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What Should Doctors Do in Cases of Abnormal Fetal Presentation?

A fetus’s position in the womb can have a significant impact on the risks for pregnancy, labor, and delivery. The most common, and generally safest, position during childbirth (or “presentation”) is for the fetus’s head to be down, allowing for a head-first birth and minimizing the risk of injuries and complications for both the mother and the child. This is known as the “cephalic” presentation.

When a fetus is not in the cephalic position, the risks for childbirth can increase – in some cases dramatically. As a result, doctors must take appropriate steps to identify abnormal fetal presentation as early in a mother’s pregnancy as possible, and they must provide appropriate care based on the particular risks involved. The failure to do so will often constitute malpractice, and families who are negatively impacted by their doctors’ mistakes can seek just compensation with the help of an experienced birth injury attorney.

What Is Abnormal Fetal Presentation?

Any form of fetal presentation other than the fetus being in the cephalic position is considered abnormal. However, “abnormal” does not necessarily mean bad, and this refers solely to the fetus’s position in the womb, not to the fetus itself. Most babies who are in abnormal fetal positions are born completely healthy, and modern medicine affords doctors numerous tools to ensure that abnormal fetal position does not lead to birth injuries or complications.

There are many different types of abnormal fetal presentation. A fetus can take virtually any position in the womb, and each different position has been given its own specific medical terminology. Some of the more common types of abnormal fetal presentation are:

  • Cephalic posterior (or occiput posterior) presentation – The fetus is in the cephalic position, but reversed so that it is faced toward the mother’s abdomen such that the face is turned upward.
  • Complete breech – The fetus is positioned with the buttocks down and with the legs folded and arms crossed forward.
  • Face or brow presentation – The fetus is generally in the cephalic position, but its neck is bent slightly backward so that either the brow or the face exits the womb first instead of the back of the head.
  • Footling breech – One or both of the fetus’s feet are pointed downward and will be the first part of the body to exit the womb and enter the birth canal.
  • Frank breech – Somewhat similar to complete breech, the frank breech is characterized by the fetus’s buttocks facing downward and hips being flexed, but with the knees extended.
  • Shoulder presentation – As the name suggests, with shoulder presentation, the fetus is rotated such that its shoulder is at the lowest point and is the first part of the body to enter the birth canal.
  • Transverse lie – The fetus’s body is lying across the uterus, meaning that the shoulder will be the first part of the body to enter the birth canal in most cases.

In the majority of cases, abnormal fetal presentations will self-correct. However, in the cases in which this does not occur, doctors must take appropriate measures to address the health concerns for the mother and child.

Appropriate Medical Care to Mitigate the Risk of Injuries and Complications Due to Abnormal Fetal Presentation

In order to mitigate the risk of birth injuries and other complications due to abnormal fetal presentation, doctors must provide appropriate care during pregnancy, labor, and delivery. Medical mistakes at any step in the process can potentially lead to issues; and, in some cases, these issues may be irreversible. Appropriate medical care to prevent birth injuries and other complications due to abnormal fetal position include:

  • Identifying risk factors for abnormal fetal presentation
  • Advising the mother regarding risks and the options to mitigate these risks
  • Providing appropriate care during pregnancy and labor
  • Delivering the baby consistent with Connecticut’s medical standard of care
  • Diagnosing the newborn baby promptly
  • Promptly providing any necessary neonatal treatment

1. Identifying Risk Factors for Abnormal Fetal Presentation

While abnormal fetal presentation can occur due to a broad range of factors, and in many cases occurs due to no particular issue at all, there are also several recognized risk factors for abnormal presentations. Doctors must be aware of all of these risk factors, and they must conduct the necessary exams and tests to identify these risk factors as early during pregnancy as possible.

There are both maternal and fetal risk factors for abnormal presentation. Maternal risk factors include:

  • Contracted pelvis
  • Cornual implantation
  • Uterine fibromyomas or ovarian cysts (neoplasm)
  • Pendulous maternal abdomen and other uterine abnormalities
  • Placenta previa
  • Placental abnormalities
  • Premature rupture of membranes (PROM)

Fetal risk factors include:

  • Anencephaly
  • Excessive amniotic fluid
  • Fetal extension
  • Hydrocephalus
  • Macrosomia (large baby)

Being pregnant with multiples can also increase the risk of one or more of the fetuses having an abnormal presentation. Additionally, since many cases of abnormal fetal position are resolved naturally during pregnancy, premature birth can increase the risk of abnormal presentation during labor and delivery as well.

2. Advising the Mother Regarding Risks and the Options to Mitigate These Risks

When one or more of these risks are present, the mother’s doctor has a duty to explain these risks and discuss the options that the mother has available. Most risks associated with abnormal fetal presentation can be avoided in most cases. Doctors must explain the risks of the abnormal fetal presentation clearly and with sufficient detail so that mothers have the opportunity to make informed decisions about their prenatal care.

Too often, doctors rush this process, fail to communicate clearly and fail to afford mothers the opportunity to ask questions. These failures often lead to a lack of understanding on both sides, and this, in turn, leads to situations that should have been avoided and that present unnecessary health risks for the mother and the fetus. In these situations, it is the doctors who failed to meet their duties who are responsible, and families will often be able to file malpractice claims based on their doctor’s failure to adequately discuss the risks of pregnancy complications.

3. Providing Appropriate Care during Pregnancy and Labor

Once it has been determined that a fetus is positioned abnormally in the mother’s womb, it is incumbent upon the mother’s doctor to provide necessary and appropriate medical care. This can involve various different forms of treatment, depending on the fetus’s position and any other risk factors that may be involved.

For example, in some cases, it may be possible to reposition the fetus in the mother’s womb. If this is a viable option, identifying the need as early as possible and repositioning the fetus at the appropriate time can greatly reduce the risk of abnormal fetal presentation and the birth injuries and complications that can come with a breech or other abnormal birth. If repositioning is not possible or not viable, then other forms of medical intervention may be necessary in order to avoid issues with the umbilical cord and mitigate the risk of traumatic birth injuries to the mother and the baby.

In appropriate cases, doctors may advise expectant mothers to perform exercises in order to encourage their babies to reposition in the womb. When this is recommended, these exercises should be performed under medical supervision, and doctors must continue to monitor the fetus’s progress. If performing exercises does not prove effective to reposition the fetus, then an alternate form of intervention must be pursued in a timely manner.

Some doctors may also recommend alternative methods, such as chiropractic treatment, acupuncture, and attempting to stimulate the fetus with sound, light, or temperature. Again, doctors cannot simply provide these recommendations and then not follow up with additional diagnosis and treatment recommendations. When a fetus is positioned abnormally, preparing for safe and low-risk delivery is an ongoing process, and deficiencies in prenatal care will support claims for malpractice in many cases.

4. Delivering the Baby Consistent with Connecticut’s Medical Standard of Care

When it is not possible to safely reposition a fetus in the mother’s womb in order to avoid abnormal fetal presentation, then the baby must be delivered consistently with Connecticut’s medical standard of care. If the fetus is in the transverse lie position or is positioned shoulder first, then a cesarean section (C-section) delivery may be necessary. When a natural birth is recommended, appropriate care must be taken to ensure that the baby is born safely. Among other steps, this includes addressing any issues related to the umbilical cord and avoiding the application of excessive force, which may cause a traumatic birth injury.

5. Diagnosing the Newborn Baby Promptly and Providing Any Necessary Neonatal Treatment

Finally, once a baby has been born following the abnormal fetal presentation, the newborn baby should be thoroughly diagnosed for any signs of traumatic birth injuries or other birth-related complications. The abnormal fetal presentation can lead to various different types of issues. While some issues can resolve themselves without medical treatment, many issues can worsen and lead to permanent effects if not treated promptly. Some examples of birth injuries that can result from issues related to abnormal fetal presentation include:

  • Bone fractures and other traumatic injuries
  • Cerebral hemorrhage
  • Cerebral palsy, Erb’s palsy, and other forms of palsy
  • Hypoxia
  • Infections
  • Kernicterus
  • Potter syndrome
  • Shoulder dystocia
  • Significant bruising
  • Spinal cord damage

An abnormal fetal position can present injury risks for the mother as well. Excessive bleeding, uterine rupture, and other potentially-dangerous complications are common, but they can also be avoided. If you or your child has experienced complications due to abnormal fetal presentation, it is important that you seek professional medical treatment promptly, and you should consult with an attorney about filing a birth injury malpractice claim as soon as possible.

Speak with a Trusted Attorney at Berkowitz Hanna

With multiple office locations throughout Connecticut, our firm represents mothers and families in birth injury malpractice claims, statewide. If you have questions and would like to speak with an attorney, we encourage you to call us directly or contact us online for a free initial consultation.