OP Malpresentation: A Precarious Situation

Course overview

Fetal malpresentation is defined as a fetus presenting at birth in a non-vertex presentation as either occiput transverse (OT) or occiput posterior (OP). This condition occurs 15% to 25% at term and 5% to 12% at birth, frequently increases risk of surgical birth, and may prompt alterations in the fetal heart rate significant for acid-base imbalance. In an effort to reduce cesarean births due to fetal malpresentation, ACOG and SMFM encourage practitioners to perform manual rotation of the fetal occiput in the setting of fetal malposition in the second stage of labor as an intervention prior to operative vaginal delivery or surgery.