Breech presentation is the most commonly encountered malpresentation. Since publication of the Term Breech Trial, management has concentrated on correcting the malpresentation by external cephalic version at term. The trial shows that planned Caesarean section benefits the fetus, although the fact remains that most babies will not be compromised by planning a vaginal birth. Maternal requests for vaginal delivery are thus not unreasonable. Many preterm fetuses and second twins presenting by breech are still delivered vaginally, and the art of vaginal breech delivery must not be lost. Fetal malpresentations other than breech are infrequently encountered and there is little evidence to guide practice. Face presentations pose few problems except where the chin (mentum) remains posterior. Brow presentation does not automatically equate to the need for Caesarean section, as some will correct as labour progresses. Shoulder presentation is encountered with transverse lie, with the attendant risk of cord prolapse and fetal compromise. If Caesarean section is undertaken it is important to keep the membranes intact when opening the uterus to allow easier manipulation and delivery.
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