Malposition of the fetal head

1. Big picture

Malposition of the fetal head means the fetus is in vertex presentation, but the occiput is not in the normal anterior position or the head is abnormally aligned in the maternal pelvis.

This is different from malpresentation:

The normal pattern is:

Cephalic presentation
↓
Well-flexed vertex
↓
Occipito-anterior position
↓
Internal rotation
↓
Normal vaginal delivery

In malposition, the fetus may still deliver vaginally, but labour is often longer, more painful, more obstructed, and more likely to require operative vaginal delivery or caesarean section.