Foetal malpresentation

Brow presentation

• section is advisable if the head is at the level of the pelvic brim

Face presentation

• impacted mento-posterior presentation is an indicaton for section

Shoulder presentation

• section is preferable to internal version

Locked or conjoined twins

Breech presentation

• 30% of breeches are delivered by caesarian section
• a breech presentation with any complication should go to section. Complications include maternal age (>35), adverse obstetric history, small pelvic or large foetus
• planned caesarian section has a lower risk for perinatal mortality and serious morbidity than planned vaginal birth in breech presentation (1)

Reference:

• (1) Hannah ME et al, for the Term Breech Trial Collaborative Group (2000). Planned caesarian section versus planned vaginal birth for breech presentation at term: a randomised trial. Lancet, 356, 1375-83.