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vertex presentation

Medical Definition of vertex presentation

Dictionary entries near vertex presentation, cite this entry.

“Vertex presentation.” Merriam-Webster.com Medical Dictionary , Merriam-Webster, https://www.merriam-webster.com/medical/vertex%20presentation. Accessed 20 Dec. 2024.

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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

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 .

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Vertex presentation

What does "Vertex presentation" mean in a report or doctor's letter? In our medical dictionary, you will find a patient-friendly explanation of the meaning of this medical term.

Explanation

Vertex presentation is a term used in childbirth to describe the position of the baby in the womb. It means that the baby's head is down and is the part that will come out first during delivery. This is the most common and safest position for the baby to be in for a vaginal birth. The term "vertex" refers to the top of the baby's head.

Univ. Prof. Dr. med. Lukas A. Huber

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Vertex Presentation : Types, Positions, Complications and Risks

Overview

When babies are about to enter the world, they are either in a vertex, breech, or transverse position. A vertex position means the baby is head-down in the pelvic region, which is the position a baby is required to be during vaginal delivery.

This blog talks about the vertex position, complications, and the other types of positions the baby can be during delivery.

What is the vertex position?

As mentioned earlier, a vertex position is a baby’s position during vaginal delivery. The baby moves into the vertex position between the 33 rd – 36 th week of pregnancy. In this position, the baby’s head comes out first through the vagina during delivery. However, it is vital to know that the baby can present with other positions like breech (feet-first position) or transverse (lying sideways) position. In such cases, the healthcare provider may suggest alternate birth plans to deliver the baby safely.

How is a baby delivered in the vertex position?

When a baby is in a vertex position, it moves through the birth canal and comes out through the vagina. Unlike other mammals that have wider birth canals, humans have smaller ones. Due to the tight space in the birth canal, the baby tends to flex their heads in different ways to fit into the area and enter the world. However, the chances of the baby changing position at the last minute reduce drastically when the baby’s head fits inside the birth canal. The baby can switch to a vertex position anytime during delivery even if it is in a breech or transverse position.

When to seek medical advice?

A pregnant woman can seek medical advice to clear any doubts or clarifications.

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What are the other positions a baby may lie in the womb?

As already mentioned, unborn babies may also assume breech or transverse positions in the womb. The following gives a detailed explanation of both.

Breech Position

In this position, the babies lie in the womb pointing their feet or buttocks toward the vagina of the mother. If the baby stays in a breech position even after 36 weeks of pregnancy, the healthcare provider may try External Cephalic Version (ECV) on the mother. ECV refers to external pressure on the belly to change the baby’s position to a vertex. This procedure is painful for the mother, but it is the safest way to keep the baby in place. In almost 50% of the cases, ECV works and assists the baby in moving into a vertex position.

In case of vaginal bleeding , the irregular heartbeat of the baby, broken water, or multiple pregnancies, ECV is not recommended. Also, ECV should not be performed if the baby is bigger or smaller than usual, if the placenta is low or if the mother develops high blood pressure and organ damage. The healthcare provider may recommend C-section to deliver the baby in such cases.

Transverse Position

The baby is lying across the uterus during delivery. The doctors may recommend an ECV procedure. If ECV fails, the healthcare provider may deliver the baby through a C-section .

Can complications happen even when the baby is in the vertex position?

Even though the vertex position is the correct way a baby should lie during delivery, there are chances of complications. If the baby weighs more than 4.5 kg, it becomes challenging for the baby to manoeuvre out of the birth canal. The shoulders of heavy babies may face trouble moving down the canal. For such babies, doctors regularly conduct checks and are extra cautious during prenatal visits and at the time of birth. For babies above 5 kg, they may recommend alternate delivery options to avoid trauma for both the baby and the mother.

What are the risks associated with the Breech and Transverse position of the baby?

Breech and transverse positions can lead to many complications, such as the following:

ECV issues : While the healthcare provider performs ECV to shift the baby’s position into a vertex position, it may rupture the amniotic sac or tear the placenta. Sometimes it may change the baby’s heartbeat or may induce early labour.

Problems with breech birth : In the breech position, the baby isn’t able to push the cervical muscles of the mother to come out. Their shoulders or heads may get stuck or impaled by the mother’s pelvis. Also, the umbilical cord may enter the vagina before the baby, reducing blood and oxygen flow to the baby.

Conclusion

Vertex position is the right way a baby should lie in the womb during delivery. It doesn’t mean that vertex position does not cause complications. It is crucial to seek expert advice during pregnancy to clarify doubts and address all concerns.

Frequently Asked Questions (FAQs)

Will the baby turn after being in a vertex position .

Even when the baby is in the proper vertex position, there are chances of them turning to other positions. Expectant mothers with excess amniotic fluid may be a risk of a vertex-positioned baby suddenly becoming breech. Consult the healthcare provider and ask what can be done about keeping the baby in the proper position until delivery.

How to know if a pregnant woman is having a vertex-positioned baby?

All healthcare professionals are trained to feel the baby’s position with their hands. This method is known as Leopold’s moves, and they may help find if the baby has a positioned vertex. An ultrasound test also helps precisely find and confirm the baby’s position.

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That actually explain what's on your next test, vertex presentation, from class:, anatomy and physiology ii.

Vertex presentation refers to the position of a fetus during labor where the top of the head is the part that is leading the way through the birth canal. This position is considered ideal for a vaginal delivery, as it aligns the fetus's head with the birth canal, facilitating an easier and safer passage during labor. Understanding vertex presentation is crucial as it impacts labor progression and delivery methods.

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5 Must Know Facts For Your Next Test

Vertex presentation is typically achieved when the fetus is in a head-down position, ideally occurring around 32 to 36 weeks of gestation.
Most fetuses are in a vertex position at term, which is associated with lower rates of complications during delivery.
When a fetus is in vertex presentation, it often allows for a more straightforward labor experience, reducing the likelihood of needing a cesarean section.
The alignment of the fetal head in vertex presentation helps in optimal fetal descent through the pelvis, improving outcomes for both mother and baby.
Healthcare providers assess fetal position through palpation and ultrasound to determine if vertex presentation is achieved prior to labor.

Review Questions

Vertex presentation plays a significant role in facilitating an efficient labor process. When the fetus's head leads during delivery, it aligns with the birth canal, which can help to minimize complications and speed up labor progression. This positioning typically leads to lower rates of intervention, such as cesarean sections, making it the preferred position for vaginal deliveries.
Non-vertex presentations, such as breech or transverse positions, can lead to several complications during childbirth. These presentations may result in obstructed labor, increased risk of umbilical cord prolapse, and higher chances of cesarean deliveries. Additionally, non-vertex presentations can also pose risks to fetal health, necessitating careful monitoring and potential interventions by healthcare providers.
Healthcare providers utilize various techniques to assess fetal position, including abdominal palpation and ultrasound imaging. By identifying whether the fetus is in vertex or another position, they can make informed decisions regarding delivery methods. If vertex presentation is confirmed, providers may proceed with a planned vaginal delivery; however, if not, they might discuss options like external cephalic version or scheduling a cesarean section to ensure safety for both mother and child.

Related terms

Breech presentation : A situation where the fetus is positioned with the buttocks or feet presenting first instead of the head.

Cephalic presentation : A broader term that includes any position where the head is the presenting part of the fetus, with vertex being one specific type.

Labor stages : The phases of labor that include dilation, expulsion, and placental delivery, all influenced by fetal position.

" Vertex presentation " also found in:

Vertex Presentation Definition

Vertex presentation refers to the manner in which a baby’s head is positioned inside the mother’s womb, which determines the points of contact on the baby’s head as they are being born. When the baby is in the vertex position, this means that the baby’s head is the first part of the body to be born. This is the most common presentation and is considered the best position for the baby to be born in. It occurs in about 97% of all births.

This position is also known as the cephalic position. However, vertex presentation is but one of the different types of cephalic presentations.

This presentation has three types. Occiput anterior is the most common, where the baby’s head is facing forward, towards the mother’s rectum. Occiput posterior is the least common, where the baby’s head is facing backward, facing the mother’s spine. Mentum anterior is a variation of occiput anterior, where the chin is leading instead of the forehead, also known as the face presentation.

The most important thing to consider during a vertex presentation is the baby’s position. If the baby is in an occiput posterior position, it may need to be turned to the occiput anterior position in order to be born. Failure to turn will result in prolonged labor. If the baby is in a mentum anterior position, it may need to be turned to the occiput posterior position in order to be born.

This image shows how often the term ‘Vertex Presentation’ is used in relation to other, similar birth terms:

[RELATED TERMS GRAPH]

Importance of the Vertex Presentation

A vertex presentation is generally a good sign that the baby is ready to be born, but there are some risks associated with it. The most common risk is cord prolapse, where the umbilical cord slips out of the baby’s vagina before the baby is born. This can cause the baby to lose its oxygen supply and can be fatal. Other risks include shoulder dystocia, where the baby’s shoulder gets stuck in the birth canal, and the nuchal cord, where the umbilical cord gets wrapped around the baby’s neck.

If the baby is in a vertex presentation and their head is not engaged in the pelvis, that means that they are not ready to be born yet. In this case, the doctor or midwife will usually try to encourage the baby to move down into the pelvis by pushing on the mother’s belly or using a vacuum extractor. If the baby does not move down into the pelvis after a certain amount of time, a cesarean section may be necessary albeit an undesirable option.

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