From the Guidelines
Screening for fetal malpresentation should be performed routinely in the third trimester, particularly at 36 weeks gestation, through clinical examination (Leopold's maneuvers) and confirmed with ultrasound when suspected, as recommended by the American College of Radiology in their 2021 guidelines 1. The methods for screening for fetal malpresentation include:
- Clinical examination (Leopold's maneuvers) to assess fetal presentation during prenatal visits in the third trimester
- Ultrasound confirmation when malpresentation is suspected, with a focus on transabdominal anatomy scans for low-risk pregnancies and transabdominal detailed scans for high-risk pregnancies 1
- Identification of risk factors for malpresentation, such as uterine anomalies, fibroids, placenta previa, multiple gestation, or polyhydramnios, to guide the screening process The American College of Radiology recommends that ultrasound screening be performed at least once during pregnancy, with evidence showing increased detection of fetal anomalies and improved detection of multiple gestations without detrimental effects on cognitive or physical development 2. Ultrasound screening, particularly transabdominal anatomy scans, is usually appropriate for initial second and third trimester screening for fetal anomaly in low-risk pregnancies, and transabdominal detailed scans are usually appropriate for high-risk pregnancies 1. It is essential to note that early detection of malpresentation allows time for potential interventions like external cephalic version (ECV), which can reduce the need for cesarean delivery and associated maternal morbidity, while ensuring appropriate delivery planning for cases where the malpresentation persists.
From the Research
Methods for Screening Fetal Malpresentation
The following methods are used for screening fetal malpresentation:
- Intrapartum ultrasound to assess fetal position and presentation 3
- Digital examination to assess malpresentation and malposition, although intrapartum ultrasound has been found to be more reliable 3
- External cephalic version (ECV) as a procedure to manually maneuver the fetus to cephalic position, allowing patients to attempt vaginal birth 4, 5, 6
Diagnosis and Management
Diagnosis of fetal malpresentation is necessary for appropriate management, which includes:
- Accurate diagnosis of fetal malpresentation and malposition 7
- Management options such as cesarean section (CS) or external cephalic version (ECV) 4, 5
- Consideration of risk factors such as multiparity, previously affected pregnancy, polyhydramnios, and fetal and uterine anomalies 5
Additional Methods
Additional methods that may be valuable in managing fetal malpresentation include:
- Chiropractors, acupuncture, and moxibustion as identified by patients as valuable additional methods of malpresentation management 4