II. Precautions

  1. Avoid Oxytocin in most malpresentations except
    1. Occiput Posterior
    2. Twin Vaginal Delivery
  2. Consider Terbutaline SC before Cesarean Section
  3. Consider maternal position changes

III. Presentations

  1. Occiput Posterior (10%)
    1. Vaginal Delivery
  2. Face Presentation (<0.2% or 1 in 550 live births; full extension of fetal head, occiput against upper back)
    1. Mentum Anterior or Face Anterior
      1. Vaginal Delivery
    2. Mentum Posterior or Face Posterior
      1. Cesarean Section
    3. Brow (0.02%) and not converted to face or occiput
      1. Vaginal Delivery
  3. Compound Presentation (<0.5%)
    1. Vaginal Delivery
  4. Transverse Presentation (0.3%):
    1. Obstetric Ultrasound
    2. Attempt External Cephalic Version
    3. Cesarean Section for failed version
      1. Consider uterine vertical incision

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