• Article

Malpresentation Association with stillbirth and neonatal mortality in low- and middle- income countries

Uncertainty exists regarding the impact of fetal presentation on fetal and neonatal outcomes. We examined rates of stillbirth (SB) and neonatal mortality (NM) associated with malpresentation in low- and middle-income countries.

Study Design
Using the NICHD Global Network’s prospective, multi-country, population-based maternal-newborn registry of pregnancy outcomes from 2010-2016, we studied fetal and neonatal outcomes by presentation in singleton pregnancies. Demographic and birth characteristics of cephalic and non-cephalic pregnancies were compared. We compared rates of SB and NM between these groups and stratified results by mode of delivery and gestational age. Robust Poisson regression was used to estimate the risk of adverse perinatal outcome associated with malpresentation.

436,112 deliveries at seven study sites in six countries (India, Pakistan, Kenya, Zambia, Democratic Republic of the Congo, and Guatemala) were included and grouped by geographic region. Of these, 2% had non-cephalic presentation at delivery. Women with malpresentations were similar to those with cephalic presentation in terms of age and education but malpresentations were more common in nulliparous women and preterm deliveries. Hospital-based and cesarean deliveries were also more common with malpresentation, although there were significant differences among study sites (data not shown). Across all regions, SB and NM were higher among deliveries with malpresentation (Figure). When groups were stratified by mode of delivery and prematurity and adjusted for region, these differences remained (Table). Among all deliveries when adjusting for region, maternal age, parity, education, preterm birth, location, and mode of delivery, malpresentation remained significantly associated with an increased risk of SB (aRR 4.0, 95% CI 3.7-4.5) and NM (aRR 2.3, 95% CI 2.1-2.6).

In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with worse perinatal outcomes.


Duffy, C., Moore, J., Saleem, S., Tshefu, A., Bose, C., Chomba, E., ... NICHD Global Network Womens (2018). Malpresentation: Association with stillbirth and neonatal mortality in low- and middle- income countries. American Journal of Obstetrics and Gynecology, 218(1), S554-S554. https://doi.org/10.1016/j.ajog.2017.11.423