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- Fetal presentation before birth
The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.
Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.
Following are some of the possible ways a baby may be positioned at the end of pregnancy.
Head down, face down
When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.
Head down, face up
When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.
Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.
In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.
Frank breech
When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.
If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.
If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.
Complete and incomplete breech
A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.
If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.
If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.
When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:
- Down, with the back facing the birth canal.
- Sideways, with one shoulder pointing toward the birth canal.
- Up, with the hands and feet facing the birth canal.
Although many babies are sideways early in pregnancy, few stay this way when labor begins.
If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.
If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.
If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.
Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.
Your health care team may suggest delivery by C-section for the second twin if:
- An attempt to deliver the baby in the breech position is not successful.
- You do not want to try to have the baby delivered vaginally in the breech position.
- An attempt to move the baby into a head-down position is not successful.
- You do not want to try to move the baby to a head-down position.
In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.
- Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
- Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
- Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
- Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
- Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
- Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
- Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
- Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.
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Fetal Presentation, Position, and Lie (Including Breech Presentation)
- Variations in Fetal Position and Presentation |
During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.
Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.
Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).
Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).
For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:
Head first (called vertex or cephalic presentation)
Facing backward (occiput anterior position)
Spine parallel to mother's spine (longitudinal lie)
Neck bent forward with chin tucked
Arms folded across the chest
If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.
Variations in fetal presentation, position, or lie may occur when
The fetus is too large for the mother's pelvis (fetopelvic disproportion).
The uterus is abnormally shaped or contains growths such as fibroids .
The fetus has a birth defect .
There is more than one fetus (multiple gestation).
Position and Presentation of the Fetus
Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed. Variations in fetal presentations include face, brow, breech, and shoulder. Occiput posterior position (facing forward, toward the mother's pubic bone) is less common than occiput anterior position (facing backward, toward the mother's spine). |
Variations in Fetal Position and Presentation
Some variations in position and presentation that make delivery difficult occur frequently.
Occiput posterior position
In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).
When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.
Breech presentation
In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).
When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.
The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.
In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.
Breech presentation is more likely to occur in the following circumstances:
Labor starts too soon (preterm labor).
The uterus is abnormally shaped or contains abnormal growths such as fibroids .
Other presentations
In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.
In brow presentation, the neck is moderately arched so that the brow presents first.
Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor. If they do not, a cesarean delivery is usually recommended.
In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.
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Pregnancy maternity notes: understanding them
Read time 5 minutes
If you’re feeling a bit confused by it all, here’s what you might want to know about your notes
What are your maternity notes or maternity notes folder?
Maternity notes, or handheld notes, are a record book/folder where your midwife will note down details of each appointment. They’re a standardised, national maternity record and you’ll need to take them with you to each antenatal appointment.
When to take them with you
Take your maternity notes wherever you go (within reason…) including on holidays, in case you need medical attention when you’re away from home. It might not be easy to understand everything in your notes, so it’s a good idea to ask your maternity team to explain anything you’re unsure about.
What’s in your maternity (handheld) notes
Your maternity notes contain the following information:
- Your name, address and hospital number and details.
- Your medical history including any disease you are currently suffering from and medications you are taking.
- Your family medical history, for example if any of your family members suffered from medical conditions like diabetes, blood pressure etc.
- Information about previous pregnancies and births.
- Your appointment times.
- Results of blood tests and investigations including ultrasound scans.
- Phone numbers for your midwife, birth suite and hospital etc.
- Information collected by your midwife during antenatal checks. This includes your blood pressure, urine tests, vaccines taken, foetal movements and foetal heart. It also includes the way your baby is lying in the womb and engagement – how deep the baby’s head is below the brim of the pelvis.
- Assessment of the baby’s growth inside the womb.
- Any problems encountered during pregnancy.
- Preferences for birth, eg where you would like to give birth, who’ll be your birth partner, what pain relief methods you would like.
- When your labour started and how it progressed. This will include foetal heart monitoring, your posture during labour and delivery, what type of birth you had and how the placenta was delivered.
Pamphlets and extra information
As well as all the above information about you, you may be given:
- Phone numbers for charities that work with parents and babies.
- Pamphlets on topics you might find interesting, eg breastfeeding, eating well when you’re pregnant.
- Advice on issues during pregnancy.
Meaning of abbreviations used in maternity notes
Urine test results (for presence of protein or sugar)
NAD: nothing abnormal detected
Nil: none found
Tr (trace): small amount of sugar or protein found
+ , ++ , +++: presence of greater amount or protein
Heartbeat or activity
FHH: foetal heart heard
FHHR: foetal heart heard and regular
FHNH: foetal heart not heard
FMF: foetal movements felt
Position of your baby – the way it is lying in the womb
L: longitudinal (length-wise)
O: oblique (slanting)
T: transverse (sideways)
Which part it presents towards the birth canal
C: cephalic (head first – also called as vertex)
B or Br: bottom first or breech
OA: occiput anterior (head down, facing your back)
OP: occiput posterior (head down, facing your front)
OL: occiput lateral (head down, facing your side)
L or R in front of these tell you which side of your body your baby is.
Engagement of baby’s head in the pelvis
NE, NEng, Not Eng: not engaged
E or Eng = engaged
4/5 = sitting on the pelvic brim
3/5 = lower but most still above the brim
2/5 = engaged, as most is below the brim
1/5 or 0/5 = deeply engaged.
If it’s your first baby, engagement tends to happen in the last weeks. In subsequent pregnancies, it may happen later or even not until labour has started.
This page was last reviewed in May 2018.
Further information.
Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.
We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.
Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
Information you can trust from NCT
When it comes to content, our aim is simple: every parent should have access to information they can trust.
All of our articles have been thoroughly researched and are based on the latest evidence from reputable and robust sources. We create our articles with NCT antenatal teachers, postnatal leaders and breastfeeding counsellors, as well as academics and representatives from relevant organisations and charities.
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Physiology of Pregnancy,Parturition,and Lactation
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- Mammary Glands
- Fallopian Tubes
- Supporting Ligaments
- Reproductive System
- Gametogenesis
- Placental Development
- Maternal Adaptations
- Menstrual Cycle
- Antenatal Care
- Small for Gestational Age
- Large for Gestational Age
- RBC Isoimmunisation
- Prematurity
- Prolonged Pregnancy
- Multiple Pregnancy
- Miscarriage
- Recurrent Miscarriage
- Ectopic Pregnancy
- Hyperemesis Gravidarum
- Gestational Trophoblastic Disease
- Breech Presentation
- Abnormal lie, Malpresentation and Malposition
- Oligohydramnios
- Polyhydramnios
- Placenta Praevia
- Placental Abruption
- Pre-Eclampsia
- Gestational Diabetes
- Headaches in Pregnancy
- Haematological
- Obstetric Cholestasis
- Thyroid Disease in Pregnancy
- Epilepsy in Pregnancy
- Induction of Labour
- Operative Vaginal Delivery
- Prelabour Rupture of Membranes
- Caesarean Section
- Shoulder Dystocia
- Cord Prolapse
- Uterine Rupture
- Amniotic Fluid Embolism
- Primary PPH
- Secondary PPH
- Psychiatric Disease
- Postpartum Contraception
- Breastfeeding Problems
- Primary Dysmenorrhoea
- Amenorrhoea and Oligomenorrhoea
- Heavy Menstrual Bleeding
- Endometriosis
- Endometrial Cancer
- Adenomyosis
- Cervical Polyps
- Cervical Ectropion
- Cervical Intraepithelial Neoplasia + Cervical Screening
- Cervical Cancer
- Polycystic Ovary Syndrome (PCOS)
- Ovarian Cysts & Tumours
- Urinary Incontinence
- Genitourinary Prolapses
- Bartholin's Cyst
- Lichen Sclerosus
- Vulval Carcinoma
- Introduction to Infertility
- Female Factor Infertility
- Male Factor Infertility
- Female Genital Mutilation
- Barrier Contraception
- Combined Hormonal
- Progesterone Only Hormonal
- Intrauterine System & Device
- Emergency Contraception
- Pelvic Inflammatory Disease
- Genital Warts
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- Obstetric History
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Abnormal Fetal lie, Malpresentation and Malposition
Original Author(s): Anna Mcclune Last updated: 1st December 2018 Revisions: 12
- 1 Definitions
- 2 Risk Factors
- 3.2 Presentation
- 3.3 Position
- 4 Investigations
- 5.1 Abnormal Fetal Lie
- 5.2 Malpresentation
- 5.3 Malposition
The lie, presentation and position of a fetus are important during labour and delivery.
In this article, we will look at the risk factors, examination and management of abnormal fetal lie, malpresentation and malposition.
Definitions
- Longitudinal, transverse or oblique
- Cephalic vertex presentation is the most common and is considered the safest
- Other presentations include breech, shoulder, face and brow
- Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) – this is ideal for birth
- Other positions include occipito-posterior and occipito-transverse.
Note: Breech presentation is the most common malpresentation, and is covered in detail here .
Fig 1 – The two most common fetal presentations: cephalic and breech.
Risk Factors
The risk factors for abnormal fetal lie, malpresentation and malposition include:
- Multiple pregnancy
- Uterine abnormalities (e.g fibroids, partial septate uterus)
- Fetal abnormalities
- Placenta praevia
- Primiparity
Identifying Fetal Lie, Presentation and Position
The fetal lie and presentation can usually be identified via abdominal examination. The fetal position is ascertained by vaginal examination.
For more information on the obstetric examination, see here .
- Face the patient’s head
- Place your hands on either side of the uterus and gently apply pressure; one side will feel fuller and firmer – this is the back, and fetal limbs may feel ‘knobbly’ on the opposite side
Presentation
- Palpate the lower uterus (above the symphysis pubis) with the fingers of both hands; the head feels hard and round (cephalic) and the bottom feels soft and triangular (breech)
- You may be able to gently push the fetal head from side to side
The fetal lie and presentation may not be possible to identify if the mother has a high BMI, if she has not emptied her bladder, if the fetus is small or if there is polyhydramnios .
During labour, vaginal examination is used to assess the position of the fetal head (in a cephalic vertex presentation). The landmarks of the fetal head, including the anterior and posterior fontanelles, indicate the position.
Fig 2 – Assessing fetal lie and presentation.
Investigations
Any suspected abnormal fetal lie or malpresentation should be confirmed by an ultrasound scan . This could also demonstrate predisposing uterine or fetal abnormalities.
Abnormal Fetal Lie
If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted – ideally between 36 and 38 weeks gestation.
ECV is the manipulation of the fetus to a cephalic presentation through the maternal abdomen.
It has an approximate success rate of 50% in primiparous women and 60% in multiparous women. Only 8% of breech presentations will spontaneously revert to cephalic in primiparous women over 36 weeks gestation.
Complications of ECV are rare but include fetal distress , premature rupture of membranes, antepartum haemorrhage (APH) and placental abruption. The risk of an emergency caesarean section (C-section) within 24 hours is around 1 in 200.
ECV is contraindicated in women with a recent APH, ruptured membranes, uterine abnormalities or a previous C-section .
Fig 3 – External cephalic version.
Malpresentation
The management of malpresentation is dependent on the presentation.
- Breech – attempt ECV before labour, vaginal breech delivery or C-section
- Brow – a C-section is necessary
- If the chin is anterior (mento-anterior) a normal labour is possible; however, it is likely to be prolonged and there is an increased risk of a C-section being required
- If the chin is posterior (mento-posterior) then a C-section is necessary
- Shoulder – a C-section is necessary
Malposition
90% of malpositions spontaneously rotate to occipito-anterior as labour progresses. If the fetal head does not rotate, rotation and operative vaginal delivery can be attempted. Alternatively a C-section can be performed.
- Usually the fetal head engages in the occipito-anterior position (the fetal occiput facing anteriorly) - this is ideal for birth
If the fetal lie is abnormal, an external cephalic version (ECV) can be attempted - ideally between 36 and 38 weeks gestation.
- Breech - attempt ECV before labour, vaginal breech delivery or C-section
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My Pregnancy NotesClose patient notes. You will need to re-enter the Access Token if you wish to view the record again. Forgotten Password? Access TokenIf you have been provided with an access token , you will need to sign in or register as a Healthcare Professional to use this. If you are experiencing technical difficulties or have any feedback on the site, please Contact Us . Use of this website is subject to Terms and Conditions . Please read the Privacy & Cookie Policy to learn how we protect your data. MyPregnancyNotes (6.0.24075.1) is part of the K2 Athena ™ suite, developed by K2 Medical Systems . © 2024 K2 Medical Systems Ltd. Terms and ConditionsTerms of Service 1. Welcome to My Pregnancy Notes/K2 Hampton (the Service), a service operated by K2 Medical Systems Limited ( Us or We ), a company registered in England and Wales with Registered Number 03809089 , on behalf of NHS Trusts and other health care providers who may be responsible for providing healthcare services at a national or local level (the Healthcare Providers). 2. Your use of the Service is governed by these terms. 3. In these terms, we will use the following phrases: • Clinician is a collective term for antenatal healthcare professionals including for example midwives and GPs; • MCP(s) means "Maternity Care Providers" which is a collective term for the facilities and locations in which Clinicians are based such as hospitals and birth centres; • Personal Data means any information that relates to you as an individual person; • Pre-Booking Stage describes the use of the Service to book you into the care of a specific MCP where certain information is collected by the Healthcare Providers and must be provided you; • Sharing Page means your use of the Service where you can choose to share your Personal Data with your MCP after the Pre-Booking Stage. Service Restrictions 4. You may only use the Service if you reside in the United Kingdom. The Service does not provide medical advice or treatment 5. The Service acts as a tool to book you into the care of an MCP during the Pre-Booking Stage and you can then use the Service to share information about your pregnancy with your MCP or use the Service for your own note-keeping purposes regarding your pregnancy. 6. We are not a Healthcare Provider and we do not offer medical advice or treatment or interpret or 'use' medical data. As a result of you inputting (or failing to input) data on the Service, we will not contact you or alert your MCP, any other Healthcare Provider or the emergency services regarding your pregnancy. 7. The Service should never be used as a way to alert Clinicians to a medical emergency or during a medical emergency. If you have any medical concerns regarding your pregnancy, you should promptly contact your MCP, your GP or, in an emergency, dial 999 . 8. Please consult your MCP, your doctor or other qualified healthcare professional if you have any questions about a medical condition, or before taking any drug, changing your diet, exercise plans or commencing or discontinuing any course of treatment during your pregnancy. Service Availability 9. Whilst we endeavour to ensure that Service is normally available 24 hours a day, we shall not be liable if for any reason the Service is unavailable at any time or for any period. 10. Access to the Service may be suspended temporarily and without notice in the case of system failure, maintenance or repair or for reasons beyond our control. Your Conduct 11. You are prohibited from posting or transmitting to or from the Service any material: a) that is threatening, defamatory, obscene, indecent, seditious, offensive, pornographic, abusive, liable to advocate bigotry, incite religious racial or ethnic hatred, discriminatory, menacing, scandalous, inflammatory, blasphemous, in breach of confidence, in breach of privacy or which may cause annoyance or inconvenience; or b) which is the personal information or sensitive personal information of another person or otherwise violates the privacy of another person; or c) for which you have not obtained all necessary approvals and/or licences; or d) which constitutes or encourages conduct that would be considered a criminal offence, give rise to civil liability, or otherwise be contrary to the law or infringe the rights of any third party; or e) which is technically harmful (including, without limitation, computer viruses, logic bombs, Trojan horses, worms, harmful components, corrupted data or other malicious software or harmful data); or f) impersonates or misrepresents your affiliation with any person or entity. 12. You may not misuse the Service (including, without limitation, by hacking). 13. We shall co-operate with any law enforcement authorities or court order requesting or directing us to disclose the identity or locate anyone posting any material in breach of this condition. 14. You are permitted to print from the Service information for your own personal use on the following basis: a) printed files are not modified in any way; b) no graphics from the Service are used separately from the corresponding text; and c) all copyright and trademark notices (whether our own, or those of a Healthcare Provider) appear in all copies. 15. Unless otherwise stated, the copyright and other intellectual property rights in all content (excluding your Personal Data) on the Service (including without limitation photographs and graphical images) are owned by us or our licensors. 16. Use of any extracts from the Service other than in accordance with this clause is prohibited for any purpose. 17. Any rights not expressly granted in these terms are reserved by us. 18. You may not resell or redistribute the Service, or any part of the Service. Your Account 19. All information you upload to the Service during the Pre-Booking Stage and during the Sharing Stage must be accurate and complete. 20. You are responsible for the security of your passwords and for any use of your account. 21. You must immediately notify us of any unauthorised use of your password or account by emailing [email protected] Use of Your Information 22. We will process your Personal Data in accordance with our Privacy Policy at all times. Contact 23. We reserve the right to contact you in order to update you on important changes to the Service. Proprietary Rights 24. We and our licensors own all intellectual property rights in the Service, and we give you a personal, revocable, non-assignable, and non-exclusive licence to use the Service. Modification and Termination of the Service 25. We may place limits on, modify, suspend or terminate the Service generally, and may suspend or terminate your use of the Service if you fail to comply with these terms. This suspension or termination may delete your information, files, and other previously available content. If we terminate the Service or your use of the Service, these terms will also terminate, but paragraphs 2, 6, 7, 8, 12, 13, and 14 shall continue to be effective after these terms are terminated. Changes to these terms 26. We may change these terms and will post the modified terms on this page and provide a summary of changes since the previous version. General Legal Terms 27. These terms and our Privacy Policy represent the entire agreement between you and us related to the Service, replacing any prior agreements. 28. Failure to enforce any provision will not constitute a waiver of that provision. If any provision is found unenforceable, it and any related provisions will be interpreted to best accomplish the essential purpose of the unenforceable provision. 29. We may assign our obligations, in whole or in part, at any time and without notice to you. The Service governed by these terms is solely for your benefit and ours. It is not for the benefit of any other person. 30. The Service is provided "as is", without any conditions, warranties or other terms of any kind. Accordingly, to the maximum extent permitted by law, we provide you with the Service on the basis that we exclude all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law) which, but for this legal notice, might have effect in relation to the Service. 31. We, any other party (whether or not involved in creating, producing, maintaining or delivering the Service), and the officers, directors, employees, shareholders or agents of any of them, exclude all liability and responsibility for any amount or kind of loss or damage that may result to you or a third party (including without limitation, any direct, indirect, punitive or consequential loss or damages, or any loss of income, profits, goodwill, data, contracts, use of money, or loss or damages arising from or connected in any way to business interruption, and whether in tort (including without limitation negligence), contract or otherwise) in connection with Service in any way or in connection with the use, inability to use or the results of your use of the Service, , including but not limited to loss or damage due to viruses that may infect your computer equipment, software, data or other property on account of your access to, use of, or browsing the Service or your downloading of any information from the Service. 32. Nothing in this legal notice shall exclude or limit our liability for death or personal injury caused by negligence, fraud, or any liability which cannot be excluded or limited under applicable law. 33. If your use of the Service results in the need for servicing, repair or correction of equipment, software or data, you assume all costs thereof. Governing law and jurisdiction 34. These terms shall be governed by and construed in accordance with English law. Disputes arising in connection with these terms shall be subject to the exclusive jurisdiction of the English courts. Terms and Conditions version 18 last updated on Friday 20 March 2020 15:54 Privacy PolicyIntroduction. Welcome to the K2 My Pregnancy Notes Privacy Policy. Please read this Privacy Policy carefully, it should only take you approximately 10 minutes to read. We have set out a very brief summary of some key points set out in this Privacy Policy in the box below.
Introduction and some important phrasesK2 Medical Systems Limited (referred to in this policy as K2 or we ) provides technology and digital services ( the Services ) to various NHS Trusts and other healthcare providers who may be responsible for providing healthcare services at a national or local level ( the Healthcare Providers ). K2 Medical Systems Limited is a company established in England with its registered address at K2 Medical Systems Ltd., The Apex, Derriford Business Park, Brest Road, Plymouth, PL6 5FL (company number 03809089). We are registered with the ICO as a data processor and as such we are not required to register a Data Protection Officer although we can be contacted on: +44 (0) 1752 397800 or email: [email protected] with any queries relating to data protection. Whilst we provide a number of services, one of our key offerings to Healthcare Providers is the provision of "electronic Personal Health Records" ( ePHR ) in maternity care that allows women under the care of the Healthcare Providers (the Women or Users ) to access digital maternity notes. The digital maternity notes technology platform that this Privacy Policy relates to is called the K2 MyPregnancyNotes ePHR or K2 Hampton - blood pressure monitoring (we will refer to it as the K2 MPN ). In this Privacy Notice we will use the following phrases:
If you have any questions about the use of your Personal Data by K2, you can contact us here: [email protected]. You can also contact your Healthcare Provider if you have questions about their use of your Personal Data. Your healthcare provider should also have a privacy policy and should be able to explain how your Personal Data is used. This statement was last updated on 28th February 2024 . We may need to make periodic changes to this Privacy Policy and we will notify Users of any changes via the K2 MPN platform. Quick LinksPurpose of this privacy policy.
What role does K2 perform in the context of the provision of maternity care?The pre-booking stage and the sharing stage, how is your personal data collected, international transfers, data security, data retention.
The purpose of this privacy policy is to provide you with important information about how your personal data is collected and processed, and to help you to understand the part that K2 and the K2 MPN platform plays in the provision of maternity care to you. We recognise that you need to have confidence in how your data is being used and processed. We provide the Services to the Healthcare Providers in the context of strict clinical requirements and guidelines that apply at both national and local level and as such we do not usually determine or influence how your personal data is processed, and in the majority of cases we only process your data on the instructions of the Healthcare Providers involved in your care. For the purposes of data protection law (including the General Data Protection Regulation, GDPR, which you may have heard of), when K2 is processing your data on the instructions of the Healthcare Providers we act as "data processors". We have set out below the limited scope of our role as a data processor. Contact detailsIf you have any questions about this privacy policy or our privacy practices, please contact our support team using the email address [email protected]. You have the right to make a complaint at any time to the Information Commissioner's Office (ICO), the UK supervisory authority for data protection issues (www.ico.org.uk, 0303 123 1113). We would, however, always appreciate the chance to deal with any concerns before you approach the ICO so please contact us in the first instance. We would also recommend that you contact your MCP or local NHS Trust if you have broader concerns about the way that your Personal Data is used in the context of the provision of maternity care. You may not have given any thought to how your Personal Data is used by Healthcare Providers, but there are some very well-established protocols that determine when data is accessible to different parties within the broader health and social care system. Digital healthcare services are however still considered relatively innovative. K2 is not a healthcare provider, nor does K2 provide medical advice or interpret or 'use' medical data. K2 is a technology provider specialised in developing technology and digital services that can be used by Healthcare Providers. We have developed the K2 MPN platform alongside Clinicians and Healthcare providers to make sure that it is fit for purpose. The main function of the K2 MPN technology is to facilitate the delivery of digital maternity notes to Women by their Clinicians and their chosen MCP. Healthcare Providers can deploy the K2 MPN in a variety of ways, including using it on a standalone basis or by integrating it with other 'on site' systems that they use. You should contact your MCP to find out how they use the K2 MPN. In any case, where your MCP has chosen the K2 MPN as its digital maternity notes system, we will be using your Personal Data and providing the Services solely on the basis that we act as a service provider (and data processor) for the Healthcare Provider and so our use of your Personal Data will be limited to use in accordance with the Healthcare Provider's instructions. Women under the care of a particular MCP where the MCP or relevant Healthcare Provider has deployed the K2 MPN will be directed to self-report their pregnancy through a K2 MPN webpage. Where Women do not have access to the internet and/or require additional help and support, the mandatory information may be entered through the K2 MPN on the Women's behalf. The collection of data at the Pre-Booking Stage includes of a series of mandatory and optional questions (all developed in close consultation with Clinicians and Trusts). It will be clearly indicated which questions are mandatory and which are optional. The optional information may include marital status, ethnicity, NHS Number, height and weight and additional medical and lifestyle information. Information provided at the Pre-Booking Stage will be shared with your MCP. The collection of Personal Data through the K2 MPN platform at this stage is carried out solely on the instructions of the relevant Healthcare Provider. At the end of the Pre-Booking Stage (i.e. once you have self-reported the pregnancy through the K2 MPN), you will be asked whether you wish to move into the Sharing Stage. In the main, this is an optional process but may be encouraged or in some cases mandated by your Clinicians and MCP. If you proceed to the Sharing Stage, the information submitted at the Sharing Stage will be shared with your MCP and relevant Clinicians. If you proceed to the Sharing Stage, an ePHR will be created that will be used by your Clinicians and MCP throughout the pregnancy unless you choose to revoke the sharing of your Personal Data with the MCP and Clinicians. K2 acts as a service provider to the Healthcare Providers and therefore processes your Personal Data only on the instructions of the relevant Healthcare Provider. Your MCP and Clinicians will be able to tell you more about how your Personal Data is used in the hospital setting and as part of your maternity care. Most of the Personal Data that K2 processes is data that Women provide directly by entering it into the K2 MPN platform. Where the relevant MCP has deployed the K2 MPN (in other words, where K2 acts as a service provider to the Healthcare Providers), additional Personal Data will be added to the K2 MPN from the Clinicians and from the "on site" systems used by the relevant Healthcare Providers (i.e. data will come from the Clinicians and MCP into the K2 MPN). Your Clinicians and MCP will be able to provide you with more information about where else they may collect data from. We do not transfer your personal data outside of the UK. We have put in place very robust security measures to prevent your Personal Data from being accidentally lost, used or accessed in an unauthorised way, altered or disclosed. In addition, we limit access to Users' Personal Data to those employees, agents, contractors and other third parties who have a need to know. We have implemented measures to ensure that they will only process your Personal Data on our instructions and they are subject to a duty of confidentiality. We have put in place procedures to deal with any suspected personal data breach and will notify you, the Healthcare Providers and any applicable regulator of a breach where we are required to do so under applicable laws. Your MCP and the relevant Healthcare Providers should be able to tell you more about how your Personal Data is secured when it processed by them. We retain Personal Data about you for as long as we are required to do so by the relevant Healthcare Provider. When we provide Users with the User Only Service version of the K2 MPN, we will only retain Personal Data for as long as you continue to have an account registered on the K2 MPN. You can ask us to delete your Personal Data at any time by contacting us at support.k2ms.com. Any request to delete or amend data must be received by K2 in a written format, we cannot accept a phone conversation as evidence for wishing to delete or amend your data. We may also ask you to provide additional information to help us identify you for verification reasons. Your Data Protection RightsYou can exercise the following rights by contacting your MCP or Healthcare Provider. If you have any questions or if you want to exercise any of the rights described below, please contact us by email on [email protected].
How do we share your Personal Data?As described above, your Personal Data will be shared with your MCP since the MCP or Healthcare Provider is the data controller responsible for the use of your data. At the Pre-Booking Stage (and if you proceed to the Sharing Stage), all of the data that you provide will be shared with your MCP (and therefore with Clinicians involved in your care). We have engaged with a service provider called Microsoft Azure to provide data storage services. Your Personal Data will be stored on equipment (servers) controlled by Microsoft Azure. We have a written agreement in place with Microsoft Azure and they are obliged to protect the data's confidentiality, integrity and availability (i.e. they are obliged to keep the data secure). We could merge with or be acquired by another business. If this happens we share the information that relates to you. You will be sent notice of such an event where required by applicable laws. In the unlikely event that it is necessary, we reserve the right to disclose your personal data in order to comply with the law, applicable regulations and government requests. We also reserve the right to use such information in order to protect our operating systems and integrity as well as other users. Cookie PolicyWhen K2 provide services, we want to make them easy, useful and reliable. Where services are delivered over the internet, this sometimes involves placing small amounts of information on your device, for example, computer or mobile phone. These include small files known as cookies. They cannot be used to identify you personally. These pieces of information are used to improve services for you through, for example:
Please note that the cookie providers listed below may distribute the gathered cookie information with other third party websites for the purpose of activity tracking. You can find out more about the policy of each cookie provider on their respective privacy pages. Cookies in Current usePlease by aware that the providers listed below may change their cookie names without notice. As an example, we use the following cookies on our website: The following cookies are listed as Marketing cookies as they could be used to for targeting ads. However, K2 only utilises these cookies as they are also mandatory to distinguish between bots and humans using the Recaptcha technology. K2 are categorically not using these cookies to target ads, as K2 does not have advertising in use on the website. How to control and delete cookiesK2 will not use cookies to collect personally identifiable information about you. However, if you wish to restrict or block the cookies which are set by our websites, or indeed any other website, you can do this through your browser settings. You can also visit www.aboutcookies.org which contains information on how to make these changes on a wide variety of browsers. You will find details on how to delete cookies from your machine as well as more general information about cookies. Please be aware that restricting cookies may impact on the functionality of our website. If you wish to view your cookie code, just click on a cookie to open it. You'll see a short string of text and numbers. The numbers are your identification card, which can only be seen by the server that gave you the cookie. For information on how to do this on the browser of your mobile phone you will need to refer to your handset manual. Accessibility PolicyThe Accessibility Policy will appear here. Product InformationIntended use. MyPregnancyNotes™ (MPN) is cloud hosted software that shares clinical maternity information between care providers and pregnant women, accessed via their personal digital devices. MPN enables clinical connectivity, oversight, care planning and health monitoring. It allows women to contribute to their digital maternity notes and access information. MPN may also integrate with the Maternity Information Systems allowing integration of the MPN data record with the maternity unit electronic patient information system. Under care provider management, MPN allows women to home monitor by entering clinical measurements into their MPN record where the data is available for clinical oversight. MPN will prompt women to seek a clinical care appointment if measurements exceed clinically determined concern thresholds. Clinical caregivers also have highlighted visibility of concerning measurements. MPN enables the safe reduction of clinic appointments to the benefit of clinical services and the woman who will be spared time and cost to attend in person. Maternal blood pressure, urine protein, blood glucose, and temperature measurements may be home monitored, as determined by MPN licensing and configuration. The woman is instructed to seek professional clinical advice if she has any concerns and the clinician remains responsible for the continued care. Women may also access MPN independently without caregiving organisation enrolment or oversight. In this scenario MPN acts as a pregnancy note and record taking tool only. Manufacturer K2 Medical Systems Ltd. The Apex Derriford Business Park Brest Road Plymouth PL6 5FL United Kingdom MyPregnancyNotes™ date of manufacture: 28th February 2024  Picis Clinical, Solutions S.A. Carrer del Císter 2, 08022 Barcelona, SPAIN Australian Sponsor K2 Medical Systems Pty Ltd P.O. Box 4558, Ringwood, VIC 3134, AUSTRALIA UKCA Marking InformationMyPregnancyNotes™ bears the UKCA mark to denote conformity with provisions to the Medical Device Regulations 2002 (SI 2002 No. 618, as amended) (UK MDR 2002) covering medical devices.
Product VersionMyPregnancyNotes™ (DI) 5060470380052 MyPregnancyNotes™ (PI) 6.0.24075.1-157 Technical SupportIf the User perceives a problem with the system, then this should be reported to a System Administrator, or senior staff member, in the first instance. If an issue cannot be resolved internally and is directly attributed to MyPregnancyNotes™, then this should be escalated to K2’s Support Team, as per the Service Level Agreement. For UK & Ireland
For Australia
Adverse IncidentsAn adverse incident is an event that causes, or has the potential to cause, unexpected or unwanted effects involving the safety of device Users (including patients) or other persons as a result of a medical device failure or its misuse. Further information can be found:
Should an adverse incident occur, the K2 Support Team and the applicable regulatory authority MUST be contacted at the earliest opportunity. Should the risk of an adverse incident increase, the K2 Support Team MUST be contacted at the earliest opportunity. Further InformationMyPregnancyNotes™ is a Medical Device MyPregnancyNotes™ K2 Medical Systems™ provides electronic instructions for use: https://help.k2ms.com/portal/en/kb More results... Presentation: Pregnancy where previous pregnancy or child diagnosed with trisomy 21, 18 or 13Non-invasive prenatal testing (NIPT) can now be offered, via the National Genomic Test Directory’s R445 pathway, to anyone who has previously had any pregnancy or child diagnosed with full trisomy 21 (Down syndrome), 18 (Edward syndrome) or 13 (Patau syndrome). Example clinical scenarioA pregnant woman is referred to an appropriately trained midwife (or genetic counsellor), having disclosed that her first pregnancy was terminated following a diagnosis of Patau syndrome (trisomy 13). This was diagnosed via a chorionic villus sample (CVS) following a higher-chance first-trimester combined screening and non-invasive prenatal testing (NIPT). She wants to discuss the chance of recurrence in this pregnancy and wishes to explore what prenatal options are available. When to consider genomic testing
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It is divided into three stages, called trimesters: first trimester, second trimester, and third trimester. The fetus undergoes many changes throughout maturation. Conception to about the 12th week of pregnancy marks the first trimester. The second trimester is weeks 13 to 27, and the third trimester starts about 28 weeks and lasts until birth.
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An educational gift to your clientele, these pregnancy guide slides are perfect as a Google Slides template, PowerPoint theme or Canva template. Fill out professionally designed, ready-made slides for general information and statistics, stages of pregnancy, customized pregnancy plans, health tips, and more. Choose an on-brand color scheme and ...
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OL: occiput lateral (head down, facing your side) L or R in front of these tell you which side of your body your baby is. Engagement of baby's head in the pelvis. NE, NEng, Not Eng: not engaged. E or Eng = engaged. 5/5 = free. 4/5 = sitting on the pelvic brim. 3/5 = lower but most still above the brim.
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Pregnancy (gestation) is the physiologic process of a developing fetus within the maternal body. Several terms are used to define the developmental stage of human conception and the duration of pregnancy. For obstetric purposes, the gestational age or menstrual age is the time elapsed since the first day of the last normal menstrual period (LNMP), which actually precedes the time of oocyte ...
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This site has been designed to be used as a resource for the Pregnancy Notes. The links below will guide you to specific information on selected aspects of the notes and a link to the Department of Health Pregnancy Book. We welcome your feedback about the Pregnancy Notes. Please e-mail us at [email protected].
My Pregnancy Notes
The R445 testing pathway is offered to all women with a history of a pregnancy or child diagnosed with full trisomy 21, 18 or 13. This group of women are offered this test because a past history of a pregnancy or child with full trisomy 21, 18 or 13 is associated with an increased chance of recurrence in a future pregnancy (a priori chance of about 1% or the chance related to maternal age ...