A fetus has both a position and presentation while in the womb. The position is the direction a fetus is facing relative to the mother’s spine. The presentation is how an infant’s body leads, or is anticipated to lead out of the birth canal. An abnormal fetal position or presentation can lead to birth injuries and serious long-term complications, including cerebral palsy.

Types of Abnormal Fetal Position and Presentations

Typically, a fetus is in the vertex or cephalic position with its head near the lower part of the abdomen before delivery. Examples of abnormal fetal position and presentation include:

Occipitoposterior Position (OP)

Occipitoposterior position is when a newborn presents in a posterior position instead of an anterior position. The newborn comes out of the birth canal headfirst but with the back part of their head facing the mother’s back and rotated to the left or the right of the sacroiliac joint.

Breech Presentation

It’s normal for fetuses to be in the breech presentation throughout a pregnancy. However, the fetus should turn to the vertex position, the position a baby needs to be in for a vaginal birth, by the 37th week to prepare for delivery. Breech presentation happens when the infant’s legs or buttocks are positioned to travel through the birth canal first.

Compound Presentation

When multiple parts of the fetus present at the same time, it’s considered a compound presentation. Usually, this occurs when an arm and the head of an infant come out at the same time. Compound presentation can also happen when the head of one twin presents with an extremity of the other twin.

Limb Presentation

Limb presentation means a limb, either a leg or arm, is the first part of a newborn’s body to emerge from the birth canal.

Shoulder Presentation

Shoulder presentation or transverse lie occurs when the trunk, arm, or shoulder of the fetus enters the birth canal first. Mothers who have had children before or are pregnant with multiple fetuses are more likely to experience shoulder presentation. Other conditions with an increased risk of experiencing shoulder presentation include:

• Polyhydramnios: This occurs when there is an excessive accumulation of amniotic fluid.
• Placenta previa: This is when the placenta is lying low in the uterus, partially or completely covering the cervix.
• Intrauterine growth restriction: This is when a fetus is smaller than it should be because it’s not growing at a normal rate inside the womb.

Diagnosis

Ultrasound examinations before birth are useful in diagnosing many abnormal fetal positions and presentations. Pelvic exams during the delivery process also help in diagnosing these conditions. Occasionally, abnormal fetal position or presentation isn’t identified until labor has started.

Risk to Fetus

The various abnormal fetus positions and presentations each carry their own set of risk factors for newborns. These can range from minor to severe.

Occipitoposterior Position

A prolapsed umbilical cord, prolonged labor and the need to use medical instruments like vacuum extractors and forceps are all risks associated with occipitoposterior position. Each of these conditions can lead to birth asphyxia, oxygen deprivation, and brain bleeds.

Breech Presentation

Newborns are at an increased risk for spinal cord fracture, traumatic head injury, prolapsed umbilical cord, and other severe complications, including death when vaginal delivery is attempted for babies in the breech position. A mismanaged breech birth can lead to seizures, brain bleeds, developmental and intellectual disabilities, and cerebral palsy.

Compound Presentation

The risk factors associated with compound presentation include prematurity, rupture of membranes at high station, intrauterine growth restriction, and polyhydramnios.

Limb Presentation

There is an increased risk for dystocia associated with limb presentation. This is a medical emergency where the infant gets stuck on the mother’s pelvis.

Shoulder Presentation

Failure to deliver a baby via cesarean section quickly once shoulder presentation is diagnosed can lead to birth asphyxia due to the umbilical cord being compressed. This can result in cerebral palsy, permanent brain damage, seizures, and hypoxic-ischemic encephalopathy (HIE), a condition caused by a lack of oxygen or blood flow to an infant’s brain.

Treatment

When abnormal fetal position or presentation is identified, appropriate and immediate treatment must be implemented. A doctor may first attempt an external cephalic version, a procedure used to manually turn a fetus into the head-down position. If this isn’t successful, the fetus should be delivered via C-section. A C-section is typically recommended for all kinds of breech positions as it can minimize the chances of umbilical cord prolapse, oxygen deprivation due to prolonged labor or other birth injuries.

Prevention

While some conditions like the breech position can be addressed or prevented through pre-delivery exercises, most abnormal fetal positions and presentations can’t be prevented. However, having a competent and experienced team of medical professionals can help in preventing severe and life-long risks, including cerebral palsy, that are often associated with them.

Beyond the issue of fetal position, there are other factors that may have come into play and contributed to your child’s cerebral palsy. If you feel that medical negligence contributed to your child’s condition, you may have a case to seek compensation. Talk to the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC to see what your options are.

Reviewed by:
Trish Fletcher, MS, BSN, CRNP, NNP-BC, ALNC
Neonatal Nurse Practitioner | Birth Injury Legal Nurse Consultant

Tricia is a dedicated, focused, Birth Injury Legal Nurse Consultant and Neonatal Nurse Practitioner with more than 25 years of experience. Her strong clinical and critical thinking skills, paired with expertise caring for neonates in a Level III Neonatal Intensive Care Unit (NICU), ensures meticulous medical records review. READ FULL BIO

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