's front side. This position is also known as "sunny side up," and is associated with uncomfortable back labor and a longer delivery. While not as ideal as a cephalic presentation, it's very ...
Your baby in the birth canal
Cephalic presentation occurs in about 97% of deliveries. There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude). If your baby is in any position other than head down, your doctor may recommend a cesarean delivery. Breech presentation is when the baby's bottom is down ...
Common baby positions during pregnancy and labor
Cephalic presentation, occiput anterior. This is the best position for labor. Your baby is head-down, their face is turned toward your back, and their chin is tucked to their chest. This allows the back of your baby's head to easily enter your pelvis when the time is right. Most babies settle into this position by week 36 of pregnancy.
Baby Positions in Womb: What They Mean
The baby's chin is tucked into their chest and their head is ready to enter the pelvis. The baby is able to flex their head and neck, and tuck their chin into their chest. This is usually ...
Fetal Presentation, Position, and Lie (Including Breech Presentation)
Head first (called vertex or cephalic presentation) Facing backward (occiput anterior position) Spine parallel to mother's spine (longitudinal lie) Neck bent forward with chin tucked. Arms folded across the chest . If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not ...
Normal Labor
Cephalic Presentation. Such presentations are classified according to the relationship between the head and body of the fetus (Fig. 22-1). Ordinarily, the head is flexed sharply so that the chin is in contact with the thorax. The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation.
Cephalic Presentation
In cephalic presentation, the intra-uterine fetal position is of universal flexion, which is carried by the child to the immediate post-partum period. The hips and knees are flexed. The lower legs are internally rotated. The feet are further internally rotated with respect to the lower legs. At times there is an external rotational contracture ...
Normal Labor
Cephalic presentations are subclassified according to the relationship between the head and body of the fetus ().Ordinarily, the head is flexed sharply so that the chin contacts the thorax. The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation.Much less often, the fetal neck may be sharply extended so that the occiput and back ...
Cephalic presentation
Cephalic presentation. In obstetrics, a cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part (the part that ...
Understanding Fetal Position
The best fetal position for your baby to be shortly before birth is feet up, head down, facing your back, with their back resting against your belly. This means that they can exit the birth canal ...
Your baby in the birth canal
Cephalic presentation occurs in about 97% of deliveries. There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude). If your baby is in any position other than head down, your doctor may recommend a cesarean delivery. Breech presentation is when the baby's bottom is down ...
Fetal Position
Fetal position reflects the orientation of the fetal head or butt within the birth canal. The bones of the fetal scalp are soft and meet at "suture lines." Over the forehead, where the bones meet, is a gap, called the "anterior fontanel," or "soft spot." This will close as the baby grows during the 1st year of life, but at birth, it is open.
Chapter 10: Normal Mechanisms of Labor
The lie is longitudinal. The long axis of the fetus is parallel to the long axis of the mother. The head is at or in the pelvis. The back is on the left and anterior and is palpated easily except in obese women. The small parts are on the right and are not felt clearly. The breech is in the fundus of the uterus.
Compound Presentations
Definition. A presentation is compound when there is prolapse of one or more of the limbs along with the head or the breech, both entering the pelvis at the same time. Footling breech or shoulder presentations are not included in this group. Associated prolapse of the umbilical cord occurs in 15 to 20 percent of cases.
Signs That Your Baby Has Turned Into a Head-Down Position
Posterior presentation can sometimes mean a longer or more complicated delivery. If your baby is posterior even in early labor, they may still turn throughout the process as contractions move them ...
10.02 Key Terms Related to Fetal Positions
In reference to the fetus head, it is extended or bent backwards. This would be called a brow presentation. It is difficult to deliver because the widest diameter of the head enters the pelvis first. This type of cephalic presentation may require a C/Section if the attitude cannot be changed. (d) Hyperextended. In reference to the cephalic ...
Your baby in the birth canal
Cephalic presentation occurs in about 97% of deliveries. There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude). If your baby is in any position other than head down, your doctor may recommend a cesarean delivery. Breech presentation is when the baby's bottom is down ...
Abnormal Cephalic Presentations
The fetus enters the pelvis in a cephalic presentation approximately 95 to 96 percent of the time. In these cephalic presentations, the occiput may be in the persistent transverse or posterior positions. In about 3 to 4 percent of pregnancies, there is a breech-presenting fetus (see Chapter 25).

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Common baby positions during pregnancy and labor

Cephalic presentation, occiput anterior

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

Position and Presentation of the Fetus

Variations in Fetal Position and Presentation

Occiput posterior position

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Signs That Your Baby Has Turned Into a Head-Down Position

When it generally occurs

Types of head-down positions

Signs and symptoms that it has happened

Belly mapping

Options for babies that aren’t yet head down

Wait-and-see approach

External cephalic version (ECV)

Cesarean delivery (C-section)

Vaginal birth

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Obstetric and Newborn Care I

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Your baby in the birth canal

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Review Date 11/10/2022

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Chapter 15: Abnormal Cephalic Presentations

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Predisposing Factors

Fetal Factors