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Factors That Increase the Risk of Abnormal Positioning of the Fetal Head

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Abnormal positioning of the fetal head can lead to complications during pregnancy. This article briefly explains abnormal fetal head positioning.

Written byDr. Asha. C

Medically reviewed byDr. Richa Agarwal

Published At December 7, 2022
Reviewed AtOctober 16, 2024

Introduction:

During normal delivery, the baby is mostly in a cephalic or vertex position or face presentation; that is, the head of the baby will be positioned downward, facing the mother's back, and the chin will be tucked towards the baby's chest. The back of the head will enter the pelvis. Most babies come in this position within the 32nd to 36th week of pregnancy. Although other fetal positions might have some difficulties during delivery, this article explains different abnormal fetal positions.

What Does Abnormal Baby Position Mean?

The direction in which the fetus faces the womb is called the position of the fetus. The safest position for a fetus just before delivery is facing the mother’s front of the body. However, it is considered abnormal when a fetus is headed down the birth canal with the face, feet, or shoulders first. Normally, the fetus may also be facing slightly right or left, with arms crossing the chest and a tucked chin; all other presentations and positions are considered abnormal. An abnormal position or presentation also means that the pregnant woman is in for a difficult or long vaginal delivery or a cesarean delivery. Regardless of the situation and position, doctors and healthcare providers must be prepared to act whenever necessary.

How Is the Position of the Baby Determined?

The position and presentation of the baby are often observed to avoid any complications during pregnancy. Each patient's risk factors are assessed by checking the patient's medical history for past pregnancies, obesity, hypertension (high blood pressure), diabetes (high blood sugar), and placenta previa (placental growth in the lower part of the uterus). A physical exam, ultrasound scan, or other prenatal tests may help in detecting abnormalities in the shape of the uterus, the amount of amniotic fluid, the position of the placenta, or a narrow pelvis. The conditions like diabetes, hypertension, and obesity are also treated.

These tests can help the medical professional to determine the spinning baby's position. To monitor the baby closely, frequent tests will be conducted in the late term, around 36 weeks of pregnancy. Once the labor begins, a healthcare professional will get a more accurate sense of the baby's position by doing a vaginal examination. When the cervix is dilated enough, the health care professionals will insert their fingers into the vagina to feel the baby's skull as the baby moves down in the birth canal.

Furthermore, mothers should also pay close attention to the movement of the baby, and if any different movements are felt, it should be noted. Belly mapping is a technique that can help mothers assess their baby's movement and obtain a sense of the spinning baby's position as they near labor. For instance, by locating where strong kicks are felt, the position of the baby's legs and feet can be determined. Another landmark a mother can feel is a large, flat plane that can mostly be the baby's back.

What Are the Factors that Increase the Risk of Abnormal Fetal Positioning?

Many factors can increase the risk of abnormal fetal positioning, including:

  • Early labor or a premature baby can cause abnormal positioning; the baby may not have had time to come in proper preparation for birth yet.

  • Suppose there are issues with the placenta, such as if the placenta is attached too low in the uterus or gets disconnected from the uterus before birth. In that case, it can prevent the baby from rotating and getting into the right position for birth.

  • In the case of multiple pregnancies, it can be hard for each baby to get into a normal position because of the limited space created as the babies grow throughout the pregnancy.

  • Suppose there is an abnormality in the shape of the uterus, such as a partial septate uterus (rare uterovaginal malformation). In that case, there might not be enough shape for a baby to move into position for birth.

  • Fibroids in the uterus can also create less space for baby movement.

What Is the Different Abnormal Position of the Fetus?

The different abnormal positions of the fetus are as follows:

1. Occiput Anterior (Right and Left): The front of a baby's head is called the anterior portion, and the back is called the posterior portion. Two different positions can be called occiput anterior (OA) positions.

  • Left Occiput Anterior (LOA) - This position is the most common in labor. The baby's head will be slightly off-center in the pelvis, and the back of the fetus's head will be toward the mother's left thigh.

  • The Right Occiput Anterior (ROA) - This presentation is also common in labor. The back of the baby's head is slightly off-center in the pelvis, with the back of the baby's head facing toward the mother's right thigh.

The occiput anterior position does not cause complications or additional labor pain during birth.

2. Occiput Transverse (Right and Left): The baby’s head is towards one of the sides of the mother and the lower body is towards the other side across her abdomen. This position is also known as the transverse lie baby's position and the transverse baby's belly shape appears sideways or positioned horizontally.

  • Right Occiput Transverse (ROT) - When the baby is positioned facing outward toward the mother's left thigh, then the baby is said to be in the right occiput transverse (ROT baby position) or right lateral position. The right occiput transverse is halfway between an anterior and posterior position. If the baby moved from a posterior position to ROT, it is a sign of a positive move toward the anterior position.

  • Left Transverse Occiput (LOT) - When the baby is positioned facing out towards the mother's right thigh, then it is a left occiput transverse baby position. This position is midway between a posterior and anterior position. If a baby moves from a posterior position to the left occiput transverse, it is a positive movement toward a normal position.

LOT or ROT baby position during labor, there will be more pain and a slower progression.

3. Occiput Posterior (Right and Left): When the baby is facing forward, then it is referred to as the occiput posterior position.

  • Right Occiput Posterior (ROP) - When the baby is positioned facing forward with a slight right tilt towards the mother's left thigh, it is called the right occiput anterior. This presentation causes more pain and slows down labor.

  • Left Occiput Posterior (LOP) - When the baby is facing forward with a slight tilt to the left toward the mother's right thigh, it is called left occiput posterior. This presentation can slow the progression of labor and lead to more back pain.

What Are the Transverse Lie Baby Symptoms?

The transverse lie baby symptoms are as follows:

  • The pregnant woman can feel the baby stretching towards the sides of the abdomen or uterus, not vertically (top to bottom).

  • The transverse lie position also improves the mother's breathing.

  • The uterus top feels flatter.

Conclusion:

Abnormal presentation occurs when the baby is in a position other than the cephalic or vertex, which is considered normal. The position of the baby is monitored from the beginning to avoid abnormalities during pregnancy because abnormal positions can cause complications during delivery. Cesarean delivery is often considered in women with abnormal fetal positions.

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Frequently Asked Questions

The normal position of the fetus is called the rearward, referring to the position towards the woman’s back. So, the face and body of the fetus angle to one side while the neck is flexed and the head at first in presentation. The abnormal positioning refers to facing forward. The abnormal presentations incorporate face and brow, followed by breech and shoulder. 
The risk factors leading to fetal presentations rather than vertex include the following.
- Abnormal levels of amniotic fluid.
- Abnormal pelvis shape.
- Slackness of muscular layer in the uterus wall.
- Multiple pregnancies.
- Tumor growth in the uterus prevents the vertex position. 
The normal position is the vertex position, where the head of the fetus is downward before giving birth. The vertex position is considered the favorable position for normal delivery. Fetal malpositions such as transverse or occiput posterior can lead to higher risks of prolonged labor, cesarean delivery, and perinatal morbidity. 
In the field of obstetrics, the position is known as the orientation or position of the fetus in the womb that is detected by the location of the presenting parts of the fetus in relation to the pelvis. Normally, the fetus is positioned head-down, facing the mother’s back. Addedly, the chin gets tucked into its chest. 
- The abnormal position of the fetus increases the risks of cesarean births. In addition, the wide placental area and distended uterus can induce bleeding after delivery in cases of multiple pregnancies.
- The long-term complication in association with the abnormal position includes the following.
- Shoulder dystocia.
- Broken bones.
- Fractured spinal cords.
- Head and brain trauma. 
Checking the fetus and mother for potential risks during pregnancy is essential. There is a range of risk factors that can be associated with pregnancy and its complications. They include the following.
- High blood pressure.
- Diabetes.
- Obesity.
- Epilepsy.
- Heart and vascular diseases.
- Infections.
- Poor-controlled asthma.
- Alcohol and drug abuse.
- Substance toxicity. 
Positioning is an important determinant in pregnancy and labor. Pregnant women using upright positions during labor can have less severe pain, shorter labor, fewer interventions, and have gratified experience. The overall childbirth experience can be favorable. These advantages seem to be less in cases of women following supine or semirecumbent positions. 
The posture and each move of the expectant’s mother can eventually influence the unborn child. The way the mother sits, stands, sleeps, and utilizes the body can influence the baby in the womb during pregnancy. So, one should take the right posture during pregnancy and labor in order to avoid risks and complications. 
The posture during sitting, standing, and sleep is considered an essential factor that can influence the unborn child inside the womb. Medical experts recommend lying on the left side since it enhances circulation and provides nutrient-rich blood right from the heart to the placenta for the nourishment of the fetus. They say the left is the best, while any side is fine. 
A range of factors can contribute to pregnancy complications by influencing them in a contrary fashion. The most common pregnancy complications include the following. 
- High blood pressure.
- Infections.
- Gestational diabetes.
- Preterm labor.
- Depression.
- Anxiety.
- Miscarriage.
- Preeclampsia. 
The term abnormal in pregnancy is the state which shows that pregnancy or labor goes unfavorable. It can be the position of the fetus, underlying medical conditions, substance abuse, or other determinants. Sometimes, the pregnancy complications can be often associated with the pregnancy itself, such as early pregnancy loss, molar pregnancies, etc.,
The positioning of the patient is considered the predominant and essential step in any means of surgery, treatment, or therapy. The patient should be in neutral alignment and also maintained as such throughout the procedure. There should be no extreme degrees of lateral rotation or hyperextension. Also, pressure is not fixated at one point since it could lead to pressure injuries. 
The position of the legs between the legs is considered beneficial for pregnant women. This position enhances and maximizes blood circulation to the uterus rather than exerting pressure on the liver. Also, women can get relief by placing pillows in between the knees in cases of hip and back pain. 
The position of the mother can influence the unborn fetus inside the womb during pregnancy. The experts say to avoid lying on the back during pregnancy, particularly during the last trimester. Also, sitting in the ideal position for more than thirty minutes can be avoided. One can also avoid standing for a prolonged period. Crossing the legs can be avoided. 
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Dr. Richa Agarwal from iCliniq
Dr. Richa Agarwal

Obstetrics and Gynecology

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