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What Is Cephalic Position?

The ideal fetal position for labor and delivery

• Why It's Best

Risks of Other Positions

• Determining Position
• Turning a Fetus

The cephalic position is when a fetus is head down when it is ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery.

About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy . Your healthcare provider will monitor the fetus's position during the last weeks of gestation to ensure this has happened by week 36.

If the fetus is not in the cephalic position at that point, the provider may try to turn it. If this doesn't work, some—but not all—practitioners will attempt to deliver vaginally, while others will recommend a Cesarean (C-section).

Getty Images

Why Is the Cephalic Position Best?

During labor, contractions dilate the cervix so the fetus has adequate room to come through the birth canal. The cephalic position is the easiest and safest way for the baby to pass through the birth canal.

If the fetus is in a noncephalic position, delivery becomes more challenging. Different fetal positions have a range of difficulties and varying risks.

A small percentage of babies present in noncephalic positions. This can pose risks both to the fetus and the mother, and make labor and delivery more challenging. It can also influence the way in which someone can deliver.

A fetus may actually find itself in any of these positions throughout pregnancy, as the move about the uterus. But as they grow, there will be less room to tumble around and they will settle into a final position.

It is at this point that noncephalic positions can pose significant risks.

Cephalic Posterior

A fetus may also present in an occiput or cephalic posterior position. This means they are positioned head down, but they are facing the abdomen instead of the back.

This position is also nicknamed "sunny-side up."

Presenting this way increases the chance of a painful and prolonged delivery.

There are three different types of breech fetal positioning:

• Frank breech: The legs are up with the feet near the head.
• Footling breech: One or both legs is lowered over the cervix.
• Complete breech: The fetus is bottom-first with knees bent.

A vaginal delivery is most times a safe way to deliver. But with breech positions, a vaginal delivery can be complicated.

When a baby is born in the breech position, the largest part—its head—is delivered last. This can result in them getting stuck in the birth canal (entrapped). This can cause injury or death.

The umbilical cord may also be damaged or slide down into the mouth of the womb, which can reduce or cut off the baby's oxygen supply.

Some providers are still comfortable performing a vaginal birth as long as the fetus is doing well. But breech is always a riskier delivery position compared with the cephalic position, and most cases require a C-section.

Likelihood of a Breech Baby

You are more likely to have a breech baby if you:

• Go into early labor before you're full term
• Have an abnormally shaped uterus, fibroids , or too much amniotic fluid
• Are pregnant with multiples
• Have placenta previa (when the placenta covers the cervix)

Transverse Lie

In transverse lie position, the fetus is presenting sideways across the uterus rather than vertically. They may be:

• Down, with the back facing the birth canal
• With one shoulder pointing toward the birth canal
• Up, with the hands and feet facing the birth canal

If a transverse lie is not corrected before labor, a C-section will be required. This is typically the case.

Determining Fetal Position

Your healthcare provider can determine if your baby is in cephalic presentation by performing a physical exam and ultrasound.

In the final weeks of pregnancy, your healthcare provider will feel your lower abdomen with their hands to assess the positioning of the baby. This includes where the head, back, and buttocks lie

If your healthcare provider senses that the fetus is in a breech position, they can use ultrasound to confirm their suspicion.

Turning a Fetus So They Are in Cephalic Position

External cephalic version (ECV) is a common, noninvasive procedure to turn a breech baby into cephalic position while it's still in the uterus.

This is only considered if a healthcare provider monitors presentation progress in the last trimester and notices that a fetus is maintaining a noncephalic position as your delivery date approaches.

External Cephalic Version (ECV)

ECV involves the healthcare provider applying pressure to your stomach to turn the fetus from the outside. They will attempt to rotate the head forward or backward and lift the buttocks in an upward position. Sometimes, they use ultrasound to help guide the process.

The best time to perform ECV is about 37 weeks of pregnancy. Afterward, the fetal heart rate will be monitored to make sure it’s within normal levels. You should be able to go home after having ECV done.

ECV has a 50% to 60% success rate. However, even if it does work, there is still a chance the fetus will return to the breech position before birth.

Natural Methods For Turning a Fetus

There are also natural methods that can help turn a fetus into cephalic position. There is no medical research that confirms their efficacy, however.

• Changing your position: Sometimes a fetus will move when you get into certain positions. Two specific movements that your provider may recommend include: Getting on your hands and knees and gently rocking back and forth. Another you could try is pushing your hips up in the air while laying on your back with your knees bent and feet flat on the floor (bridge pose).
• Playing stimulating sounds: Fetuses gravitate to sound. You may be successful at luring a fetus out of breech position by playing music or a recording of your voice near your lower abdomen.
• Chiropractic care: A chiropractor can try the Webster technique. This is a specific chiropractic analysis and adjustment which enables chiropractors to establish balance in the pregnant person's pelvis and reduce undue stress to the uterus and supporting ligaments.
• Acupuncture: This is a considerably safe way someone can try to turn a fetus. Some practitioners incorporate moxibustion—the burning of dried mugwort on certain areas of the body—because they believe it will enhance the chances of success.

A Word From Verywell

While most babies are born in cephalic position at delivery, this is not always the case. And while some fetuses can be turned, others may be more stubborn.

This may affect your labor and delivery wishes. Try to remember that having a healthy baby, and staying well yourself, are your ultimate priorities. That may mean diverting from your best laid plans.

Speaking to your healthcare provider about turning options and the safest route of delivery may help you adjust to this twist and feel better about how you will move ahead.

Glezerman M. Planned vaginal breech delivery: current status and the need to reconsider . Expert Rev Obstet Gynecol. 2012;7(2):159-166. doi:10.1586/eog.12.2

Cleveland Clinic. Fetal positions for birth .

MedlinePlus. Breech birth .

UT Southwestern Medical Center. Can you turn a breech baby around?

The American College of Obstetricians and Gynecologists. If your baby is breech .

Roecker CB. Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios .  Journal of Chiropractic Medicine . 2013;12(2):74-78. doi:10.1016/j.jcm.2013.06.003

By Cherie Berkley, MS Berkley is a journalist with a certification in global health from Johns Hopkins University and a master's degree in journalism.

• Learn   /  

Why Is Cephalic Presentation Ideal For Childbirth?

5   Dec   2017 | 8 min Read

During labour, contractions stretch your birth canal so that your baby has adequate room to come through during birth. The cephalic presentation is the safest and easiest way for your baby to pass through the birth canal.

If your baby is in a non-cephalic position, delivery can become more challenging. Different fetal positions pose a range of difficulties and varying risks and may not be considered ideal birthing positions.

Two Kinds of Cephalic Positions

There are two kinds of cephalic positions:

• Cephalic occiput anterior , where your baby’s head is down and is facing toward your back.
• Cephalic occiput posterior , where your baby is positioned head down, but they are facing your abdomen instead of your back. This position is also nicknamed ‘sunny-side-up’ and can increase the chances of prolonged and painful delivery. 

How to Know if Your Baby is In a Cephalic Position?

You can feel your baby’s position by rubbing your hand on your belly. If you feel your little one’s stomach in the upper stomach, then your baby is in a cephalic position. But if you feel their kicks in the lower stomach, then it could mean that your baby is in a breech position.

You can also determine whether your baby is in the anterior or posterior cephalic position. If your baby is in the anterior position, you may feel their movement underneath your ribs and your belly button could also pop out. If your baby is in the posterior position, then you may feel their kicks in their abdomen, and your stomach may appear rounded up instead of flat. 

You can also determine your baby’s position through an ultrasound scan or a physical examination at your healthcare provider’s office. 

Benefits of Cephalic Presentation in Pregnancy

Cephalic presentation is one of the most ideal birth positions, and has the following benefits:

• It is the safest way to give birth as your baby’s position is head-down and prevents the risk of any injuries.
• It can help your baby move through the delivery canal as safely and easily as possible.
• It increases the chances of smooth labour and delivery.

Are There Any Risks Involved in Cephalic Position?

Conditions like a cephalic posterior position in addition to a narrow pelvis of the mother can increase the risk of pregnancy complications during delivery. Some babies in the head-first cephalic presentation might have their heads tilted backward. This may, in some rare cases, cause preterm delivery.

What are the Risks Associated with Other Birth Positions?

A small percentage of babies may settle into a non-cephalic position before their birth. This can pose risks to both your and your baby’s health, and also influence the way in which you deliver. 

In the next section, we have discussed a few positions that your baby can settle in throughout pregnancy, as they move around the uterus. But as they grow old, there will be less space for them to tumble around, and they will settle into their final position. This is when non-cephalic positions can pose a risk.  

Breech Position

There are three types of breech fetal positioning:

• Frank breech : Your baby’s legs stick straight up along with their feet near their head.
• Footling breech: One or both of your baby’s legs are lowered over your cervix.
• Complete breech: Your baby is positioned bottom-first with their knees bent.

If your baby is in a breech position , vaginal delivery is considered complicated. When a baby is born in breech position, the largest part of their body, that is, their head is delivered last. This can lead to injury or even fetal distress. Moreover, the umbilical cord may also get damaged or get wrapped around your baby’s neck, cutting off their oxygen supply.  

If your baby is in a breech position, your healthcare provider may recommend a c-section, or they may try ways to flip your baby’s position in a cephalic presentation.

Transverse Lie

In this position, your baby settles in sideways across the uterus rather than being in a vertical position. They may be:

• Head-down, with their back facing the birth canal
• One shoulder pointing toward the birth canal
• Up with their hands and feet facing the birth canal

If your baby settles in this position, then your healthcare provider may suggest a c-section to reduce the risk of distress in your baby and other pregnancy complications.

Turning Your Baby Into A Cephalic Position

External cephalic version (ECV) is a common, and non-invasive procedure that helps turn your baby into a cephalic position while they are in the womb. However, your healthcare provider may only consider this procedure if they consider you have a stable health condition in the last trimester, and if your baby hasn’t changed their position by the 36th week.

You can also try some natural remedies to change your baby’s position, such as:

• Lying in a bridge position: Movements like bridge position can sometimes help move your baby into a more suitable position. Lie on your back with your feet flat on the ground and your legs bent. Raise your pelvis and hips into a bridge position and hold for 5-10 minutes. Repeat several times daily.
• Chiropractic care: A chiropractor can help with the adjustment of your baby’s position and also reduce stress in them.
• Acupuncture: After your doctor’s go-ahead, you can also consider acupuncture to get your baby to settle into an ideal birthing position.

While most babies settle in a cephalic presentation by the 36th week of pregnancy, some may lie in a breech or transverse position before birth. Since the cephalic position is considered the safest, your doctor may recommend certain procedures to flip your baby’s position to make your labour and delivery smooth. You may also try the natural methods that we discussed above to get your baby into a safe birthing position and prevent risks or other pregnancy complications. 

When Should A Baby Be In A Cephalic Position?

Your baby would likely naturally drop into a cephalic position between weeks 37 to 40 of your pregnancy .

Is Cephalic Position Safe?

Research shows that 95% of babies take the cephalic position a few weeks or days before their due date. It is considered to be the safest position. It ensures a smooth birthing process.

While most of the babies are in cephalic position at delivery, this is not always the case. If you have a breech baby, you can discuss the available options for delivery with your doctor.

Does cephalic presentation mean labour is near?

Head-down is the ideal position for your baby within your uterus during birth. This is known as the cephalic position. This posture allows your baby to pass through the delivery canal more easily and safely.

Can babies change from cephalic to breech?

The external cephalic version (ECV) is the most frequent procedure used for turning a breech infant.

How can I keep my baby in a cephalic position?

While your baby naturally gets into this position, you can try some exercises to ensure that they settle in cephalic presentation. Exercises such as breech tilt, forward-leaning position (spinning babies program), cat and camel pose can help.

Stitches after a normal delivery : How many stitches do you need after a vaginal delivery? Tap this post to know.

Vaginal birth after caesarean delivery : Learn all about the precautions to consider before having a vaginal delivery after a c-section procedure. 

How many c-sections can you have : Tap this post to know the total number of c-sections that you can safely have.

Cover Image Credit: Freepik.com

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Qu’est-ce que la présentation céphalique ?

En obstétrique, le terme « présentation céphalique » est utilisé pour décrire une situation dans laquelle le bébé est accouché la tête la première. Cette présentation de livraison est la plus sûre et la plus courante. Les présentations anormales telles qu’un siège, dans lesquelles les fesses ou les pieds sortent en premier, peuvent être dangereuses et peuvent nécessiter une intervention sous la forme d’une césarienne pour l’accouchement. Au fur et à mesure que la grossesse progresse dans les derniers stades, un médecin peut vérifier la position du fœtus pour s’assurer qu’il s’aligne correctement pour l’accouchement.

La tendance naturelle du fœtus à tomber dans une présentation céphalique, généralement celle dans laquelle la couronne de la tête est livrée en premier. La forme de l’utérus est conçue de manière à ce que cette position soit présentée comme la plus naturelle pour le fœtus à mesure qu’il grandit et que l’espace devient limité. Cependant, le bébé peut mentir de diverses manières avec une présentation céphalique, et certaines d’entre elles peuvent être dangereuses pour le bébé ou la mère. Par exemple, le fait que le bébé sorte les sourcils en premier peut rendre l’accouchement difficile.

Le fœtus commence à se mettre en position pour l’accouchement avant que la mère ne commence le travail. Si un médecin soupçonne qu’un fœtus ne se dirige pas vers la présentation céphalique, il peut faire des suggestions destinées à faire tourner ou déplacer le bébé en position. L’échographie fœtale peut être utilisée pour voir si le fœtus est au bon endroit, et les obstétriciens peuvent également le dire à la palpation. Cela peut également être utilisé pour déterminer si le bébé est dans une position inconfortable, mais toujours dans une présentation céphalique, pour planifier à l’avance l’accouchement.

Les présentations peuvent devenir compliquées lorsqu’une femme en porte plusieurs. C’est l’une des nombreuses raisons pour lesquelles les grossesses multiples sont considérées comme une grossesse à risque potentiellement élevé. Si le médecin soupçonne que la présentation d’une grossesse unique ou multiple est trop risquée, une recommandation pour une césarienne peut être faite. Cela peut être fait par souci pour le bébé ou la mère, et une intervention très rapide est disponible si un accouchement commence à mal se passer.

La grande majorité des grossesses se terminent par une présentation céphalique. La petite fraction qui ne le fait pas peut être traitée de diverses manières. Différents médecins ou sages-femmes peuvent avoir des recommandations différentes pour la manipulation du siège et d’autres positions pendant le travail et l’accouchement.

• Vishal's account
• Prenatal Care

Fetal Cephalic Presentation During Pregnancy

What Is Cephalic Position?

Types of cephalic position, benefits of cephalic presentation, risks of cephalic position, what are some other positions and their associated risks, when does a foetus get into the cephalic position, how do you know if baby is in cephalic position, how to turn a breech baby into cephalic position, natural ways to turn a baby into cephalic position.

If your baby is moving around in the womb, it’s a good sign as it tells you that your baby is developing just fine. A baby starts moving around in the belly at around 14 weeks. And their first movements are usually called ‘ quickening’ or ‘fluttering’.

A baby can settle into many different positions throughout the pregnancy, and it’s alright. But it is only when you have reached your third and final trimester that the position of your baby in your womb will matter the most. The position that your baby takes at the end of the gestation period will most likely be how your baby will make its appearance in the world. Out of all the different positions that your baby can settle into, the cephalic position at 36 weeks is considered the best position. Read on to learn more about fetal cephalic presentation.

When it comes to cephalic presentation meaning, the following can be considered. A baby is in the cephalic position when he is in a head-down position. This is the best position for them to come out in. In case of a ‘cephalic presentation’, the chances of a smooth delivery are higher. This position is where your baby’s head has positioned itself close to the birth canal, and the feet and bottom are up. This is the best position for your baby to be in for safe and healthy delivery.

Your doctor will begin to keep an eye on the position of your baby at around 34 weeks to 36 weeks . The closer you get to your due date, the more important it is that your baby takes the cephalic position. If your baby is not in this position, your doctor will try gentle nudges to get your baby in the right position.

Though it is pretty straightforward, the cephalic position actually has two types, which are explained below:

1. Cephalic Occiput Anterior

Most babies settle in this position. Out of all the babies who settle in the cephalic position, 95% of them will settle this way. This is when a baby is in the head-down position but is facing the mother’s back. This is the preferred position as the baby is able to slide out more easily than in any other position.

2. Cephalic Occiput Posterior

In this position, the baby is in the head-down position but the baby’s face is turned towards the mother’s belly. This type of cephalic presentation is not the best position for delivery as the baby’s head could get stuck owing to its wide position. Almost 5% of the babies in cephalic presentation settle into this position. Babies who come out in this position are said to come out ‘sunny side up’.

Cephalic presentation, where the baby’s head is positioned down towards the birth canal, is the most common and optimal fetal presentation for childbirth. This positioning facilitates a smoother delivery process for both the mother and the baby. Here are several benefits associated with cephalic presentation:

1. Reduced risk of complications

Cephalic presentation decreases the likelihood of complications during labor and delivery , such as umbilical cord prolapse or shoulder dystocia, which can occur with other presentations.

2. Easier vaginal delivery

With the baby’s head positioned first, vaginal delivery is generally easier and less complicated compared to other presentations, resulting in a smoother labor process for the mother.

3. Lower risk of birth injuries

Cephalic presentation reduces the risk of birth injuries to the baby, such as head trauma or brachial plexus injuries, which may occur with other presentations, particularly breech or transverse positions.

4. Faster progression of labor

Babies in cephalic presentation often help to stimulate labor progression more effectively through their positioning, potentially shortening the duration of labor and reducing the need for medical interventions.

5. Better fetal oxygenation

Cephalic presentation typically allows for optimal positioning of the baby’s head, which facilitates adequate blood flow and oxygenation, contributing to the baby’s well-being during labor and delivery.

Factors such as the cephalic posterior position of the baby and a narrow maternal pelvis can increase the likelihood of complications during childbirth. Occasionally, infants in the cephalic presentation may exhibit a backward tilt of their heads, potentially leading to preterm delivery in rare instances.

In addition to cephalic presentation, there are several other fetal positions that can occur during pregnancy and childbirth, each with its own associated risks. These positions can impact the delivery process and may require different management strategies. Here are two common fetal positions and their associated risks:

1. Breech Presentation

• Babies in breech presentation, where the buttocks or feet are positioned to enter the birth canal first, are at higher risk of birth injuries such as hip dysplasia or brachial plexus injuries.
• Breech presentation can lead to complications during labor and delivery, including umbilical cord prolapse, entrapment of the head, or difficulty delivering the shoulders, necessitating interventions such as cesarean section.

2. Transverse Lie Presentation

• Transverse lie , where the baby is positioned sideways across the uterus, often leads to prolonged labor and increases the likelihood of cesarean section due to difficulties in the baby’s descent through the birth canal.
• The transverse position of the baby may result in compression of the umbilical cord during labor, leading to decreased oxygen supply and potential fetal distress. This situation requires careful monitoring and intervention to ensure the baby’s well-being.

When a foetus is moving into the cephalic position, it is known as ‘head engagement’. The baby stars getting into this position in the third trimester, between the 32nd and the 36th weeks, to be precise. When the head engagement begins, the foetus starts moving down into the pelvic canal. At this stage, very little of the baby is felt in the abdomen, but more is felt moving downward into the pelvic canal in preparation for birth.

You may think that in order to find out if your baby has a cephalic presentation, an ultrasound is your only option. This is not always the case. You can actually find out the position of your baby just by touching and feeling their movements.

By rubbing your hand on your belly, you might be able to feel their position. If your baby is in the cephalic position, you might feel their kicks in the upper stomach. Whereas, if the baby is in the breech position, you might feel their kicks in the lower stomach.

Even in the cephalic position, it may be possible to tell if your baby is in the anterior position or in the posterior position. When your baby is in the anterior position, they may be facing your back. You may be able to feel your baby move underneath your ribs. It is likely that your belly button will also pop out.

When your baby is in the posterior position, you will usually feel your baby start to kick you in your stomach. When your baby has its back pressed up against your back, your stomach may not look rounded out, but flat instead.

Mothers whose placentas have attached in the front, something known as anterior placenta , you may not be able to feel the movements of your baby as well as you might like to.

Breech babies can make things complicated. Both the mother and the baby will face some problems. A breech baby is positioned head-up and bottom down. In order to deliver the baby, the birth canal needs to open a lot wider than it has to in the cephalic position. Besides this, your baby can get an arm or leg entangled while coming out.

If your baby is in the breech position, there are some things that you can do to encourage the baby to get into the cephalic position. There are a few exercises that could help such as pelvic tilts , swimming , spending a bit of time upside down, and belly dancing are a few ways you can try yourself to get your baby into the head-down position .

If this is not working either, your doctor will try an ECV (External Cephalic Version) . Here, your doctor will be hands-on, applying some gentle, but firm pressure to your tummy. In order to reach a cephalic position, the baby will need to be rolled into a bottom’s up position. This technique is successful around 50% of the time. When this happens, you will be able to have a normal vaginal delivery.

Though it sounds simple enough to get the fetal presentation into cephalic, there are some risks involved with ECV. If your doctor notices your baby’s heart rate starts to become problematic, the doctor will stop the procedure right away.

Encouraging a baby to move into the cephalic position, where the head is down towards the birth canal, is often desirable for smoother labor and delivery. While medical interventions may be necessary in some cases, there are natural methods that pregnant individuals can try to help facilitate this positioning. Here are several techniques that may help turn a baby into the cephalic position:

1. Optimal Maternal Positioning

Maintaining positions such as kneeling, hands and knees, or pelvic tilts may encourage the baby to move into the cephalic position by utilizing gravity and reducing pressure on the pelvis.

2. Spinning Babies Techniques

Specific exercises and positions recommended by the Spinning Babies organization, such as Forward-Leaning Inversion or the Sidelying Release, aim to promote optimal fetal positioning and may help encourage the baby to turn cephalic.

3. Chiropractic Care or Acupuncture

Some individuals find that chiropractic adjustments or acupuncture sessions with qualified practitioners can help address pelvic misalignment or relax tight muscles, potentially creating more space for the baby to maneuver into the cephalic position.

4. Prenatal Yoga and Swimming

Engaging in gentle exercises like prenatal yoga or swimming may help promote relaxation, reduce stress on the uterine ligaments, and encourage the baby to move into the cephalic position naturally. These activities also support overall physical and mental well-being during pregnancy.

1. What factors influence whether my baby will be in cephalic presentation?

Several factors can influence your baby’s position during pregnancy, including the shape and size of your uterus, the strength of your abdominal muscles, the amount of amniotic fluid, and the position of the placenta . Additionally, your baby’s own movements and preferences play a role.

2. Is it necessary for my baby to be in cephalic presentation for a vaginal delivery?

While cephalic presentation is considered the optimal position for vaginal delivery, some babies born in non-cephalic presentations can still be safely delivered vaginally with the guidance of a skilled healthcare provider. However, certain non-cephalic presentations may increase the likelihood of needing a cesarean section.

3. What can I do to encourage my baby to stay in the cephalic presentation?

Maintaining good posture, avoiding positions that encourage the baby to settle into a breech or transverse lie, staying active with gentle exercises, and avoiding excessive reclining can all help encourage your baby to remain in the cephalic presentation. Additionally, discussing any concerns with your healthcare provider and following their recommendations can be beneficial.

This was all about fetus with cephalic presentation. Most babies get into the cephalic position on their own. This is the most ideal situation as there will be little to no complications during normal vaginal labour. There are different cephalic positions, but these should not cause a lot of issues. If your baby is in any position other than cephalic in pregnancy, you may need C-Section . Keep yourself updated on the smallest of progress during your pregnancy so that you are aware of everything that is going on. Go for regular check-ups as your doctor will be able to help you if a complication arises during acephalic presentation at 20, 28 and 30 weeks.

References/Resources:

1. Glezerman. M; Planned vaginal breech delivery: current status and the need to reconsider (Expert Review of Obstetrics & Gynecology); Taylor & Francis Online; https://www.tandfonline.com/doi/full/10.1586/eog.12.2 ; January 2014

2. Feeling your baby move during pregnancy; UT Southwestern Medical Center; https://utswmed.org/medblog/fetal-movements/

3. Fetal presentation before birth; Mayo Clinic; https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-positions/art-20546850

4. Fetal Positions; Cleveland Clinic; https://my.clevelandclinic.org/health/articles/9677-fetal-positions-for-birth

5. FAQs: If Your Baby Is Breech; American College of Obstetricians and Gynecologists; https://www.acog.org/womens-health/faqs/if-your-baby-is-breech

6. Roecker. C; Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios (Journal of Chiropractic Medicine); Science Direct; https://www.sciencedirect.com/science/article/abs/pii/S1556370713000588 ; June 2013

7. Presentation and position of baby through pregnancy and at birth; Pregnancy, Birth & Baby; https://www.pregnancybirthbaby.org.au/presentation-and-position-of-baby-through-pregnancy-and-at-birth

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Cephalic Presentation Definition

Cephalic presentation is the most common type of fetal presentation, in which the baby is in a head-down position in the uterus. In this position, the baby’s head is the first part of the body to come out of the mother’s vagina. Cephalic presentation is also sometimes called vertex presentation, although the latter is only one of the different categories of the former. This fetus turning to this position happens during the last three months of pregnancy.

The process by which the fetus moves from a breech to a cephalic position is known as head engagement. This occurs when the baby’s head is able to move down into the pelvis. The chin and forehead will press against the sacrum, and the occiput will press against the back of the mother’s pubic bone.

Other Types of Cephalic Presentations

The cephalic presentation can be further classified, according to the degree of flexion of the fetal head. A presentation is considered vertex if the fetal head is well-flexed. An incomplete flexion is called a sinciput presentation, a partially deflexed head is called a brow presentation, and a completely extended head is called a face presentation.

This image shows how often the term ‘Cephalic presentation” is used in relation to other, similar birth terms:

Other Types of Fetal Presentations

There are other types of presentations , including breech presentation, shoulder presentation, and transverse presentation . Breech presentation occurs when the baby’s buttocks or feet are the first to come out of the vagina. Shoulder presentation occurs when the baby’s arm or shoulder is the first to come out of the vagina. Transverse presentation occurs when the baby is lying across the uterus, instead of head-down.

These presentations other types of presentations, but they are much less common than cephalic presentation. In fact, breech presentation occurs in only about 3 percent of births, and shoulder presentation occurs in only 1 percent of births. transverse presentation occurs in even fewer pregnancies, about 0.5 percent. Giving birth with these presentations come along with certain risks.

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External cephalic version for breech presentation at term

Affiliation.

• 1 Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
• PMID: 25828903
• PMCID: PMC6505738
• DOI: 10.1002/14651858.CD000083.pub3

Background: Management of breech presentation is controversial, particularly in regard to manipulation of the position of the fetus by external cephalic version (ECV). ECV may reduce the number of breech presentations and caesarean sections, but there also have been reports of complications with the procedure.

Objectives: The objective of this review was to assess the effects of ECV at or near term on measures of pregnancy outcome. Methods of facilitating ECV, and ECV before term are reviewed separately.

Search methods: We searched the Cochrane Pregnancy and Childbirth Trials Register (28 February 2015) and reference lists of retrieved studies.

Selection criteria: Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation.

Data collection and analysis: Two review authors assessed eligibility and trial quality, and extracted the data.

Main results: We included eight studies, with a total of 1308 women randomised. The pooled data from these studies show a statistically significant and clinically meaningful reduction in non-cephalic presentation at birth (average risk ratio (RR) 0.42, 95% confidence interval (CI) 0.29 to 0.61, eight trials, 1305 women); vaginal cephalic birth not achieved (average RR 0.46, 95% CI 0.33 to 0.62, seven trials, 1253 women, evidence graded very low); and caesarean section (average RR 0.57, 95% CI 0.40 to 0.82, eight trials, 1305 women, evidence graded very low) when ECV was attempted in comparison to no ECV attempted. There were no significant differences in the incidence of Apgar score ratings below seven at one minute (average RR 0.67, 95% CI 0.32 to 1.37, three trials, 168 infants) or five minutes (RR 0.63, 95% CI 0.29 to 1.36, five trials, 428 infants, evidence graded very low), low umbilical vein pH levels (RR 0.65, 95% CI 0.17 to 2.44, one trial, 52 infants, evidence graded very low), neonatal admission (RR 0.80, 95% CI 0.48 to 1.34, four trials, 368 infants, evidence graded very low), perinatal death (RR 0.39, 95% CI 0.09 to 1.64, eight trials, 1305 infants, evidence graded low), nor time from enrolment to delivery (mean difference -0.25 days, 95% CI -2.81 to 2.31, two trials, 256 women).All of the trials included in this review had design limitations, and the level of evidence was graded low or very low. No studies attempted to blind the intervention, and the process of random allocation was suboptimal in several studies. Three of the eight trials had serious design limitations, however excluding these studies in a sensitivity analysis for outcomes with substantial heterogeneity did not alter the results.

Authors' conclusions: Attempting cephalic version at term reduces the chance of non-cephalic presentation at birth, vaginal cephalic birth not achieved and caesarean section. There is not enough evidence from randomised trials to assess complications of ECV at term. Large observational studies suggest that complications are rare.

PubMed Disclaimer

Conflict of interest statement

GJ Hofmeyr (GJH) is an author of one of the papers included in this review (Hofmeyr 1983) but he was not involved in assessing this study for inclusion, assessing trial quality, or data extraction. GJH receives royalties from UpToDate for chapters related to breech pregnancy , delivery of a baby in breech presentation and external cephalic version . UpToDate is an electronic publication by Wolters Kluwer to disseminate evidence‐based medicine (such as Cochrane reviews).

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1.1. Analysis

Comparison 1 External cephalic version…

Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 1…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 2…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 3…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 4…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 6…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 7…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 8…

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Comparison 1 External cephalic version at term versus no ECV attempt, Outcome 10…

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Comparison 2 Sensitivity analysis (excluding studies with high risk of bias), Outcome 1…

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Comparison 3 Sensitivity analysis (excluding studies in Africa), Outcome 1 Vaginal cephalic birth…

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Comparison 3 Sensitivity analysis (excluding studies in Africa), Outcome 2 Caesarean section.

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Comparison 3 Sensitivity analysis (excluding studies in Africa), Outcome 3 Non cephalic presentation…

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Comparison 3 Sensitivity analysis (excluding studies in Africa), Outcome 4 Vaginal breech birth.

• External cephalic version for breech presentation at term. Hofmeyr GJ, Kulier R. Hofmeyr GJ, et al. Cochrane Database Syst Rev. 2012 Oct 17;10:CD000083. doi: 10.1002/14651858.CD000083.pub2. Cochrane Database Syst Rev. 2012. Update in: Cochrane Database Syst Rev. 2015 Apr 01;(4):CD000083. doi: 10.1002/14651858.CD000083.pub3. PMID: 23076883 Updated. Review.

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References to studies included in this review

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• Zhang J, Bowes WA, Fortney JA. Efficacy of external cephalic version: a review. Obstetrics & Gynecology 1993;82:306‐12. - PubMed

References to other published versions of this review

Hofmeyr 1995.

• Hofmeyr GJ. External cephalic version at term. [revised 04 October 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.

Hofmeyr 1996

• Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews 1996, Issue 1. [DOI: 10.1002/14651858.CD000083] - DOI - PubMed

Hofmeyr 2012

• Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD000083.pub2] - DOI - PubMed

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Présentation des céphalées

• Évaluation |
• Traitement |
• Aspects essentiels concernant les personnes âgées |
• Points clés |

Les céphalées sont une douleur dans une partie de la tête, y compris le crâne, le haut du cou, le visage et l’intérieur de la tête. Les céphalées sont une des raisons les plus fréquentes de consultation chez le médecin.

Les céphalées peuvent interférer avec l’activité professionnelle et l’accomplissement des activités quotidiennes. Certaines personnes présentent fréquemment des céphalées. D’autres personnes n’en ont presque jamais.

Causes des céphalées

Même si les céphalées peuvent être douloureuses et stressantes, elles ne sont que rarement indicatrices d’une pathologie sous-jacente grave. Les céphalées peuvent être divisées en deux groupes :

Les céphalées primaires : Elles ne sont pas causées par un autre trouble

Les céphalées secondaires : Causée par un autre trouble

Les céphalées primaires comprennent

Algie vasculaire de la face et autres céphalalgies autonomes du trijumeau, comme l’hémicrânie paroxystique chronique, l’hémicrânie continue et la céphalée névralgique unilatérale brève avec injection conjonctivale et larmoiement (SUNCT)

Céphalée de tension

Les céphalalgies autonomes du trijumeau sont rares.

Les céphalées secondaires peuvent être dues à des troubles du cerveau, des yeux, du nez, de la gorge, des sinus, des dents, des mâchoires, des oreilles ou du cou ou d’un trouble de l’organisme (systémique).

Causes fréquentes

Les deux causes les plus fréquentes de céphalées sont les céphalées primaires :

De tension (la plus fréquente globalement)

Causes moins fréquentes

Moins souvent, les céphalées sont dues à un trouble de céphalées primaires moins courant appelé algie vasculaire de la face ou à l’un des nombreux troubles de céphalées secondaires (voir le tableau Quelques causes et caractéristiques des céphalées ). Certains troubles de céphalées secondaires sont graves, particulièrement ceux qui impliquent le cerveau, comme la méningite , une tumeur cérébrale , ou un saignement dans le cerveau ( hémorragie intracérébrale ).

La fièvre peut provoquer des céphalées, comme de nombreuses infections qui n’impliquent pas forcément le cerveau. Ces infections comprennent la maladie de Lyme , la fièvre pourprée des montagnes Rocheuses et la grippe .

Les céphalées se produisent fréquemment lorsque les personnes arrêtent de consommer de la caféine ou arrêtent de prendre des antalgiques après les avoir utilisés pendant longtemps ( céphalées par surconsommation de médicaments ).

Contrairement à ce que la plupart des personnes pensent, la fatigue visuelle et l’hypertension artérielle (sauf pour des hypertensions artérielles extrêmes) ne provoquent généralement pas de céphalées.

Évaluation des céphalées

Les priorités des médecins sont de :

Déterminer si les céphalées ont une autre cause (c’est-à-dire, s’il s’agit de céphalées secondaires)

Identifier d’éventuels symptômes suggérant que les céphalées seraient causées par un trouble grave

Si aucune cause n’est identifiée, ils cherchent à identifier quel type de céphalées primaires est présent.

Signes avant-coureurs

Chez les personnes présentant des céphalées, certaines caractéristiques sont un sujet de préoccupation :

Les changements de sensation ou de vision, une faiblesse soudaine, une perte de coordination, des convulsions, des troubles de l’élocution ou à comprendre un discours ou des changements dans les niveaux de conscience comme la somnolence ou la confusion (suggérant un trouble cérébral)

Une fièvre et une raideur du cou qui rendent le mouvement du menton vers le thorax douloureux et parfois impossible

Des céphalées graves et soudaines (céphalées ictales)

Sensibilité de la tempe (comme lors du coiffage des cheveux) ou mâchoire douloureuse à la mastication

La présence d’un cancer ou d’un trouble qui affaiblit le système immunitaire ( déficit immunitaire ), comme le SIDA

Prise d’un médicament qui inhibe le système immunitaire (immunosuppresseur)

Symptômes affectant tout l’organisme, tels que fièvre ou perte de poids

Céphalée qui s’aggrave progressivement (en termes de fréquence ou de sévérité)

Yeux rouges et halos autour des lumières

Forte hypertension artérielle

Céphalées qui commencent après 50 ans

Quand consulter un médecin

Les personnes qui ont des signes avant-coureurs doivent consulter immédiatement un médecin. La présence d’un signe avant-coureur peut suggérer que les céphalées seraient causées par un grave trouble, comme dans les cas suivants :

Céphalées sévères avec fièvre et raideur de la nuque : Méningite , infection menaçant le pronostic vital de l’espace rempli de liquide entre les tissus qui enveloppent le cerveau et la moelle épinière (méninges)

Céphalée ictale : Hémorragie sous-arachnoïdienne (saignement dans les méninges), souvent due à une rupture d’anévrisme

Sensibilité des tempes, particulièrement chez les personnes âgées qui ont perdu du poids et ont des douleurs musculaires : Artérite à cellules géantes

Céphalées chez les personnes atteintes d’un cancer ou dont le système immunitaire est affaibli (en raison d’un trouble ou d’un médicament) : Méningite ou propagation du cancer au cerveau

Yeux rouges et halos autour des lumières : Glaucome qui, en l’absence de traitement, entraîne une perte de vision irréversible

Si une personne ne présentant aucun de ces symptômes ou caractéristiques commence à souffrir de céphalées qui sont différentes de toutes celles qu’elle a eues jusqu’ici ou si les céphalées habituelles deviennent inhabituellement intenses, elle doit appeler un médecin. Selon les autres symptômes, le médecin peut lui demander de venir pour un examen.

Que fait le médecin

Les médecins posent d’abord des questions sur les symptômes et les antécédents médicaux de la personne. Le médecin réalise ensuite un examen clinique. Les observations faites par le médecin pendant le relevé des antécédents et l’examen clinique les aiguillent souvent sur la cause de la douleur et les examens complémentaires à réaliser le cas échéant (voir le tableau Quelques causes et caractéristiques des céphalées ).

Le médecin pose des questions sur les caractéristiques des céphalées :

Quelle est leur fréquence ?

Depuis combien de temps durent-ils ?

Où se situe la douleur ?

Quel est leur degré d’intensité ?

De quel type de douleur s’agit-il (par exemple, pulsatile, diffuse ou comme un coup de poignard) ?

Y a-t-il des symptômes qui les accompagnent ?

Quelle est la durée avant qu’une céphalée soudaine atteigne son intensité maximale ?

Ce qui déclenche les céphalées (par exemple, si elles surviennent uniquement en position debout), ce qui les aggrave et ce qui les soulage

Les autres questions peuvent comprendre :

La personne a-t-elle déjà eu des céphalées auparavant ?

Les céphalées récidivent-elles et, le cas échéant, quand ont-elles commencé et à quelle fréquence se produisent-elles ?

La céphalée en cours est-elle identique ou différente des céphalées précédentes ?

Le médecin pose aussi des questions sur les facteurs de risque des céphalées. À savoir :

Si les personnes prennent ou ont arrêté de prendre certains médicaments ou certaines substances (en particulier si elles ingèrent trop de caféine ou arrêtent la caféine)

Si elles ont un trouble qui pourrait être à l’origine des céphalées

Si des membres de leur famille ont des céphalées sévères

Si elles ont eu une blessure à la tête récente

Si elles ont récemment subi une ponction lombaire

Il est possible de réfléchir à la façon de répondre aux questions précédentes et de noter les réponses avant de se rendre chez le médecin. Parfois, les médecins demandent aux personnes de remplir un questionnaire sur les céphalées qui contient la plupart des questions pertinentes. Les personnes peuvent remplir le questionnaire avant leur visite et apporter les résultats. Le fait de disposer de ces informations écrites peut permettre d’économiser du temps et faciliter l’évaluation.

Un examen clinique général est réalisé. Il se concentre sur la tête et le cou et sur le cerveau, la moelle épinière et la fonction nerveuse ( examen neurologique ). Un examen oculaire est parfois également réalisé.

La plupart des personnes n’ont pas besoin de test. Cependant, si les médecins suspectent un trouble grave, des tests sont réalisés. Pour certains troubles suspectés, des tests sont réalisés dès que possible. Dans d’autres cas, les tests pourront être réalisés dans un ou plusieurs jours.

Imagerie par résonance magnétique (IRM) et/ou angiographie par résonance magnétique (qui fournit des images détaillées des vaisseaux sanguins) ou, si l’IRM n’est pas disponible ou contre-indiquée, une tomodensitométrie (TDM) est réalisée dès que possible si les personnes présentent :

Une céphalée ictale

Des changements dans les niveaux de conscience, comme une somnolence ou une confusion

Un gonflement du nerf optique ( œdème papillaire ), détecté par un examen de l’œil avec un ophtalmoscope

Des symptômes qui suggèrent une réponse généralisée grave à une infection ( septicémie ), comme un certain type d’éruption cutanée ou un choc

Des symptômes qui évoquent un trouble cérébral, comme des changements dans la sensation ou la vision (notamment vision double), une faiblesse soudaine, une perte de coordination, des convulsions ou des difficultés à parler ou à comprendre un discours

Un traumatisme crânien qui provoque des céphalées et une perte de connaissance

Si les personnes présentent une céphalée ictale, une angiographie par résonance magnétique (ou une TDM) est immédiatement réalisée.

Une IRM est réalisée dans un délai d’un jour environ si la personne présente certaines affections, telles que :

Système immunitaire affaibli (en raison d’une maladie telle que le SIDA ou d’un médicament)

Une IRM ou une TDM (si l’IRM n’est pas disponible ou est contre-indiquée) est réalisée dans les quelques jours qui suivent si la personne présente d’autres caractéristiques, telles que :

Vision double

Une nouvelle céphalée qui s’aggrave lorsque la personne se réveille le matin ou qui réveille la personne pendant son sommeil

Une augmentation de la fréquence, de la durée ou de l’intensité des céphalées chroniques

Une ponction lombaire est généralement réalisée dans les cas suivants :

Une méningite ou une encéphalite aiguë (infection du cerveau) est suspectée.

Les personnes présentent une céphalée ictale (évoquant une hémorragie sous-arachnoïdienne ), même lorsque les résultats de la TDM, de l’IRM ou des autres examens d’imagerie sont normaux.

Les personnes ont un système immunitaire affaibli.

Les céphalées s’aggravent et/ou les médecins suspectent une hypertension intracrânienne idiopathique ou une méningite chronique .

Généralement, les médecins réalisent une TDM ou une IRM avant la ponction lombaire s’ils pensent que la pression intracrânienne peut augmenter, par exemple en raison d’une masse (comme une tumeur, un abcès ou un hématome). La ponction lombaire peut être dangereuse si la pression intracrânienne est augmentée. Lorsque le liquide rachidien est retiré et que la pression intracrânienne est augmentée, des parties du cerveau peuvent brusquement se déplacer vers le bas. Si ces parties sont comprimées à l’intérieur des interstices qui séparent le cerveau en compartiments, peut apparaître un trouble menaçant le pronostic vital appelé engagement cérébral .

D’autres tests sont réalisés dans les heures ou les jours qui suivent, selon les résultats de l’examen et les causes suspectées.

Quelques causes et caractéristiques des céphalées

Traitement des céphalées

Le traitement la céphalée dépend de la cause.

Si la céphalée est une céphalée de tension ou si elle accompagne une infection virale mineure, les personnes peuvent prendre du paracétamol ou des anti-inflammatoires non stéroïdiens (AINS) pour soulager la douleur.

Aspects essentiels concernant les personnes âgées : Céphalées

Si les céphalées commencent après 50 ans, les médecins supposent en général qu’elles résultent d’un autre trouble jusqu’à preuve du contraire. De nombreux troubles à l’origine de céphalées, comme l’artérite à cellules géantes, les tumeurs cérébrales ou les hématomes sous-duraux (qui peuvent résulter de chutes) sont plus fréquents chez les personnes âgées.

Le traitement des céphalées peut être limité chez les personnes âgées. Les personnes âgées sont plus susceptibles de présenter des troubles qui les empêchent de prendre des médicaments utilisés pour traiter la migraine et des algies vasculaires de la face (triptans et dihydroergotamine ; voir le tableau Quelques médicaments utilisés pour traiter les migraines ). Ces troubles comprennent : angine, maladie coronarienne et hypertension non contrôlée.

Si les personnes âgées doivent prendre des médicaments pour traiter les céphalées qui peuvent les rendre somnolentes, elles doivent être étroitement surveillées.

Points clés

La plupart des céphalées n’ont pas de cause grave, particulièrement si les céphalées commencent à un jeune âge, si elles n’ont pas changé dans le temps et si les résultats de l’examen sont normaux.  

Si des céphalées surviennent fréquemment ou si des signes avant-coureurs sont présents, les personnes doivent consulter un médecin.  

La plupart des céphalées ne nécessitent pas d’examen. 

Les médecins peuvent en général déterminer le type ou la cause des céphalées d’après les antécédents médicaux, les symptômes et les résultats d’un examen clinique.

Si les médecins suspectent que la cause est un trouble grave (comme une hémorragie ou une infection), une IRM est généralement réalisée, souvent de manière immédiate.  

Si les médecins suspectent une méningite, une encéphalite ou une hémorragie sous-arachnoïdienne, une ponction lombaire est réalisée, généralement après une TDM ou une IRM effectuée pour exclure des anomalies qui augmentent la pression intracrânienne.

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Definition of cephalic

Examples of cephalic in a sentence.

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'cephalic.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

Middle French céphalique , from Latin cephalicus , from Greek kephalikos , from kephalē head; akin to Old High German gebal skull, Old Norse gafl gable, Tocharian A śpāl head

1571, in the meaning defined at sense 1

Phrases Containing cephalic

cephalic index

Dictionary Entries Near cephalic

Cite this entry.

“Cephalic.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/cephalic. Accessed 20 Aug. 2024.

Medical Definition

Medical definition of cephalic.

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Phrases avec le mot céphalique, dictionnaire universel de furetière (1690), définition ancienne de cephalique adj. m. & f..

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Présentation du siège. Recommandations pour la pratique clinique du CNGOF – Épidémiologie, facteurs de risque et complications - 02/01/20

Breech presentation: cngof guidelines for clinical practice – epidemiology, risk factors and complications.

Bienvenue sur EM-consulte, la référence des professionnels de santé. Article gratuit. Connectez-vous pour en bénéficier!

Étudier la fréquence, les facteurs associés et les modalités d’accouchement de la présentation du siège. Analyser la morbi-mortalité périnatale de la présentation du siège en comparaison à la présentation céphalique toutes voies d’accouchement confondues.

Recherche bibliographique en langue française et anglaise à partir des bases de données Medline et Cochrane entre 1980 et 2019 et à partir des recommandations de sociétés savantes internationales.

Il existe trois modes de présentation du siège en fonction de la position des membres inférieurs du fœtus : décomplété dans 2/3 des cas, complet dans 1/3 des cas ou, plus rarement, semi-décomplété (NP3). Environ 5 % des femmes accouchent d’un enfant en présentation du siège en France (NP3). La fréquence de la présentation du siège diminuant avec l’avancement de l’âge gestationnel, cette incidence est moins importante après 37 SA et ne représente plus que 3 % des accouchements à terme (NP3). La présence d’une malformation utérine congénitale (NP3) ou de myomes (NP3), l’oligoamnios (NP3), la prématurité (NP3), la présence de certaines malformations congénitales chez le fœtus (NP3) et le petit poids pour l’âge gestationnel (NP3) sont les principaux facteurs retrouvés dans la littérature comme associés à la présentation du siège. En France, une tentative de voie basse est réalisée pour un tiers des femmes avec un fœtus en présentation du siège à terme (NP3) avec un taux de succès de 70 % (NP3). Le mode de présentation du siège (complet ou décomplété) ne semble pas modifier l’issue néonatale en cas de tentative de voie basse à partir de 37 SA (NP3). La morbi-mortalité périnatale après 37 SA en cas de présentation par le siège semble plus importante qu’en cas de présentation céphalique, toutes voies d’accouchement confondues (NP3). Le risque de lésions traumatiques en cas d’accouchement par le siège est estimé à moins de 1 % (NP3). Les lésions les plus fréquemment retrouvées sont les fractures de la clavicule, les hématomes ou contusions et les lésions du plexus brachial (NP3). La présentation par le siège est associée à une augmentation du risque de dysplasie des hanches (NP3), et la césarienne ne semble pas en être un facteur protecteur (NP3). La présentation du siège ne semble pas être associée à une augmentation du risque de paralysie cérébrale en comparaison à la présentation céphalique lorsque les fœtus atteints de malformation congénitale sont exclus (NP3).

Le mode d’accouchement de la présentation du siège dans le monde a profondément été modifié après la publication du Term Breech Trial . Il existe des facteurs intrinsèques associés à la présentation du siège, qu’il ne faut pas méconnaître pour interpréter le surcroît de morbi-mortalité périnatale observé en cas de présentation du siège.

To study the frequency, the risk factors and the mode of delivery of breech presentation. To analyze the perinatal morbidity and mortality associated with breech presentation in comparison to cephalic presentation from all mode of delivery.

MedLine and Cochrane Library databases search in French and English and review of the main foreign guidelines between 1980 and 2019.

Three modes of breech presentation exist according to fetal lower limbs position: frank in 2/3 of cases, complete in 1/3 of cases or, more rarely, incomplete (LE3). About 5% of women gave birth in breech presentation in France (LE3). As the frequency of breech presentation decreases with increasing gestational age, this incidence is lower after 37 WG and represents only 3% of term deliveries (LE3). Congenital uterine malformation (LE3) and fibroma (LE3), prematurity (LE3), oligoamnios (LE3), some fetal congenital malformations (LE3) and low birthweight for gestational age (LE3) are the main risk factors with breech presentation. In France, one-third of women with a term fetus in breech presentation attempt a vaginal delivery (LE3), which is successful in 70% of cases (LE3). Neonatal outcome is not associated with type of breech presentation (frank or complete) in case of vaginal delivery attempt after 37 WG (LE3). Overall, perinatal morbidity and mortality after 37 WG of breech presentation appear to be greater than in cephalic presentation from all mode of delivery (LE3). The risk of traumatic injury in breech delivery is estimated under 1% (LE3). The most common injuries are collarbone fractures, hematomas or contusions, and brachial plexus injury (LE3). Breech presentation is associated with an increased risk of hip dysplasia (LE3) and cesarean delivery does not seem to be a protective factor (LE3). Breech presentation does not appear to be associated with an increased risk of cerebral palsy compared to cephalic presentation after exclusion of fetuses with congenital malformations (LE3).

Worldwide, mode of delivery of breech presentation has undergone profound changes since the publication of the TBT (Term Breech Trial). There are intrinsic factors associated with breech presentation, which should not be overlooked when interpreting the increased perinatal morbidity and mortality observed in case of breech presentation.

Mots clés :  Recommandations, Siège, Épidémiologie, Facteurs associés, Morbi-mortalité périnatale

Keywords :  Guidelines, Breech, Epidemiology, Risk factors, Perinatal morbidity and mortality

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Vol 48 - N° 1

• Présentation du siège. Recommandations pour la pratique clinique du CNGOF – Texte court
• L. Sentilhes, T. Schmitz, E. Azria, D. Gallot, G. Ducarme, D. Korb, A. Mattuizzi, O. Parant, N. Sananès, S. Baumann, P. Rozenberg, M.-V. Senat, É. Verspyck

• Présentation du siège. Recommandations pour la pratique clinique du CNGOF — Version par manœuvre externe et techniques de version alternatives

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Definition of cephalic adjective from the Oxford Advanced Learner's Dictionary

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8: Présentations de la face, du front, du bregma et de l’épaule

Chapitre 8 Présentations de la face, du front, du bregma et de l’épaule J. Lansac, F. Perrotin Objectifs L’interne ou la sage-femme doivent être capables : de faire le diagnostic de présentation de la face, du front, du bregma ou de l’épaule et d’en préciser la variété ; d’expliquer les phénomènes mécaniques caractéristiques de chaque présentation ; d’expliquer le retentissement de chacune de ces présentations sur la dynamique utérine, sur le fœtus et sur le périnée ; de proposer une conduite à tenir en fonction de la nature de la présentation et des anomalies observées pendant la dilatation ou l’expulsion. À l’inverse des présentations du sommet dans lesquelles la tête est bien fléchie sur le tronc, les présentations de la face, du front et du bregma sont des présentations défléchies (seuls les diamètres sagittaux changent) ( planche 8.1 ) : • soit partiellement : bregma (1 er tiers de la déflexion) et front (2 e tiers) ; • soit totalement : face (3 e tiers). PLANCHE 8.1 LES DIFFÉRENTES PRÉSENTATIONS CÉPHALIQUES a. Coupe sagittale. b. Coupe transversale. Types de présentation céphalique en fonction de la déflexion de la tête Position de la tête Diamètre d’engagement Accouchement Sommet Eutocie : voie basse. Sommet mal fléchi Dystocie ± : voie basse. BREGMA Dystocie + : voie base ou césarienne. Front Dystocie +++ : césarienne. FACE Eutocie (si menton antérieur) : voie basse. Dystocie (si menton postérieur) : césarienne. Types de présentation céphalique et leurs points de repères Diamètre d’engagement Point de repère Ce que l’on sent Ce que l’on ne sent pas Dimensions Sommet très fléchi La fontanelle postérieure au centre du pelvis, la suture sagittale La fontanelle antérieure Sommet mal fléchi (variété antérieure) La fontanelle postérieure en périphérie, la suture sagittale, la grande fontanelle Les orbites, le nez Bregma La grande fontanelle au centre du pelvis, la racine du nez La petite fontanelle, la pyramide nasale Front Les orbites, le nez, la grande fontanelle Le menton, la petite fontanelle FACE Les orbites, le front, le nez, la bouche, le menton La grande fontanelle antérieure Diamètres d’engagement Pronostic des types de présentation céphalique Elles sont la conséquence d’une mauvaise accommodation fœto-pelvienne, du fait : • d’un bassin anormal (bassin aplati), d’un utérus atone (grandes multipares) ou surdistendu (hydramnios) ; • d’un placenta ou d’un obstacle praevia (fibrome), d’un circulaire du cordon ; • d’une malformation fœtale, en particulier de la région cervicale (goitre, kyste branchial, tératome), de la charnière cervico-occipitale ou rarement d’une anencéphalie non diagnostiquée en prénatal. On ne saurait trop répéter l’importance de leur diagnostic précoce au cours du travail : les présentations de la face et du bregma autorisent le plus souvent l’accouchement par voie basse, alors que celle du front (sauf situations exceptionnelles) conduit obligatoirement à la césarienne, comme la présentation de l’épaule [ 11 ]. La pratique montre que le diagnostic de présentation céphalique défléchie est le plus souvent tardif au cours du travail, parfois posé seulement à dilatation complète. Une certaine expectative peut être utile au cours du travail, dans la mesure où, par exemple, certaines formes transitoires de bregma peuvent évoluer par flexion vers un sommet. Toutefois, cette expectative n’est envisageable qu’en tout début de travail, si la confrontation céphalo-pelvienne est favorable et tant que la présentation n’est pas fixée. La prudence veut qu’elle ne soit pas prolongée au-delà de deux heures en l’absence d’évolution favorable sous ocytociques. Présentation du front Rare (environ 1/1 000), elle a été décrite par Lacomme comme une « présentation où la déflexion partielle du pôle céphalique fixe de façon définitive et fait pénétrer dans le détroit supérieur une partie plus ou moins voisine du front ». Présentation hautement dystocique, son diagnostic doit être aussi précoce que possible, permettant de poser l’indication d’une césarienne qui évite les complications fœto-maternelles que ne manqueraient pas d’entraîner une tentative de voie basse. Mécanique obstétricale Deux situations doivent être bien séparées. Accouchement à terme d’un enfant de poids normal La tête, initialement haute et en position indifférente, se défléchit au lieu de se fléchir, évoluant vers une présentation du front. Fixée dans cette position, elle présente au détroit supérieur (DS) son plus grand diamètre sagittal, allant du synciput (point le plus saillant de l’occiput), à la pointe du menton, c’est-à-dire le diamètre syncipito-mentionnier (environ 13,5 cm), supérieur aux plus grands diamètres du bassin (les diamètres obliques et transverses n’excèdent pas 12,5 à 13 cm) ( voir figure 8.1 et planche 8.1 ). Fig. 8.1 Présentation du front en naso-iliaque gauche transverse. a. Coupe transversale. b. Vue périnéale. L’engagement est en conséquence impossible ; toutefois, quelques très rares cas d’accouchement par voie basse ont été rapportés avec des enfants de poids normal : cela n’est possible qu’avec un bassin exceptionnellement grand , comportant un diamètre antéro-postérieur supérieur à 12,5 cm ; une application de forceps est en principe alors nécessaire, dans les cas exceptionnels où la tête fœtale, ayant terminé sa descente, est arrivée au détroit inférieur (DI) en naso-antérieure. Il s’agit toutefois d’une situation périlleuse demandant une grande expérience obstétricale et à laquelle on s’attachera de ne pas aboutir (front négligé). Accouchement d’un enfant prématuré et/ou de petit poids (jumeau) Cette possibilité représente une situation exceptionnelle chez un enfant de moins de 2 000 g. Si l’accouchement par voie basse est possible, il ne faut jamais oublier qu’il s’agit d’un accouchement difficile, se produisant en force et nécessitant, lorsqu’il a été accepté, une surveillance attentive. Ces différents temps sont représentés sur la figure 8.2 . Fig. 8.2 Accouchement en présentation du front. 1. Engagement : – diamètre transverse ou oblique ; – déformations plastiques importantes de la tête. 2. Descente-rotation : – diamètre antéro-postérieur ; – tête en position naso-pubienne (le fœtus mord la symphyse pubienne). 3. Dégagement : – diamètre antéro-postérieur ; – maxillaire supérieur contre la symphyse pubienne ; – dégagement en « S » (flexion – F – puis déflexion – D). Engagement La tête s’engage dans un diamètre transverse ou oblique ; elle doit s’amoindrir avec, en particulier, un chevauchement des os du crâne. L’apparition précoce d’une bosse séro-sanguine est fréquente. Le front plonge dans l’excavation alors que l’occiput s’allonge vers le dos. Descente et rotation Elles sont lentes et difficiles, et amènent la tête en position naso-pubienne. La face est derrière la symphyse pubienne, maxillaire supérieur contre son bord inférieur, l’occiput se logeant dans la concavité sacrée. L’axe de la tête vient se superposer à l’axe antéro-postérieur du DI ; le fœtus « mord » la symphyse pubienne. Dégagement Il s’effectue autour du pivot formé par la symphyse pubienne et le maxillaire supérieur, réalisant un mouvement en « S » avec, successivement : • flexion de la tête : apparition à la vulve de la partie de la tête fœtale allant du nez au sous-occiput ; • puis déflexion : le sous-occiput s’appuyant sur la fourchette vulvaire, la tête se défléchit pour dégager la bouche et le menton. Lors du dégagement de l’occiput, l’ampliation périnéale est importante et les indications de l’épisiotomie sont très larges. La suite de l’accouchement est sans particularité.

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• CSRD – Your questions answered?

European Commission releases FAQs relating to the CSRD

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Global IFRS Institute

Why has the European Commission released these FAQs?

What do you need to know?

What’s next – Key actions for companies

To support companies in scope of the Corporate Sustainability Reporting Directive (CSRD), the European Commission (EC) has issued 90 frequently asked questions covering:

• which companies are in scope of the CSRD;
• details around the assurance of CSRD disclosures; and
• practical arrangements for publishing CSRD disclosures.

Companies need clarity to navigate the complexity of the CSRD. The EC’s FAQs are helpful, but we expect more questions to arise as companies continue their implementation journey.

Mark Vaessen Partner Global Head of Corporate & Sustainability Reporting

The EC is responsible for developing the CSRD and its ongoing maintenance. It asked the European Financial Reporting Advisory Group (EFRAG) to develop European Sustainability Reporting Standards (ESRSs) on its behalf.

The EC has released these FAQs to clarify the content already included in the CSRD. The FAQs provide guidance – without expanding the requirements – to help companies and their stakeholders to apply the requirements. They complement the implementation guidance and FAQ s published by EFRAG on ESRSs.

The guidance summarises the requirements in the CSRD for scoping and timing of reporting by individual companies, consolidated groups and ultimate non-EU parent companies.

When and to whom will the CSRD apply?

The CSRD applies for years beginning on or after 1 January 2024 (reporting in 2025). Phased introduction starts with Public Interest Entities (PIEs) and companies with listed securities on EU-regulated markets that are large and have more than 500 employees (e.g. those already subject to reporting requirements under the Non-Financial Reporting Directive).

Ultimately, ESRSs will be applied by companies, such as:

• large EU companies 1
• most companies with listed securities on EU-regulated markets (irrespective of whether they are based in the EU 2 ); and
• ultimate non-EU parent companies 4 with a combined group level turnover in the EU of more than EUR 150 million for each of the last two consecutive financial years.  

The FAQs provide detailed guidance on the practicalities for assurance including:

• who can provide assurance and the structure of the assurance report;
• how EU non-audit service restrictions are impacted; and
• that a combination of reasonable and limited assurance is permitted.

The FAQs confirm that companies which  voluntarily comply with the CSRD are not required to obtain an assurance conclusion.

Assurance practitioners are required to express a limited assurance conclusion on whether:

• the requirement to digitally tag the information; and
• the requirement to provide disclosures under the EU Taxonomy Regulation 5 ; and
• the outcome of the process has resulted in the disclosure of all material sustainability-related impacts, risks and opportunities in accordance with ESRSs.

The European Securities and Markets Authority highlight  that companies need to have robust governance, processes and controls over their sustainability reporting.

Practicalities

The FAQs confirm practical details about

• the language, location and timing of publication, including when the ‘reporting entity’ does not publish a management report or financial statements;
• digital tagging requirements;
• interaction with the EU Taxonomy Regulation, including for non-EU parent undertakings;
• what constitutes ‘reasonable effort’ in obtaining information from the value chain before relying on using estimates; and
• when standards for SMEs can be used.
• Read the FAQs to see if they answer your key questions.
• Track the transposition of the CSRD into legislation in the countries where you may be in scope. This will help you to understand if there are country-specific issues to consider.
• Discuss the assurance requirements with your assurance provider to make sure you are ready.
• See our ESRS Sustainability reporting page for information about implementing ESRSs.

1 Large companies are those that, on the balance sheet date, exceed two of the following three criteria (including EU and non-EU subsidiaries): 250 employees, net revenue of EUR 50m (formerly EUR 40m) or total assets of EUR 25m (formerly EUR 20m). The new thresholds take effect from FY 2024. EU member states can choose to adopt them early from FY 2023.

2 Exemptions apply, for example, for micro-undertakings (companies that do not exceed two of the following three criteria (including EU and non-EU subsidiaries): 10 employees, net revenue of EUR 900,000 (formerly EUR 700,000) or total assets of EUR 450,000 (formerly EUR 350,000) and for certain debt listings. The new thresholds take effect from FY 2024. EU member states can choose to adopt them early from FY 2023.

3 Separate standards will be developed for SMEs and non-EU parent companies.

4 Small and non-complex institutions and captive insurers are treated like listed SMEs (the option to opt out until 2028 does not apply unless they also meet the definition of an SME).

5  Regulation (EU) 2020/852 (EU Taxonomy Regulation) is the EU’s framework to facilitate sustainable investment.

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