Malpresentation, Malposition, Cephalopelvic Disproportion and Obstetric Procedures

The individual accoucheur must develop skills in the critical assessment of labour progress, with the knowledge and ability to carefully assess the relationship of the fetus to the maternal pelvis. In modern practice, poor progress in the first and second stages of labour is often related to persistent malposition resulting in relative cephalopelvic disproportion and labour dystocia. At full dilatation, ‘arrest’ is often at the mid-pelvic level. In this chapter, the various malpositions and malpresentations are described and the obstetric procedures available for effecting safe delivery, both abdominally and vaginally, are critically reviewed: vaginal breech delivery, vacuum extraction, forceps delivery, manual rotation and caesarean section. The management of perineal trauma is also reviewed. Our aim is to ensure that accoucheurs are aware how to manage malpositions and malpresentations and to encourage them to carefully consider the advantages and disadvantages of all assisted delivery methods, selecting the safest and most appropriate method to use in each case.