Although rare, nonvertex cephalic presentations can present to labor and delivery at any gestation. It is important to be able to describe and understand the mechanics as well as risks to these malpresentations in order to be able to counsel patients and decrease maternal and neonatal complications. There are significant differences in the fetal skull diameters and with persistent brow presentation there is a risk of fetal trauma or hypoxic injury. Persistent mentum posterior and brow presentations require cesarean delivery. Informed consent should be obtained, and parents should be aware of the risks of fetal compromise based on malpresentation. Given the natural mechanics of labor, some patients remain great candidates for vaginal birth. However, in certain scenarios, patients will warrant surgical intervention with cesarean delivery.

A 21-year-old gravida 2, para 1011 presents to the outpatient office for missing intrauterine device (IUD) strings following IUD insertion. The patient had an IUD placed at her six-week postpartum visit. She noted increased discomfort with this IUD placement compared with the one she had prior to the pregnancy. She also noted increased bleeding immediately following the procedure. Since placement she has had unprovoked intermittent abdominal discomfort that is sharp in nature and self resolves. She denies changes in her bowel or bladder habits and reports her menstrual cycles are short, one to three days, occurring monthly. Her past medical history is significant for depression and postpartum endometritis. Her past surgical history is significant for right anterior cruciate ligament repair. She is not taking any medications and she has no allegies.