Describe foetal attitudes,and different lie of the foetus with their presentation and position in simplified language
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Foetal Attitude, Lie, Presentation & Position — Simplified
1. Foetal Attitude
Attitude = the posture of the foetus — how its body parts relate to each other.
In normal pregnancy, the foetus adopts a posture of universal flexion:
- Head bent forward (chin on chest)
- Arms folded across the chest
- Knees and hips bent (curled up)
- Back curved outward (like a ball)
This compact, curled-up posture is called attitude of flexion and is the normal, ideal attitude. It makes the foetus take up the least possible space and allows the smallest diameter of the head to enter the pelvis.
When the head deviates from this:
| Degree of deviation | Name |
|---|---|
| Head fully flexed (chin on chest) | Vertex presentation (normal) |
| Head partially flexed | Sinciput presentation |
| Head partially extended (neck straightened a little) | Brow presentation |
| Head fully extended (face looking down the canal) | Face presentation |
The more the head is extended from its normal flexed posture, the larger the diameter that presents — making delivery harder.
2. Foetal Lie
Lie = the relationship of the long axis of the foetus to the long axis of the uterus/mother.
Think of it as: "Which direction is the baby lying in?"
Types of Lie:
| Type | What it means | Outcome |
|---|---|---|
| Longitudinal lie | Baby's spine runs parallel to mother's spine (up-down) | Normal — occurs in >99% of term pregnancies |
| Transverse lie | Baby lies sideways (crosswise) | Cannot deliver vaginally — requires C-section |
| Oblique lie | Baby at a diagonal angle | Unstable — will shift to longitudinal or transverse during labour |
3. Presentation
Presentation = which part of the baby is closest to (or foremost in) the birth canal.
It is the part that would come out first.
Based on the lie:
A. Longitudinal Lie → Two types of presentation:
i. Cephalic (Head) Presentations (most common)
The head is the presenting part. Further classified by how flexed or extended the head is:
| Presentation | Head position | Part presenting | Diameter |
|---|---|---|---|
| Vertex | Fully flexed | Back of head (occiput) | Smallest — most favourable |
| Sinciput | Partially flexed | Bregma (forehead area) | Larger |
| Brow | Partially extended | Brow | Very large — usually needs C-section |
| Face | Fully extended | Face/chin (mentum) | Large but can sometimes deliver vaginally if chin is anterior |
ii. Breech Presentations (3% at term)
The buttocks or feet come first:
| Type | What it looks like |
|---|---|
| Frank breech | Hips flexed, knees straight — buttocks first, legs up beside the head |
| Complete breech | Hips and knees both flexed — baby sitting cross-legged, buttocks first |
| Incomplete (footling) breech | One or both feet are the lowest part |
B. Transverse Lie → Shoulder Presentation
The shoulder is the presenting part. This cannot deliver vaginally.
C. Compound Presentation
A limb (e.g., a hand) comes down alongside the main presenting part (e.g., head + hand together).
4. Position
Position = the relationship of a specific landmark on the presenting part to the mother's pelvis (left or right, anterior or posterior).
Think of it as: "Which way is the baby facing within the pelvis?"
Reference landmarks used:
| Presentation | Landmark used |
|---|---|
| Vertex (head) | Occiput (back of head) |
| Face | Mentum (chin) |
| Breech | Sacrum |
| Shoulder | Acromion |
Common positions in vertex presentation:
| Abbreviation | Full name | Meaning |
|---|---|---|
| OA | Occiput Anterior | Back of head facing mother's front — most common, easiest delivery |
| OP | Occiput Posterior | Back of head facing mother's back — longer, harder labour |
| LOA | Left Occiput Anterior | Back of head facing left-front — most common of all |
| ROA | Right Occiput Anterior | Back of head facing right-front |
| LOT / ROT | Left/Right Occiput Transverse | Head sideways in the pelvis |
The Left Occiput Anterior (LOA) position is the most common and most favourable.
MRI Showing All Four Lie Types
Quick Summary Table
| Term | Question it answers | Normal finding |
|---|---|---|
| Attitude | How is the baby's body postured? | Flexion (curled up) |
| Lie | Which direction does the baby lie? | Longitudinal |
| Presentation | Which part comes out first? | Vertex (back of head) |
| Position | Which way does the presenting part face in the pelvis? | Left occiput anterior (LOA) |
Sources: Roberts and Hedges' Clinical Procedures in Emergency Medicine; Textbook of Family Medicine, 9e; Creasy & Resnik's Maternal-Fetal Medicine.
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