ABSTRACT
Breech is the commonest malpresentation, followed by the much rarer face, brow and compound. The MRCOG candidate should know that malpresentation has its own specific complications and traditional management strategies. Whether home or hospital management is decided, an honest discussion of the risks is required using the ‘three-domain’ decision model where the woman’s values, intuition and understanding of risks can be evaluated to enable skilful support and informed choice. Many of these women have an unstable lie because of their high parity, and therefore have children at home. Many obstetricians recommend hospital admission from that gestation until delivery because of the small risk of cord prolapse. The benefits of minimising the harms of cord prolapse by recommending hospital admission have to be balanced against the emotional and financial harms of being in hospital for a fairly long time and having to arrange alternative childcare.
