Malpresentations in labour

SummaryMalpresentations of the fetus can arise by chance but can also be associated with maternal or foetal pathology. Excluding pathology is an important preliminary in their management, but even then they are associated with increased risks to both mother and fetus, including prolonged labour, cord prolapse, traumatic delivery and caesarean section. Early diagnosis and expert timely management are the cornerstones of good obstetric care generally, but they are crucial when malpresentations are first recognised in labour. The increasingly liberal use of caesarean section combined with the reduction in junior doctor working hours is decreasing clinical exposure and experience to these relatively rare obstetric complications. They will continue to occur, however, and therefore training to acquire and maintain skills in clinical assessment, decision making and obstetric manoeuvres is receiving increasing attention.