fetal presentation cephalic meaning in hindi

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Home • हिंदी • गर्भावस्था

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क्या नॉर्मल डिलीवरी के लिए वर्टेक्स पोजीशन अच्छी है? | Vertex Position Of Baby In Hindi

विनिता पंगेनी ने एचएनबी गढ़वाल विश्वविद्यालय से मास कॉम्युनिकेशन में मास्टर डिग्री हासिल की है। इन्होंने सबसे पहले एक कॉपी राइटर, उसके बाद पत्रकार, फिर संपादक के रूप में विभन्न मीडिया कंपनियों में कार... read full bio

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गर्भावस्था के दौरान, खासकर जिन्होंने पहली बार गर्भधारण किया हो उन्हें सबसे बड़ी चिंता इस बात की सताती है कि उनकी नॉर्मल डिलीवरी होगी या सिजेरियन। यह पूरी तरह से गर्भवती के स्वास्थ्य और गर्भ में पल रहे बच्चे की पोजीशन पर निर्भर करता है। गर्भ में बच्चे की पोजीशन अलग-अलग होती हैं, जिसमें वर्टेक्स भी एक है। मॉमजंक्शन के इस लेख में हम बच्चे की वर्टेक्स पोजीशन के बारे में विस्तार से बात करेंगे। इस लेख में हम जानेंगे कि वर्टेक्स पोजीशन क्या है, इसमें डिलीवरी कैसे होती है और इसके क्या जोखिम हो सकते हैं। इन सभी सवालों के जवाब जानने के लिए लेख को अंत तक पढ़ें।

चलिए सबसे पहले समझते हैं कि बच्चे की वर्टेक्स पोजीशन क्या होती है।

वर्टेक्स पोजीशन (शीर्ष स्थिति) क्या है?

जैसा कि हम सभी जानते हैं कि गर्भ में भ्रूण की वृद्धि होने के साथ–साथ बच्चा अपनी पोजीशन बदलता रहता है। वहीं, जब बच्चे का सिर महिला की योनी के नीचे की ओर घूम जाता है, तो इसे वर्टेक्स पोजीशन यानी शीर्ष स्थिति कहते हैं। अक्सर डिलीवरी के कुछ हफ्तों पहले लगभग 34 हफ्ते तक बच्चा सिर-नीचे की स्थिति में आ जाता है। इस पोजीशन को हेड डाउन और सेफेलिक पोजीशन (Cephalic Position) के नाम से भी जाना जाता है। नॉर्मल डिलीवरी के लिए ये पोजीशन सबसे अच्छी मानी जाती है। इससे प्रसव के दौरान मां और बच्चे दोनों को कम परेशानियों का सामना करना पड़ सकता है (1) (2) । लेख में आगे वर्टेक्स पोजीशन कितनी तरह की होती है, इसके बारे में बता रहे हैं।

वर्टेक्स पोजीशन (सिर नीचे की ओर) के प्रकार – Types of Vertex Position

वर्टेक्स पोजीशन दो तरह की होती हैं, जो इस प्रकार हैं (1) :

1. ऑकीपुट इंटीरियर (Occiput anterior) : इसमें बच्चे का सिर नीचे की तरफ और चेहरा व शरीर मां की पीठ की तरफ होता है। डिलीवरी के लिए इस पोजीशन को सबसे बेहतर माना जाता है।

2. ऑकीपुट पोस्टीरियर (Occiput Posterior) : इसमें भी बच्चे का सिर नीचे की तरफ होता है, लेकिन चेहरा मां की पीठ की जगह पेट की तरफ होता है। आमतौर पर डिलीवरी के लिए इस अवस्था को भी सुरक्षित माना जाता है, लेकिन इसमें बच्चे के लिए पेल्विस से निकलना थोड़ा मुश्किल हो सकता है। कई बार बच्चा लेबर के दौरान खुद इस पोजीशन से घूम कर ऑकीपुट इंटीरियर पोजीशन में आ जाता है।

यदि डिलीवरी के दौरान बच्चा इस अवस्था में होता है, तो उसे मुड़ने के लिए प्रोत्साहित करने के लिए गर्भवती महिलाओं को टहलने यानी वॉक करने के लिए कहा जाता है। इसके अलावा, डिलीवरी की अलग-अलग पोजीशन ट्राई की जा सकती है। वहीं, जरूरत पड़ने पर वैक्यूम डिवाइस की मदद से बच्चे को बाहर निकाला जा सकता है।

लेख के इस भाग में जानते हैं कि गर्भवती महिला में वर्टेक्स पोजीशन कितनी आम है।

क्या शीर्ष स्थिति सामान्य है?

जैसा कि लेख में ऊपर बताया गया है कि डिलीवरी के दौरान बेबी का सिर नीचे की ओर यानी सिर के बल वाली अवस्था (वर्टेक्स पोजीशन) में होना सबसे अच्छा माना जाता है। गर्भावस्था में 34 हफ्ते के बाद ज्यादातर शिशु सिर के बल नीचे वाली स्थिति में आ जाते हैं। लगभग 97 फीसदी बच्चे डिलीवरी से पहले हेड डाउन अवस्था में आ जाते हैं। बाकी के 3 प्रतिशत बच्चे ब्रीच पोजीशन (पेट में बच्चा उल्टा) में हो सकते हैं, जिससे प्रसव के दौरान कई जटिलताएं हो सकती हैं (3) । अब जानें शिशु के वर्टेक्स पोजीशन का कैसे पता लगा सकते हैं।

क्या मेरा शिशु वर्टेक्स पोजीशन में है? | Shishu Ke Vertex Position me Hone Ke Lakshan

बच्चा किस पोजिशन में है, गर्भवती महिलाएं खुद इसका पता नहीं लगा सकती हैं। बच्चे की पोजिशन से जुड़े कोई लक्षण नहीं होते हैं। निम्नलिखित तरीकों से इसका पता लगाया जा सकता है :

1. एब्डोमिनल पल्पेशन (abdominal palpation) : गर्भावस्था के दौरान बच्चे की पोजीशन जानने के लिए डॉक्टर पेट को छूकर जांच कर सकते हैं। बच्चे की स्थिति जानने का यह सबसे आसान तरीका है। इस तकनीक को लियोपोल्ड मन्यूवर्स कहते हैं (4) ।

2. अल्ट्रासाउंड स्कैन : प्रसव का समय पास आने पर डॉक्टर गर्भ में बच्चे की पोजीशन की पुष्टि के लिए अल्ट्रासाउंड स्कैन की सलाह दे सकते हैं (5) ।

आगे विस्तार से जानिए वर्टेक्स पोजीशन में प्रसव के बारे में।

शीर्ष स्थिति में बच्चे की डिलीवरी कैसे होती है?

नॉर्मल डिलीवरी के लिए बच्चे की वर्टेक्स पोजीशन (हेड डाउन) को सबसे अच्छा माना जाता है। जैसा कि लेख में बताया गया है कि यह भी दो प्रकार की होती है। भ्रूण का ऑकीपुट इंटीरियर पोजीशन (सिर नीचे और शरीर मां की पीठ की तरफ) में होना नॉर्मल है। गर्भवती महिला की नॉर्मल डिलीवरी की शुरुआत में भले ही बच्चा ऑकीपुट इंटीरियर पोजीशन में हो, लेकिन कई बार पेल्विस में आगे बढ़ते हुए वह ऑकीपुट पोस्टीरियर (सिर नीचे और चेहरा मां की पीठ की तरफ) की स्थिति में आ सकता। इसमें कोई परेशानी वाली बात नहीं है। 5 प्रतिशत मामलों में अचानक बच्चा घूम कर अपनी पोजीशन बदल सकता है (6) ।

• सबसे पहले शिशु पेल्विस की तरफ आगे बढ़ता है और धीरे-धीरे इतनी जगह बनाता है कि उसमें से निकलकर जननमार्ग (बर्थ कैनाल-birth canal) से गुजर सके। बर्थ कैनाल छोटा होने की वजह से बच्चा अपने सिर को भी काफी इधर–उधर घुमाता है।
• इसके बाद भ्रूण की ग्रेविटी और एमनियोटिक द्रव सिर को घुमाते हुए शिशु को नीचे की तरफ जाने के लिए प्रेरित करते हैं। यही कारण है कि बच्चे के जन्म के दौरान सबसे पहले उसका सिर मां की योनी से बाहर निकलता है।
• इसके बाद प्रसव का दूसरा चरण शुरू होता है। इस दौरान गर्भाशय ग्रीवा (cervical dilatation) पूरी तरह से खुल जाती है और शिशु का सिर नीचे आ जाता है। इस दौरान शिशु ऑकीपुट पोस्टीरियर में है, तो उसे सिर की मदद से आराम से घुमाकर ऑकीपुट इंटीरियर पोजीशन में लाया जा सकता है।
• इसके बाद बच्चे के बाकी शरीर को बाहर निकाला जाता है।

बच्चे के जन्म की यह प्रक्रिया देखी जाए, तो काफी दिलचस्प है, क्योंकि सोचने वाली बात यह है कि बच्चे को कैसे पता की उसे प्रसव के दौरान अपना शरीर और सिर कहां और किधर से निकालना है। वर्टेक्स यानी शीर्ष पोजीशन में बच्चे का जन्म जल्दी हो जाता है, क्योंकि इसमें बच्चे का सिर दबाव डालता है, जिससे वह संकरे मार्ग को भी चौड़ा कर खुद-ब-खुद बाहर निकल आता है (7) । इसलिए, वर्टेक्स पोजीशन को नॉर्मल डिलीवरी के लिए सबसे बेहतर माना जाता है।

लेख में आगे शिशु की वर्टेक्स पोजीशन के जोखिम के बारे में बता रहे हैं।

क्या बच्चे के लिए शीर्ष (वर्टेक्स) स्थिति में कोई जोखिम है?

हर प्रेगनेंसी और डिलीवरी अलग-अलग होती है। इसलिए, कई बार बच्चे की वर्टेक्स पोजीशन होने के बावजूद प्रसव के दौरान समस्याएं आ सकती हैं, जिनके बारे में नीचे जानकारी दे रहे हैं (8) :

1. कमजोर संकुचन : कई बार संकुचन कमजोर हो सकता है, जिस वजह से गर्भाशय ग्रीवा समय पर पूरी तरह से खुल नहीं पाता है। ऐसे में शिशु बर्थ कैनाल से नहीं निकल पाता है। यदि लेबर की प्रक्रिया ठीक से आगे नहीं बढ़ती है, तो डॉक्टर संकुचन के लिए दवा दे सकते हैं या सिजेरियन डिलीवरी कर सकते हैं।

2. पेरिनियल टियर्स : डिलीवरी के समय योनि और आसपास के ऊतक पर अधिक दबाव पड़ता है, जिससे कभी-कभी वह हिस्सा फट जाता है। कई बार यह टियर अपने आप ठीक हो जाते हैं। यदि टियरिंग गंभीर है, तो परिस्थिति को देखते हुए एपीसीओटोमी (योनि और गुदा के बीच एक सर्जिकल कट) का सहारा लेना पड़ सकता है।

3. गर्भनाल संबंधित समस्या : बर्थ कैनाल से निकलते समय गर्भनाल शिशु के हाथ या पैर में फंस सकती है, लेकिन कई बार गर्भनाल शिशु के गले में लिपट जाती है, जिससे बच्चे के लिए जोखिम की स्थिति बन सकती है।

4. बच्चे की असामान्य हृदय गति : ज्यादातर लेबर के दौरान शिशु की हृदय गति का असामान्य होना कोई परेशानी वाली बात नहीं है। ऐसे में मां को पोजीशन बदलने के लिए कहा जा सकता है, जिससे शिशु का ब्लड फ्लो अच्छे से हो सके। कुछ मामलों में यह परेशानी गंभीर रूप ले सकती है, जिस वजह से तुरंत डिलीवरी करनी पड़ सकती है।

5. पानी की थैली का जल्दी फट जाना : आमतौर पर प्रसव की प्रक्रिया पानी की थैली के फटने के 24 घंटे के अंदर खुद शुरू हो जाती है। यदि ऐसा नहीं होता है, तो डॉक्टर लेबर को प्रेरित करने के लिए दवा दे सकते हैं।

6. पेरिनेटल एस्फेक्सिया : जब भ्रूण को गर्भाशय में या शिशु को प्रसव के दौरान पर्याप्त ऑक्सीजन नहीं मिलती है, तो पेरिनेटल एस्फेक्सिया की परेशानी हो सकती है।

7. शोल्डर डिस्टोकिया : यह परेशानी तब होती है जब प्रसव के दौरान योनी से बच्चे का सिर निकल आता है, लेकिन कोई एक कंधा फंस जाता है।

8. अत्यधिक रक्तस्राव : यदि डिलीवरी के दौरान गर्भाशय में टियर्स ज्यादा आ जाते हैं या प्लेसेंटा गर्भाशय को ढक लेती है, तो रक्तस्राव की स्थिति उत्पन्न हो सकती है।

चलिए, अब जानते हैं कि बच्चे को वर्टेक्स पोजीशन में कैसे लाया जा सकता है।

बच्चे को वर्टेक्स पोजीशन में कैसे लाएं?

नीचे बताए गए तरीकों से बच्चे को वर्टेक्स पोजीशन में लाने में मदद हो सकती है :

• एक्सरसाइज : बच्चे को वर्टेक्स पोजीशन में लाने के लिए डॉक्टर कई एक्सरसाइज की सलाह दे सकते हैं। हालांकि, ये एक्सरसाइज बच्चे को सिर के बल आने में मदद कर सकती हैं, लेकिन इसका मतलब नहीं है कि यू यह पूर्णतः कारगर है। इस विषय में संबंधित डॉक्टर से जरूर बात करें।
• एक्सटर्नल सेफेलिक वर्जन (ईसीवी) : डिलीवरी के कुछ समय पहले तक अगर बच्चा ब्रीच अवस्था (गर्भ में बच्चा उल्टा) है, तो संभव है कि डॉक्टर एक्सटर्नल सेफेलिक वर्जन (ईसीवी-मां के पेट पर हाथों से दबाव देकर भ्रूण की स्थिति को ठीक करने की प्रक्रिया) की मदद से बच्चे को सिर के बल लाने का प्रयास कर सकते हैं। ऐसा नॉर्मल डिलीवरी की संभावना बढ़ाने के लिए किया जाता है (9) ।

लेख के अंतिम भाग में जानिए क्या प्रसव के दौरान भी बच्चा शीर्ष स्थिति में आ सकता है।

क्या डिलीवरी के दौरान बच्चा वर्टेक्स पोजीशन से मुड़ सकता है?

डिलीवरी से पहले शिशु गर्भ में अपनी स्थिति बदलता रहता है, लेकिन प्रसव के शुरू होने के बाद यदि शिशु वर्टेक्स पोजीशन में है, तो अमूमन मामलों में वो इसी अवस्था में योनि से बाहर आता है। कुछ दुर्लभ मामलों में आखिरी के पलों में बच्चा वर्टेक्स पोजीशन से दूसरी अवस्था में आ सकता है (10) ।

1. Delivery presentations By Medlineplus 2. Your baby in the birth canal By Medlineplus 3. Labor with Abnormal Presentation and Position By Researchgate 4. Leopold Maneuvers By NCBI 5. Ultrasound By Medlineplus 6. Clinical effectiveness of position management and manual rotation of the fetal position with a U-shaped birth stool for vaginal delivery of a fetus in a persistent occiput posterior position By Sage Journals 7. Labor Stage 2 By Science Direct 8. What are some common complications during labor and delivery? By NIH 9. Effects of external cephalic version for breech presentation at or near term in high-resource settings: A systematic review of randomized and non-randomized studies By European Journal of Midwifery 10. BREECH PRESENTATIONS IN GENERAL PRACTICE . By Medical Journal

• Learn   /  

Why Is Cephalic Presentation Ideal For Childbirth?

5   Dec   2017 | 8 min Read

During labour, contractions stretch your birth canal so that your baby has adequate room to come through during birth. The cephalic presentation is the safest and easiest way for your baby to pass through the birth canal.

If your baby is in a non-cephalic position, delivery can become more challenging. Different fetal positions pose a range of difficulties and varying risks and may not be considered ideal birthing positions.

Two Kinds of Cephalic Positions

There are two kinds of cephalic positions:

• Cephalic occiput anterior , where your baby’s head is down and is facing toward your back.
• Cephalic occiput posterior , where your baby is positioned head down, but they are facing your abdomen instead of your back. This position is also nicknamed ‘sunny-side-up’ and can increase the chances of prolonged and painful delivery. 

How to Know if Your Baby is In a Cephalic Position?

You can feel your baby’s position by rubbing your hand on your belly. If you feel your little one’s stomach in the upper stomach, then your baby is in a cephalic position. But if you feel their kicks in the lower stomach, then it could mean that your baby is in a breech position.

You can also determine whether your baby is in the anterior or posterior cephalic position. If your baby is in the anterior position, you may feel their movement underneath your ribs and your belly button could also pop out. If your baby is in the posterior position, then you may feel their kicks in their abdomen, and your stomach may appear rounded up instead of flat. 

You can also determine your baby’s position through an ultrasound scan or a physical examination at your healthcare provider’s office. 

Benefits of Cephalic Presentation in Pregnancy

Cephalic presentation is one of the most ideal birth positions, and has the following benefits:

• It is the safest way to give birth as your baby’s position is head-down and prevents the risk of any injuries.
• It can help your baby move through the delivery canal as safely and easily as possible.
• It increases the chances of smooth labour and delivery.

Are There Any Risks Involved in Cephalic Position?

Conditions like a cephalic posterior position in addition to a narrow pelvis of the mother can increase the risk of pregnancy complications during delivery. Some babies in the head-first cephalic presentation might have their heads tilted backward. This may, in some rare cases, cause preterm delivery.

What are the Risks Associated with Other Birth Positions?

A small percentage of babies may settle into a non-cephalic position before their birth. This can pose risks to both your and your baby’s health, and also influence the way in which you deliver. 

In the next section, we have discussed a few positions that your baby can settle in throughout pregnancy, as they move around the uterus. But as they grow old, there will be less space for them to tumble around, and they will settle into their final position. This is when non-cephalic positions can pose a risk.  

Breech Position

There are three types of breech fetal positioning:

• Frank breech : Your baby’s legs stick straight up along with their feet near their head.
• Footling breech: One or both of your baby’s legs are lowered over your cervix.
• Complete breech: Your baby is positioned bottom-first with their knees bent.

If your baby is in a breech position , vaginal delivery is considered complicated. When a baby is born in breech position, the largest part of their body, that is, their head is delivered last. This can lead to injury or even fetal distress. Moreover, the umbilical cord may also get damaged or get wrapped around your baby’s neck, cutting off their oxygen supply.  

If your baby is in a breech position, your healthcare provider may recommend a c-section, or they may try ways to flip your baby’s position in a cephalic presentation.

Transverse Lie

In this position, your baby settles in sideways across the uterus rather than being in a vertical position. They may be:

• Head-down, with their back facing the birth canal
• One shoulder pointing toward the birth canal
• Up with their hands and feet facing the birth canal

If your baby settles in this position, then your healthcare provider may suggest a c-section to reduce the risk of distress in your baby and other pregnancy complications.

Turning Your Baby Into A Cephalic Position

External cephalic version (ECV) is a common, and non-invasive procedure that helps turn your baby into a cephalic position while they are in the womb. However, your healthcare provider may only consider this procedure if they consider you have a stable health condition in the last trimester, and if your baby hasn’t changed their position by the 36th week.

You can also try some natural remedies to change your baby’s position, such as:

• Lying in a bridge position: Movements like bridge position can sometimes help move your baby into a more suitable position. Lie on your back with your feet flat on the ground and your legs bent. Raise your pelvis and hips into a bridge position and hold for 5-10 minutes. Repeat several times daily.
• Chiropractic care: A chiropractor can help with the adjustment of your baby’s position and also reduce stress in them.
• Acupuncture: After your doctor’s go-ahead, you can also consider acupuncture to get your baby to settle into an ideal birthing position.

While most babies settle in a cephalic presentation by the 36th week of pregnancy, some may lie in a breech or transverse position before birth. Since the cephalic position is considered the safest, your doctor may recommend certain procedures to flip your baby’s position to make your labour and delivery smooth. You may also try the natural methods that we discussed above to get your baby into a safe birthing position and prevent risks or other pregnancy complications. 

When Should A Baby Be In A Cephalic Position?

Your baby would likely naturally drop into a cephalic position between weeks 37 to 40 of your pregnancy .

Is Cephalic Position Safe?

Research shows that 95% of babies take the cephalic position a few weeks or days before their due date. It is considered to be the safest position. It ensures a smooth birthing process.

While most of the babies are in cephalic position at delivery, this is not always the case. If you have a breech baby, you can discuss the available options for delivery with your doctor.

Does cephalic presentation mean labour is near?

Head-down is the ideal position for your baby within your uterus during birth. This is known as the cephalic position. This posture allows your baby to pass through the delivery canal more easily and safely.

Can babies change from cephalic to breech?

The external cephalic version (ECV) is the most frequent procedure used for turning a breech infant.

How can I keep my baby in a cephalic position?

While your baby naturally gets into this position, you can try some exercises to ensure that they settle in cephalic presentation. Exercises such as breech tilt, forward-leaning position (spinning babies program), cat and camel pose can help.

Stitches after a normal delivery : How many stitches do you need after a vaginal delivery? Tap this post to know.

Vaginal birth after caesarean delivery : Learn all about the precautions to consider before having a vaginal delivery after a c-section procedure. 

How many c-sections can you have : Tap this post to know the total number of c-sections that you can safely have.

Cover Image Credit: Freepik.com

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Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech) as well as sideways (transverse lie) and diagonal (oblique lie).

Fetal presentation and position

During the last trimester of your pregnancy, your provider will check your baby's presentation by feeling your belly to locate the head, bottom, and back. If it's unclear, your provider may do an ultrasound or an internal exam to feel what part of the baby is in your pelvis.

Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery.

Here are the many possibilities for fetal presentation and position in the womb.

Medical illustrations by Jonathan Dimes

Head down, facing down (anterior position)

A baby who is head down and facing your spine is in the anterior position. This is the most common fetal presentation and the easiest position for a vaginal delivery.

This position is also known as "occiput anterior" because the back of your baby's skull (occipital bone) is in the front (anterior) of your pelvis.

Head down, facing up (posterior position)

In the posterior position , your baby is head down and facing your belly. You may also hear it called "sunny-side up" because babies who stay in this position are born facing up. But many babies who are facing up during labor rotate to the easier face down (anterior) position before birth.

Posterior position is formally known as "occiput posterior" because the back of your baby's skull (occipital bone) is in the back (posterior) of your pelvis.

Frank breech

In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section .

Some providers will attempt to turn your baby manually to the head down position by applying pressure to your belly. This is called an external cephalic version , and it has a 58 percent success rate for turning breech babies. For more information, see our article on breech birth .

Complete breech

A complete breech is when your baby is bottom down with hips and knees bent in a tuck or cross-legged position. If your baby is in a complete breech, you may feel kicking in your lower abdomen.

Incomplete breech

In an incomplete breech, one of the baby's knees is bent so that the foot is tucked next to the bottom with the other leg extended, positioning that foot closer to the face.

Single footling breech

In the single footling breech presentation, one of the baby's feet is pointed toward your cervix.

Double footling breech

In the double footling breech presentation, both of the baby's feet are pointed toward your cervix.

Transverse lie

In a transverse lie, the baby is lying horizontally in your uterus and may be facing up toward your head or down toward your feet. Babies settle this way less than 1 percent of the time, but it happens more commonly if you're carrying multiples or deliver before your due date.

If your baby stays in a transverse lie until the end of your pregnancy, it can be dangerous for delivery. Your provider will likely schedule a c-section or attempt an external cephalic version , which is highly successful for turning babies in this position.

Oblique lie

In rare cases, your baby may lie diagonally in your uterus, with his rump facing the side of your body at an angle.

Like the transverse lie, this position is more common earlier in pregnancy, and it's likely your provider will intervene if your baby is still in the oblique lie at the end of your third trimester.

Was this article helpful?

What to know if your baby is breech

What's a sunny-side up baby?

How your twins’ fetal positions affect labor and delivery

What happens to your baby right after birth

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

Ahmad A et al. 2014. Association of fetal position at onset of labor and mode of delivery: A prospective cohort study. Ultrasound in obstetrics & gynecology 43(2):176-182. https://www.ncbi.nlm.nih.gov/pubmed/23929533 Opens a new window [Accessed September 2021]

Gray CJ and Shanahan MM. 2019. Breech presentation. StatPearls.  https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed September 2021]

Hankins GD. 1990. Transverse lie. American Journal of Perinatology 7(1):66-70.  https://www.ncbi.nlm.nih.gov/pubmed/2131781 Opens a new window [Accessed September 2021]

Medline Plus. 2020. Your baby in the birth canal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002060.htm Opens a new window [Accessed September 2021]

Where to go next

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• Pregnancy week by week
• 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.

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.

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.

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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In this Article

The ABCs of Cephalic Presentation: A Comprehensive Guide for Moms-to-Be

Updated on 24 November 2023

As expectant mothers eagerly anticipate the arrival of their little ones, understanding the intricacies of pregnancy becomes crucial. One term that frequently arises in discussions about childbirth is "cephalic presentation." In this article, we will understand its meaning, types, benefits associated with it, the likelihood of normal delivery and address common concerns expectant mothers might have.

What is the meaning of cephalic presentation in pregnancy?

Cephalic presentation means the baby's head is positioned down towards the birth canal, which is the ideal fetal position for childbirth. This position is considered optimal for a smoother and safer delivery. In medical terms, a baby in cephalic presentation is said to be in a "vertex" position.

The majority of babies naturally assume a cephalic presentation before birth. Other presentations, such as breech presentation (where the baby's buttocks or feet are positioned to enter the birth canal first) or transverse presentation (where the baby is lying sideways), may complicate the delivery process and may require medical intervention.

Cephalic presentation types

There are different types of cephalic presentation, each influencing the birthing process. The primary types include:

1. Vertex Presentation

The most common type where the baby's head is down, facing the mother's spine.

2. Brow Presentation

The baby's head is slightly extended, and the forehead presents first.

3. Face Presentation

The baby is positioned headfirst, but the face is the presenting part instead of the crown of the head.

Understanding these variations is essential for expectant mothers and healthcare providers to navigate potential challenges during labor.

You may also like: How to Get Baby in Right Position for Birth?

What are the benefits of cephalic presentation?

In order to understand whether cephalic presentation is good or bad, let’s take a look at its key advantages:

1. Easier Engagement

This presentation facilitates the baby's engagement in the pelvis, aiding in a smoother descent during labor.

2. Reduced Risk of Complications

Babies in head-first position typically experience fewer complications during delivery compared to other presentations.

3. Faster Labor Progression

This position is associated with quicker labor progression, leading to a potentially shorter and less stressful birthing process.

4. Lower Cesarean Section Rates

The chances of a cesarean section are significantly reduced when the baby is in cephalic presentation in pregnancy.

5. Optimal Fetal Oxygenation

The head-first position allows for optimal oxygenation of the baby as the head can easily pass through the birth canal, promoting a healthy start to life.

What are the chances of normal delivery in cephalic presentation?

The chances of a normal delivery are significantly higher when the baby is in cephalic or head-first presentation. Vaginal births are the natural outcome when the baby's head leads the way, aligning with the natural mechanics of childbirth.

While this presentation increases the chances of a normal delivery, it's important to note that individual factors, such as the mother's pelvic shape, the size of the baby, and the progress of labor, can also influence the delivery process. Sometimes complications may arise during labor and medical interventions or a cesarean section may be necessary.

You may also like: Normal Delivery Tips: An Expecting Mother's Guide to a Smooth Childbirth Experience

How to achieve cephalic presentation in pregnancy?

While fetal positioning is largely influenced by genetic and environmental factors, there are strategies to encourage head-first fetal position:

1. Regular Exercise

Engaging in exercises such as pelvic tilts and knee-chest exercises may help promote optimal fetal positioning.

2. Correct Posture

Maintaining good posture, particularly during the third trimester , can influence fetal positioning.

3. Hands and Knees Position

Spend some time on your hands and knees. This position may help the baby settle into the pelvis with the head down.

4. Forward-leaning Inversion

Under the guidance of a qualified professional, some women try forward-leaning inversions to encourage the baby to move into a head-down position. This involves positioning the body with the hips higher than the head.

5. Prenatal Yoga

Prenatal yoga focuses on strengthening the pelvic floor and promoting flexibility, potentially aiding in cephalic presentation.

6. Professional Guidance

Seeking guidance from a healthcare provider or a certified doula can provide personalized advice tailored to individual needs.

1. Cephalic presentation is good or bad?

Cephalic position is generally considered good as it aligns with the natural process of childbirth. It reduces the likelihood of complications and increases the chances of a successful vaginal delivery . However, it's essential to note that the overall health of both the mother and baby determines its appropriateness.

2. How to increase the chances of normal delivery in cephalic presentation?

Increasing the chances of normal delivery in cephalic presentation involves adopting healthy practices during pregnancy, such as maintaining good posture, engaging in appropriate exercises, and seeking professional guidance. However, individual circumstances vary, and consultation with a healthcare provider is paramount.

Final Thoughts

Navigating the journey of pregnancy involves understanding various aspects, and cephalic presentation plays a crucial role in determining the birthing experience. The benefits of a head-first position, coupled with strategies to encourage it, empower expectant mothers to actively participate in promoting optimal fetal positioning. As always, consulting with healthcare professionals ensures personalized care and guidance, fostering a positive and informed approach towards childbirth.

1. Makajeva J, Ashraf M. Delivery, Face and Brow Presentation. (2023). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing

2. Boos R, Hendrik HJ, Schmidt W. (1987). Das fetale Lageverhalten in der zweiten Schwangerschaftshälfte bei Geburten aus Beckenendlage und Schädellage [Behavior of fetal position in the 2d half of pregnancy in labor with breech and vertex presentations]. Geburtshilfe Frauenheilkd

Anupama Chadha

Anupama Chadha, born and raised in Delhi is a content writer who has written extensively for industries such as HR, Healthcare, Finance, Retail and Tech.

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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).

Position and Presentation of the Fetus

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 .

Other presentations

In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.

In brow presentation, the neck is moderately arched so that the brow presents first.

Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor. If they do not, a cesarean delivery is usually recommended.

In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.

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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).

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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.

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Abnormal Fetal lie, Malpresentation and Malposition

Original Author(s): Anna Mcclune Last updated: 1st December 2018 Revisions: 12

• 1 Definitions
• 2 Risk Factors
• 3.2 Presentation
• 3.3 Position
• 4 Investigations
• 5.1 Abnormal Fetal Lie
• 5.2 Malpresentation
• 5.3 Malposition

The lie, presentation and position of a fetus are important during labour and delivery.

In this article, we will look at the risk factors, examination and management of abnormal fetal lie, malpresentation and malposition.

Definitions

• Longitudinal, transverse or oblique
• Cephalic vertex presentation is the most common and is considered the safest
• Other presentations include breech, shoulder, face and brow
• Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) – this is ideal for birth
• Other positions include occipito-posterior and occipito-transverse.

Note: Breech presentation is the most common malpresentation, and is covered in detail here .

Fig 1 – The two most common fetal presentations: cephalic and breech.

Risk Factors

The risk factors for abnormal fetal lie, malpresentation and malposition include:

• Multiple pregnancy
• Uterine abnormalities (e.g fibroids, partial septate uterus)
• Fetal abnormalities
• Placenta praevia
• Primiparity

Identifying Fetal Lie, Presentation and Position

The fetal lie and presentation can usually be identified via abdominal examination. The fetal position is ascertained by vaginal examination.

For more information on the obstetric examination, see here .

• Face the patient’s head
• Place your hands on either side of the uterus and gently apply pressure; one side will feel fuller and firmer – this is the back, and fetal limbs may feel ‘knobbly’ on the opposite side

Presentation

• Palpate the lower uterus (above the symphysis pubis) with the fingers of both hands; the head feels hard and round (cephalic) and the bottom feels soft and triangular (breech)
• You may be able to gently push the fetal head from side to side

The fetal lie and presentation may not be possible to identify if the mother has a high BMI, if she has not emptied her bladder, if the fetus is small or if there is polyhydramnios .

During labour, vaginal examination is used to assess the position of the fetal head (in a cephalic vertex presentation). The landmarks of the fetal head, including the anterior and posterior fontanelles, indicate the position.

Fig 2 – Assessing fetal lie and presentation.

Investigations

Any suspected abnormal fetal lie or malpresentation should be confirmed by an ultrasound scan . This could also demonstrate predisposing uterine or fetal abnormalities.

Abnormal Fetal Lie

If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted – ideally between 36 and 38 weeks gestation.

ECV is the manipulation of the fetus to a cephalic presentation through the maternal abdomen.

It has an approximate success rate of 50% in primiparous women and 60% in multiparous women. Only 8% of breech presentations will spontaneously revert to cephalic in primiparous women over 36 weeks gestation.

Complications of ECV are rare but include fetal distress , premature rupture of membranes, antepartum haemorrhage (APH) and placental abruption. The risk of an emergency caesarean section (C-section) within 24 hours is around 1 in 200.

ECV is contraindicated in women with a recent APH, ruptured membranes, uterine abnormalities or a previous C-section .

Fig 3 – External cephalic version.

Malpresentation

The management of malpresentation is dependent on the presentation.

• Breech – attempt ECV before labour, vaginal breech delivery or C-section
• Brow – a C-section is necessary
• If the chin is anterior (mento-anterior) a normal labour is possible; however, it is likely to be prolonged and there is an increased risk of a C-section being required
• If the chin is posterior (mento-posterior) then a C-section is necessary
• Shoulder – a C-section is necessary

Malposition

90% of malpositions spontaneously rotate to occipito-anterior as labour progresses. If the fetal head does not rotate, rotation and operative vaginal delivery can be attempted. Alternatively a C-section can be performed.

• Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) - this is ideal for birth

If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted - ideally between 36 and 38 weeks gestation.

• Breech - attempt ECV before labour, vaginal breech delivery or C-section

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

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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Cephalic मीनिंग : Meaning of Cephalic in Hindi - Definition and Translation

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CEPHALIC MEANING IN HINDI - EXACT MATCHES

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Definition of cephalic.

• of or relating to the head

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Cephalic meaning in Hindi : Get meaning and translation of Cephalic in Hindi language with grammar,antonyms,synonyms and sentence usages by ShabdKhoj. Know answer of question : what is meaning of Cephalic in Hindi? Cephalic ka matalab hindi me kya hai (Cephalic का हिंदी में मतलब ). Cephalic meaning in Hindi (हिन्दी मे मीनिंग ) is शीर्ष.English definition of Cephalic : of or relating to the head

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Antonym/Opposite Words : caudal

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Chapter 15:  Abnormal Cephalic Presentations

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Malpresentations.

• TRANSVERSE POSITIONS OF THE OCCIPUT
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The fetus enters the pelvis in a cephalic presentation approximately 95 percent to 96 percent of the time. In these cephalic presentations, the occiput may be in the persistent transverse or posterior positions. In about 3 percent 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 baby 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 intraabdominal 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

Tears of the uterus, cervix, and vagina

Uterine atony from prolonged labor

Early rupture of the membranes

Excessive blood loss

Tissue damage

Frequent rectal and vaginal examinations

Prolonged labor

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• Patient Information Series
• Patient Information: Pregnancy Conditions
• General Ultrasound Background

Fetal cephalic malpresentation and malposition

This leaflet is to help you understand the fetal cephalic malpresentation and malposition.

What are cephalic malpresentations and malpositions?

During labor, the baby’s head (cephalic) is usually the first part entering the birth canal. The baby is usually looking at the maternal back, with the back of the head (occiput) towards the maternal pubic bone. This position is known as occiput anterior, and is the most physiological position to deliver a baby. If the baby’s head is in any other position during labor, the condition is called cephalic malposition.

Most of the babies enter the birth canal with the chin close to the chest (flexion of the baby’s head). This allows the baby to accommodate the head with the shortest possible diameters to descend through the birth canal. If the baby extends the head, then the baby’s forehead or face are the first to enter the birth canal. This condition is known as cephalic malpresentation or deflexion.

Why do malposition or malpresentation occur?

It is not known why these conditions happen. Most of the patients have some risk factors, which predispose them to any of these conditions. However, these conditions might also present in patients without risk factors. Some of the common risk factors include: anatomical differences in  the maternal uterus, twin pregnancies, small or big babies, increased amniotic liquid, among others.

Can it be reliably diagnosed?

Traditionally, doctors have always used their examining fingers to assess the position and the degree of flexion of the baby’s head during a vaginal examination. The main limitation of this exam is that it is subjective and may be uncomfortable for the patients. Recently, ultrasound has been introduced into the labor ward with the aim of improving its accuracy of the vaginal examination. Ultrasound can fast and reliably identify the baby’s position and presentation, and several studies showed that the accuracy is higher compared to vaginal examination

Are malpresentation and malposition dangerous conditions?

If labor is progressing normally, most of these conditions will resolve spontaneously without any type of intervention. Contrarily, if these conditions persist throughout labor, they can lead to prolonged labors, an increased risk of operative delivery and other outcomes affecting the mother and the baby. Therefore, monitoring these conditions is important and it might require more examinations (vaginal examination or ultrasound), compared to normal labors.

Is there anything to do to prevent an operative delivery?

In the case of malpresentations, unfortunately not. The management usually involves waiting for the spontaneous resolution of the condition. However, if persistent, the correct management usually involves Cesarean section.

For malpositions, the doctor might attempt to manually rotate the baby’s head to correct the malposition and increase the probabilities of a vaginal delivery. This intervention is mostly safe for the mother and the fetus and has a 50-60% chance of being successful. However, it might be uncomfortable for the mother, as the doctor might need to introduce a hand into the vagina.

How are these conditions managed during labor?

These conditions can be encountered throughout labor. Management of malpresentations is straightforward, as there is no known intervention besides cesarean section to correct the baby’s head deflexion. It is common practice to monitor the progression of labor despite the presence of a malpresentation, as many of these conditions will correct spontaneously during labor. Persistence of this condition usually leads to prolonged labors and cesarean section. However, if the baby’s face is presenting, spontaneous vaginal delivery is possible, as long as labor progresses normally. After vaginal delivery, the baby’s face is usually swollen but it recovers quickly after a couple of hours.

Regarding fetal malpositions, management differs depending on the stage of labor. During the early stages of labor, the baby’s head position does not necessarily affect the outcome of labor. Over 50% of fetuses begin labor with the head facing towards the maternal pubic bone and rotate spontaneously.

If you experience a prolonged early labor or the cervix does not dilate correctly, the doctor might need to perform a Cesarean section. Contrarily, if you are diagnosed with prolonged labor in the advanced stages, the doctor might perform an operative vaginal delivery, if the baby’s head has descended far enough into the birth canal. An operative vaginal delivery refers to the use of instruments (forceps, ventouse/vacuum)) to help the baby’s head out. In such cases, ultrasound might assist in the correct assessment of the baby’s head position before the intervention.

If the baby’s head has not descended far enough down into the birth canal or the intervention fails, the doctor might perform a Cesarean section to deliver the baby.

Last updated February 2024