Face presentation

Август 4, 2022

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Face presentation

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2. Definition Head hyper extended, with face as presenting part
3. Epidemiology Incidence: 0.1 to 0.2% of singleton deliveries
4. Pathophysiology Face presentation is an extended attitude Results in largest head diameter: Occipitomental Increases diameter 3
6. Causes Polyhydramnios Multiple pregnancy Multiparity,lax uterus Contracted pelvis
7. Cont. Anencephaly Loops of cord around the neck Tumours in front of neck, cystic hygroma, goitre
8. Diagnosis During pregnancy High head Head protuberance on the same side as the back USG In
10. Labour in face presentation Prolonged labour Early ROM Perineal & vaginal tears May end in obstructed
11. Management Do not attempt to convert face presentation to vertex Never apply vacuum extractor to face
12. Management No active intervention Wait for the spontaneous rotation and delivery Epidural analgesia If prolonged second
13. Cont. If persistant mentotransverse: rotation manually or with Kielland forceps In persistant mentoposterior: C.Section
14. Brow Presentation
15. Epidemiology Incidence: 0.02% of singleton deliveries Brow is an area between the orbital ridges and anterior
18. Diagnosis Never made during pregnancy In labour High head Frontal suture & anterior fontanelle on one
19. Pathophysiology Results in largest head diameter: Occipitomental (mentovertical )13.5cms
20. Management Cesarean section required in most cases Brow presentation rarely can deliver vaginally unless: spontaneously converts
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Definition
Head hyper extended, with face as presenting part

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Epidemiology
Incidence: 0.1 to 0.2% of singleton deliveries

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Pathophysiology
Face presentation is an extended attitude
Results in largest head diameter:

Occipitomental
Increases diameter 3 cm (24%) over flexed head

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Causes
Polyhydramnios
Multiple pregnancy
Multiparity,lax uterus
Contracted pelvis

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Cont.
Anencephaly
Loops of cord around the neck
Tumours in front of neck, cystic

hygroma, goitre

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Diagnosis
During pregnancy
High head
Head protuberance on the same side as the

back
USG
In labour
Mouth, jaws, nose,alveolar and orbital ridges are felt

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Labour in face presentation
Prolonged labour
Early ROM
Perineal & vaginal tears
May end in

obstructed labour due to mentoposterior or mentotransverse position

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Management
Do not attempt to convert face presentation to vertex
Never apply

vacuum extractor to face
Do not apply internal scalp electrodes
Avoid Oxytocin in most cases
Consider large episiotomy if fetus delivers vaginally

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Management
No active intervention
Wait for the spontaneous rotation and delivery
Epidural analgesia
If prolonged

second stage and mento- anterior :apply forceps

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Cont.
If persistant mentotransverse:
rotation manually or with Kielland forceps
In persistant mentoposterior:

C.Section

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Brow Presentation

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Epidemiology
Incidence: 0.02% of singleton deliveries
Brow is an area between the

orbital ridges and anterior fontanelle
Results when head is halfway between flexion & extension

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Diagnosis
Never made during pregnancy
In labour
High head
Frontal suture & anterior fontanelle on

one side and orbital ridges on other side

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Pathophysiology

Results in largest head diameter: Occipitomental (mentovertical )13.5cms

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Management
Cesarean section required in most cases
Brow presentation rarely can deliver

vaginally unless:
spontaneously converts to vertex or face presentation
fetus is very small or pelvis is very large