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INTRODUCTION

Diagnosis and management of face and brow presentations will be reviewed here. Other cephalic malpresentations are discussed separately. (See "Occiput posterior position" and "Occiput transverse position" .)

Prevalence  —  Face and brow presentation are uncommon. Their prevalences compared with other types of malpresentations are shown below [ 1-9 ]:

● Occiput posterior – 1/19 deliveries

● Breech – 1/33 deliveries

Medical Information

Delivery, Face Presentation, and Brow Presentation: Understanding Fetal Positions and Birth Scenarios

Delivery, Face Presentation, and Brow Presentation: Understanding Fetal Positions and Birth Scenarios

Introduction:.

During childbirth, the position of the baby plays a significant role in the delivery process. While the most common fetal presentation is the head-down position (vertex presentation), variations can occur, such as face presentation and brow presentation. This comprehensive article aims to provide a thorough understanding of delivery, face presentation, and brow presentation, including their definitions, causes, complications, and management approaches.

Delivery Process:

  • Normal Vertex Presentation: In a typical delivery, the baby is positioned head-down, with the back of the head (occiput) leading the way through the birth canal.
  • Engagement and Descent: Prior to delivery, the baby's head engages in the pelvis and gradually descends, preparing for birth.
  • Cardinal Movements: The baby undergoes a series of cardinal movements, including flexion, internal rotation, extension, external rotation, and restitution, which facilitate the passage through the birth canal.

Face Presentation:

  • Definition: Face presentation occurs when the baby's face is positioned to lead the way through the birth canal instead of the vertex (head).
  • Causes: Face presentation can occur due to factors such as abnormal fetal positioning, multiple pregnancies, uterine abnormalities, or maternal pelvic anatomy.
  • Complications: Face presentation is associated with an increased risk of prolonged labor, difficulties in delivery, increased fetal malposition, birth injuries, and the need for instrumental delivery.
  • Management: The management of face presentation depends on several factors, including the progression of labor, the size of the baby, and the expertise of the healthcare provider. Options may include closely monitoring the progress of labor, attempting a vaginal delivery with careful maneuvers, or considering a cesarean section if complications arise.

Brow Presentation:

  • Definition: Brow presentation occurs when the baby's head is partially extended, causing the brow (forehead) to lead the way through the birth canal.
  • Causes: Brow presentation may result from abnormal fetal positioning, poor engagement of the fetal head, or other factors that prevent full flexion or extension.
  • Complications: Brow presentation is associated with a higher risk of prolonged labor, difficulty in descent, increased chances of fetal head entrapment, birth injuries, and the potential need for instrumental delivery or cesarean section.
  • Management: The management of brow presentation depends on various factors, such as cervical dilation, progress of labor, fetal size, and the presence of complications. Close monitoring, expert assessment, and a multidisciplinary approach may be necessary to determine the safest delivery method, which can include vaginal delivery with careful maneuvers, instrumental assistance, or cesarean section if warranted.

Delivery Techniques and Intervention:

  • Obstetric Maneuvers: In certain situations, skilled healthcare providers may use obstetric maneuvers, such as manual rotation or the use of forceps or vacuum extraction, to facilitate delivery, reposition the baby, or prevent complications.
  • Cesarean Section: In cases where vaginal delivery is not possible or poses risks to the mother or baby, a cesarean section may be performed to ensure a safe delivery.

Conclusion:

Delivery, face presentation, and brow presentation are important aspects of childbirth that require careful management and consideration. Understanding the definitions, causes, complications, and appropriate management approaches associated with these fetal positions can help healthcare providers ensure safe and successful deliveries. Individualized care, close monitoring, and multidisciplinary collaboration are crucial in optimizing maternal and fetal outcomes during these unique delivery scenarios.

Hashtags: #Delivery #FacePresentation #BrowPresentation #Childbirth #ObstetricDelivery

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Face Presentation and Birth Injury

Normally, children are born head-first with the chin tucked towards the chest (vertex presentation). In a face presentation, the chin is not tucked and the neck is hyperextended. This can inhibit the engagement of the head and complicate the labor process. In some cases, a baby in face presentation can be delivered vaginally, but in other cases vaginal delivery is difficult and dangerous. Face presentation increases the risk of facial edema, skull molding, breathing problems (due to tracheal and laryngeal trauma), prolonged labor, fetal distress, spinal cord injuries, permanent brain damage, and neonatal death. Usually, medical staff conduct a vaginal examination to determine the position of the baby. If they suspect an abnormal presentation, they can confirm with an ultrasound and take action to properly handle the delivery of a baby in the face presentation. This includes additional monitoring and in some cases requires a C-Section. Because ventilation issues are more common in babies with face presentation, staff should be ready to intubate immediately after delivery (1).

Baby in utero in face presentation.

Risk factors and causes of face presentation

Conditions that may increase the likelihood of a face presentation include the following (1, 2, 3, 4):

  • Prematurity
  • Very low birth weight
  • Fetal macrosomia (large baby)
  • Cephalopelvic disproportion, or CPD (a mismatch in size between the mother’s pelvis and the baby’s head)
  • Anencephaly (a birth defect in which the baby is missing part of the brain and skull)
  • Severe hydrocephalus with enlargement of the head
  • Anterior neck mass
  • Multiple nuchal cords (umbilical cord wrapped around baby’s neck more than once)
  • Maternal pelvis abnormalities
  • Maternal obesity
  • Multiparity (the mother has previously given birth)
  • Polyhydramnios (too much amniotic fluid)
  • Previous cesarean delivery

Diagnosing face presentation

Face presentation is diagnosed late in the first or second stage of labor by vaginal examination. The distinctive facial features of the chin, mouth, nose, and cheekbones can be felt.  Face presentation is sometimes confused with breech presentation (because both are characterized by soft tissues with an orifice), which is why it is imperative that a very skilled physician be present during any potentially risky delivery or malpresentation . Diagnosis can be confirmed by an ultrasound, which reveals a deflexed/hyperextended neck (1).

face presentation define medical

Face presentation and delivery

There are three types of face presentation:

  • Mentum anterior (MA) . In this position, the chin is facing the front of the mother, and will be the presenting part of the face. Babies in mentum anterior position are usually delivered vaginally, although in some cases a C-section may be necessary.
  • Mentum posterior (MP) . In this position, the chin is facing the mother’s back.  The baby’s head, neck, and shoulders enter the pelvis at the same time, and the pelvis is usually not large enough to accommodate this (however, the baby may spontaneously rotate into mentum anterior position) . Typically, a C-section is indicated, but there are certain circumstances under which vaginal delivery may be attempted (e.g. the mother is multiparous, the infant in face presentation is relatively small compared to her other children, fetal monitoring is reassuring, and the baby is progressing in labor). Regardless, the medical team should be prepared to perform a prompt C-section if there are any complications.
  • Mentum transverse (MT) .  In this position, the baby’s chin is facing the side of the birth canal. Doctors may recommend a trial of labor under certain circumstances, but they should promptly proceed to a C-section if there are issues. If labor is progressing and the fetal heart monitor is reassuring when face presentation is present, physician intervention may not be necessary since many MP and MT positions convert to MA.  Oxytocin (Pitocin) augmentation may be used in a face presentation with a normal fetus and abnormally slow progress, as long as fetal heart rate patterns remain reassuring (although there are certain risks associated with this drug, including uterine tachysystole ). Of course, in any face presentation, if progress in dilation and descent ceases despite adequate contractions, delivery must occur by C-section.

There is an increased risk of trauma to the baby when the face presents first, and the physician should not internally manipulate (try to rotate) the baby.  In addition, the physician must not use vacuum extractors or manual extraction (grasping the baby with hands) to pull the baby from the uterine cavity.  Furthermore, midforceps ( forcep extraction when the baby’s station is above +2 cm, but the head is engaged) should never be used. Outlet forceps should only be used by experienced physicians who understand the circumstances under which this is appropriate (1).

Abnormalities of the fetal heart rate occur more frequently with face presentation.  In one study, 59% of infants in face presentation had variable heart decelerations, and 24% had late decelerations. Of the babies who were born live, 37% had 1-minute Apgar scores lower than 7, and 13% had 5-minute Apgar scores lower than 7. The majority of the low 5-minute Apgar scores were babies that had been in mentum posterior position (5).

For these reasons, it is crucial that babies are continuously monitored during labor, ideally with an external heart monitoring device.  An internal device may cause facial or eye injuries if improperly placed. If internal monitoring is needed, the electrode should be cautiously placed over a bony structure such as the forehead, jaw or cheekbone to minimize the risk of trauma (1).

It is always critical that doctors obtain a mother’s informed consent , which means discussing delivery options (vaginal, C-section, enhanced with oxytocin, etc.) with her and explaining the potential risks and benefits of each.  Failure to do so constitutes negligence.

Baby facing sideways in pelvis / birth canal.

Complications and side effects of face presentation

Complications associated with face presentation include the following:

  • Prolonged labor
  • Facial trauma
  • Facial edema (fluid build up in the face, often caused by trauma)
  • Skull molding (abnormal head shape that results from pressure on the baby’s head during childbirth)
  • Respiratory distress /difficulty in ventilation due to airway trauma and edema
  • Spinal cord injury
  • Abnormal fetal heart rate patterns
  • Low  Apgar score

A baby may be at increased risk of complications if forceps or oxytocin are used during labor.  Forceps can cause traumatic injury to the head, and oxytocin can deprive a baby of oxygen due to uterine tachysystole/hyperstimulation (strong, frequent contractions). Hyperstimulation increases pressure on the blood vessels in the womb, which can deprive the baby of oxygen-rich blood.

Trauma to the head and decreased oxygenation can cause permanent brain damage, such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP) , as well as fetal deaths.

face presentation define medical

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Standards of care, medical malpractice, and face presentation

Informed consent must be given during all medical procedures. This means that when a mother has a baby with face presentation, she must be given the option of a C-section versus a vaginal birth. One of the reasons a mother may opt for a C-section is to avoid the extensive facial bruising/trauma that is common in babies with face presentation. In addition to thoroughly explaining the risks and benefits of each type of delivery method, the physician must explain and obtain consent from the mother if forceps or oxytocin are used.

Because there are many complications associated with face presentation, it is essential that the baby be closely monitored and that delivery is handled by a physician with experience in this area. Furthermore, the physician must quickly proceed to a C-section delivery if there are any signs of fetal distress , labor is not progressing, or the baby fails to convert (rotate) to MA position.  In addition, once a face presentation is diagnosed, the physician must check for pelvic adequacy. When the pelvis is inadequate (contracted/small), a C-section is recommended (1).

Since respiratory problems can occur in babies with face presentation, equipment and staff to perform intubation of the baby (placement of a breathing tube) should be readily available at the time of delivery.

Failure to follow any of these standards of care is negligence. If this negligence results in injury to the baby, it is medical malpractice .

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  • Julien, S., Lockwood, C. J., & Barss, V. A. (2014). Face and brow presentations in labor. Up to date.
  • Duff, P. (1981). Diagnosis and management of face presentation. Obstetrics and gynecology, 57(1), 105-112.
  • S. BHAL NJ DAVIES T. CHUNG, P. (1998). A population study of face and brow presentation. Journal of Obstetrics and Gynaecology, 18(3), 231-235.
  • Shaffer, B. L., Cheng, Y. W., Vargas, J. E., Laros Jr, R. K., & Caughey, A. B. (2006). Face presentation: predictors and delivery route. American journal of obstetrics and gynecology, 194(5), e10-e12.
  • Benedetti, T. J., Lowensohn, R. I., & Truscott, A. M. (1980). Face presentation at term. Obstetrics and gynecology, 55(2), 199-202.

The above information is intended to be an educational resource. It is not meant to be, and should not be interpreted as, medical advice.

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Management of face presentation, face and lip edema in a primary healthcare facility case report, Mbengwi, Cameroon

Nzozone henry fomukong.

1 Microhealth Global Medical Centre, Mbengwi, Cameroon

2 Department of Medicine and Surgery, Faculty of Health Sciences University of Buea, Buea, Cameroon

Ngouagna Edwin

Mandeng ma linwa edgar, ngwayu claude nkfusai.

3 Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon

4 Cameroon Baptist Convention Health Services (CBCHS), Yaoundé, Cameroon

Yunga Patience Ijang

5 Department of Public Health, School of Health Sciences, Catholic University of Central Africa, Box 1110, Yaoundé, Cameroon

Joyce Shirinde

6 School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, 0001, Pretoria, South Africa

Samuel Nambile Cumber

7 Institute of Medicine, Department of Public Health and Community Medicine (EPSO), University of Gothenburg, Box 414, SE - 405 30 Gothenburg, Sweden

8 Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

Face presentation is a rare obstetric event and most practitioners will go through their carriers without ever meeting one. Face presentation can be delivered vaginally only if the foetus is in the mentum anterior position. More than half of the cases of face presentation are delivered by caesarean section. Newborn infants with face presentation usually have severe facial oedema, facial bruising or ecchymosis. These syndromic facial features usually resolved within 24-48 hours.

Introduction

Face presentation is a rare unanticipated obstetric event characterized by a longitudinal lie and full extension of the foetal head on the neck with the occiput against the upper back [ 1 - 3 ]. Face presentation occurs in 0.1-0.2% of deliveries [ 3 - 5 ] but is more common in black women and in multiparous women [ 5 ]. Studies have shown that 60 per cent of face presentations have one or more of the following risk factors: small fetus, large fetus, high parity, previous caesarean section (CS), contracted pelvis, fetopelvic disproportion, cord around the neck multiple pregnancy, hypertensive disorders of pregnancy, polyhydramnios, uterine or nuchal cord anomaly. But 40 per cent of face presentations occur with none of these factors [ 6 , 7 ]. A vaginal birth at term is possible only if the fetus is in the mentum anterior position. More than half of cases of face presentation are delivered by caesarean section [ 4 ]. Newborn infants with face presentation usually have severe facial edema, facial bruising or ecchymosis [ 8 ]. Repeated vaginal examination to assess the presenting part and the progress of labor may lead to bruises in the face as well as damage to the eyes.

Patient and observation

Case presentation: a 21 year old primigravida at 40 weeks gestation from the last normal menstrual period referred to our facility for prolonged second stage of labor after visiting two health centres. She labored for a total of 14hrs, membrane ruptured spontaneously 12hrs before referral. Amniotic fluid was documented by midwife to be clear. She attended antenatal clinics in Mbengwi health centre 5 times, was diagnosed of hepatitis B during antenatal consultations, received no treatment. She did not do any ultrasound due to financial constraints. On examination, she was healthy, in painful distress, blood pressure 131/76mmhg, pulse 85 beats/min, temperature 37.2 o C SPO2 98%. On abdominal exams, uterus was gravid, fundal height 35cm, lie longitudinal, fetal heart rate 137bpm, cephalic presentation, engaged 2/5, with moderate contractions of 2 in 10 minutes. On vaginal examination, cervix was fully dilated, membranes ruptured, presenting part was face, mentum anterior. The conclusion made was mento-anterior face presentation ( Figure 1 ). Paturient was counseled, labor was augmented with 1 amp of oxytocin in 500ml of glucose 5% and started at 10drops/mins. Ten minutes later she delivered a male baby with Apgar score 6/10, 8/10 on the first and fifth minute. The baby weighed 3.2kg, length was 50cm, and head circumference was 41cm. Syndromic facial appearance with marked edema at the baby's lips, face and scalp was evident and he had bruising on the right nasolabial groove and right cheeks ( Figure 2 ). Physical examination of the infant's respiratory system, cardiovascular system, and his abdominal examination were normal, as was his neurological examination. Placenta was delivered by controlled cord traction 5mins later with all cotyledons. Delivery was complicated by a second degree perineal tear. Perineal tear was repaired with absorbable suture under local anaesthesia. Estimated blood lost was 350ml. baby received Hepatitis B immunoglobulins, hepatitis B vaccine and vitamin K were administered to the baby. 24 hours later, facial swellings resolved ( Figure 3 ), baby breast feeds well. Baby and mother were discharged on day 3 postpartum all fine.

An external file that holds a picture, illustration, etc.
Object name is PAMJ-33-292-g001.jpg

Men-tum anterior face presentation

An external file that holds a picture, illustration, etc.
Object name is PAMJ-33-292-g002.jpg

Bruising, marked lip and facial edema

An external file that holds a picture, illustration, etc.
Object name is PAMJ-33-292-g003.jpg

Baby 24 hours later with all syndromic facial features resolved

Ethics : informed consent: written informed consent was obtained from the patient's parents for the publication of this case report.

Face presentation is a rare obstetric event and most practitioner will go through their carriers without ever meeting one [ 3 ]. We presented a case of face presentation noticed in the delivery room on digital examination in a patient with no risk factors. In a poor resource setting as ours where ultrasound is not readily available, this event is often scary and confusing to most midwives and nurses. This may prompt repeated vaginal exams for confirmation of presentation. This intend will lead to bruising of the baby's face and delay effective management [ 8 ]. Exact knowledge about the fetal position and level is important for providing the correct management of this malpresentation. When face presentation is diagnosed, around 60% of cases are in the mentum anterior position, 25% are mentum posterior and 15% are mentum transverse [ 5 ]. The patient presented the most common form of face presentation (mentum anterior). Labor was augmented, vaginal delivery was attempted and successfully conducted. Facial bruising, lip and face edema are very common complication of face presentation. These complications usually resolve within 24-48 hours [ 9 , 10 ] in this case facial edema completely resolved within 24hours ( Figure 3 ) and baby breastfeed well.

Repeated vaginal exams should be avoided when presenting part is unsure. Vaginal delivery should be attemped only on mentum anterior face presentation, in other cases, emergency ceserian section should be performed. Syndromic facial features in babies born from face presentation resolve completely within 24-48 hours.

Competing interests

The authors declare no competing interests.

Acknowledgements

We thank the participant of this study.

Authors’ contributions

NHF, NE, MMLE, NCN, YPI, FB, JS and SNC conceived the case series, assisted with the study design and participant enrollment, designed the study protocol and collected the data. NE, MMLE, NCN and SNC assisted in interpretation of results and wrote the manuscript. All authors read and approved the final manuscript.

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Labour and Delivery pp 99–105 Cite as

Face Presentation

  • Shubhra Agarwal 2 &
  • Suchitra Pandit 3  
  • First Online: 02 August 2023

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Face presentation is defined as a cephalic presentation in which the presenting part is face and it occurs due to factors that lead to extension of of fetal head. It is a rare obstetric presentation and may not be encountered even in the entire carrier of an obstetrician.

  • Face presentation
  • Active phase of labor
  • Prematurity
  • Deflexed head
  • Congenital malformations
  • Dolichocephalic skull
  • Mento-anterior
  • Crichton’s method

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Shaffer BL. Face presentation: predictors and delivery route. Am J Obstet Gynecol. 2006;194:e10–2.

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Schwartz Z, Dgani R, Lancet M, Kessler I. Face presentation. Aust N Z J Obstet Gynaecol. 1986;26:172–6.

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Westgren M, et al. Face presentation in modern obstetrics-a study with special reference to fetal long term morbidity. Z Geburtshilfe Perinatol. 1984;188(2):87–9.

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Agarwal, S., Pandit, S. (2023). Face Presentation. In: Garg, R. (eds) Labour and Delivery. Springer, Singapore. https://doi.org/10.1007/978-981-19-6145-8_6

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Diagnosis and management of face presentation

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Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different from those of simple vertex presentation, there is no consistent alteration in the duration of labor in the absence of underlying CPD. When disproportion does not exist and gross anomalies are not present, the prognosis for spontaneous vaginal delivery is excellent. The majority of perinatal losses reported in face presentation have resulted from traumatic operative vaginal deliveries, specifically version and extraction and midforceps rotations. Recent experience at this institution with a limited series of face presentations demonstrates that, with careful intrapartum surveillance, delivery can be accomplished with no increase in risk to either mother or fetus.

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Malpresentations and Malpositions

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Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.

Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.

In this article

Malpresentation, malposition.

Usually the fetal head engages in the occipito-anterior position (more often left occipito-anterior (LOA) rather than right) and then undergoes a short rotation to be directly occipito-anterior in the mid-cavity. Malpositions are abnormal positions of the vertex of the fetal head relative to the maternal pelvis. Malpresentations are all presentations of the fetus other than vertex.

Obstetrics - the pelvis and head

OBSTETRICS - THE PELVIS AND HEAD

Predisposing factors to malpresentation include:

  • Prematurity.
  • Multiple pregnancy.
  • Abnormalities of the uterus - eg, fibroids.
  • Partial septate uterus.
  • Abnormal fetus.
  • Placenta praevia.
  • Primiparity.

Breech presentation

See the separate  Breech Presentations  article for more detailed discussion.

  • Breech presentation is the most common malpresentation, with the majority discovered before labour. Breech presentation is much more common in premature labour.
  • Approximately one third are diagnosed during labour when the fetus can be directly palpated through the cervix.
  • After 37 weeks, external cephalic version can be attempted whereby an attempt is made to turn the baby manually by manipulating the pregnant mother's abdomen. This reduces the risk of non-cephalic delivery [ 1 ] .
  • Maternal postural techniques have also been tried but there is insufficient evidence to support these [ 2 ] .
  • Many women who have a breech presentation can deliver vaginally. Factors which make this less likely to be successful include [ 3 ] :
  • Hyperextended neck on ultrasound.
  • High estimated fetal weight (more than 3.8 kg).
  • Low estimated weight (less than tenth centile).
  • Footling presentation.
  • Evidence of antenatal fetal compromise.

Transverse lie [ 4 ]

  • When the fetus is positioned with the head on one side of the pelvis and the buttocks in the other (transverse lie), vaginal delivery is impossible.
  • This requires caesarean section unless it converts or is converted late in pregnancy. The surgeon may be able to rotate the fetus through the wall of the uterus once the abdominal wall has been opened. Otherwise, a transverse uterine incision is needed to gain access to a fetal pole.
  • Internal podalic version is no longer attempted.
  • Transverse lie is associated with a risk of cord prolapse of up to 20%.

Occipito-posterior position

  • This is the most common malposition where the head initially engages normally but then the occiput rotates posteriorly rather than anteriorly. 5.2% of deliveries are persistent occipito-posterior [ 5 ] .
  • The occipito-posterior position results from a poorly flexed vertex. The anterior fontanelle (four radiating sutures) is felt anteriorly. The posterior fontanelle (three radiating sutures) may also be palpable posteriorly.
  • It may occur because of a flat sacrum, poorly flexed head or weak uterine contractions which may not push the head down into the pelvis with sufficient strength to produce correct rotation.
  • As occipito-posterior-position pregnancies often result in a long labour, close maternal and fetal monitoring are required. An epidural is often recommended and it is essential that adequate fluids be given to the mother.
  • The mother may get the urge to push before full dilatation but this must be discouraged. If the head comes into a face-to-pubis position then vaginal delivery is possible as long as there is a reasonable pelvic size. Otherwise, forceps or caesarean section may be required.

Occipito-transverse position

The head initially engages correctly but fails to rotate and remains in a transverse position.

Alternatives for delivery include manual rotation of fetal head using Kielland's forceps, or delivery using vacuum extraction. This is inappropriate if there is any fetal acidosis because of the risk of cerebral haemorrhage.

Therefore, there must be provision for a failure of forceps delivery to be changed immediately to a caesarean. The trial of forceps is therefore often performed in theatre. Some centres prefer to manage by caesarean section without trial of forceps.

Face presentations

  • Face presents for delivery if there is complete extension of the fetal head.
  • Face presentation occurs in 1 in 1,000 deliveries [ 5 ] .
  • With adequate pelvic size, and rotation of the head to the mento-anterior position, vaginal delivery should be achieved after a long labour.
  • Backwards rotation of the head to a mento-posterior position requires a caesarean section.

Brow positions

  • The fetal head stays between full extension and full flexion so that the biggest diameter (the mento-vertex) presents.
  • Brow presentation occurs in 0.14% of deliveries [ 5 ] .
  • Brow presentation is usually only diagnosed once labour is well established.
  • The anterior fontanelle and super orbital ridges are palpable on vaginal examination.
  • Unless the head flexes, a vaginal delivery is not possible, and a caesarean section is required.

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Further reading and references

Hofmeyr GJ, Kulier R, West HM ; External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2015 Apr 1(4):CD000083. doi: 10.1002/14651858.CD000083.pub3.

Hofmeyr GJ, Kulier R ; Cephalic version by postural management for breech presentation. Cochrane Database Syst Rev. 2012 Oct 1710:CD000051. doi: 10.1002/14651858.CD000051.pub2.

Management of Breech Presentation ; Royal College of Obstetricians and Gynaecologists (Mar 2017)

Szaboova R, Sankaran S, Harding K, et al ; PLD.23 Management of transverse and unstable lie at term. Arch Dis Child Fetal Neonatal Ed. 2014 Jun99 Suppl 1:A112-3. doi: 10.1136/archdischild-2014-306576.324.

Gardberg M, Leonova Y, Laakkonen E ; Malpresentations - impact on mode of delivery. Acta Obstet Gynecol Scand. 2011 May90(5):540-2. doi: 10.1111/j.1600-0412.2011.01105.x.

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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions .

7.9 Face presentation

7.9.1 diagnosis.

  • Palpation of the mother's abdomen at the start of labour: palpate the occipital region; a cleft between the head and the back will be palpable, due to hyperextension of the head.
  • On vaginal examination: no suture or fontanelle can be felt; orbits, nose, mouth, ears and chin palpable. Palpation of the chin is essential to confirm the diagnosis.

7.9.2 Management

Determine the orientation of the chin—anterior (at the mother's pubis) or posterior.

The chin is anterior

Vaginal delivery is possible. Labour may be slow, patience is required. If uterine contractions are inadequate, oxytocin may be used. Episiotomy is usually needed during delivery (Figures 7.4), given the maximum amount the perineum can stretch. If instrumental delivery is necessary, use forceps. Vacuum extraction is contra-indicated for a live fœtus.

Figures 7.4 - Chin anterior: delivery possible

Figure 7-4

The chin is posterior

Vaginal delivery is not possible (Figure 7.5). A caesarean section must be arranged. Refer if necessary.

Figure 7.5 - Chin posterior: impaction

Figure 7-5

If caesarean section is not feasible and referral is not possible, attempt the following manoeuvres:

  • Flex the head to obtain a vertex presentation: with one hand in the vagina, grasp the top of the skull and flex the neck, using the other hand, on the abdomen, to apply pressure to the foetal chest and buttocks. Obviously, the presenting part must not be engaged, and it is often hard—or impossible—to keep the head flexed (Figures 7.6).

Figure 7-6

  • Rotate the head to bring the chin anteriorly: push the face and chin back to free the shoulders from the pelvic inlet then, turn the head within the pelvic cavity, using a hand on the abdomen to help the rotation by applying pressure to the shoulders. In this way, the chin is brought to the front (Figures 7.7).

Figure 7-7

  • Version: internal podalic version, then total breech extraction (Figure 7.8).

Figure 7-8

All these manoeuvres are difficult and pose a significant risk of uterine rupture. They must be done when the uterus is not contracting. Whenever possible, caesarean section should be performed instead.

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Malpresentations and malpositions.

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 09/03/2015

This article have been viewed 9226 times

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Introduction

Malpresentation.

Malposition

During pregnancy, abdominal palpation should aim to define the lie, presentation and position of the fetus. The lie refers to the long axis of the fetus in relation to the long axis of the uterus. Usually, the fetus is longitudinal, but occasionally it may be transverse or oblique. The presentation is that part of the fetus which is at the pelvic brim, in other words the part of the fetus presenting to the pelvic inlet. Normal presentation is the vertex of the fetal head and the word ‘malpresentation’ describes any non-vertex presentation. This may be of the face, brow, breech, or some other part of the body if the lie is oblique or transverse.

The position of the fetus refers to the way in which the presenting part is positioned in relation to the maternal pelvis. Strictly speaking this refers to any presenting part, but here it will be considered in relation to those fetuses presenting head first (cephalic). As we have seen, the head is usually occipitotransverse at the pelvic brim and rotates to occipitoanterior at the pelvic floor. ‘Malposition’ is when the head, coming vertex first, does not rotate to occipitoanterior, presenting instead as persistent occipitotransverse or occipitoposterior.

As described above, ‘malpresentation’ is a term used to describe any non-vertex presentation. Over 95% of fetuses are in cephalic presentation at term. Malpresentations include face presentation, brow presentation and breech presentation. When the fetus has a cephalic presentation, the presenting diameter is dependent on the degree of flexion or extension of the fetal head – deflexed and brow presentations offer a wide diameter to the pelvic inlet ( Table 45.1 and Fig. 45.1 ).

Presenting diameters of the fetal head

face presentation define medical

Fig. 45.1 The presenting diameter is dependent on the degree of flexion or extension of the fetal head.

As the fetal skull is made up of individual bony plates (the occipital, sphenoid, temporal and ethmoid bones), which are joined by cartilaginous sutures (the frontal, sagittal, lambdoid and coronal sutures), it has the potential to be ‘moulded’ during labour. This allows the head to fit the birth canal more closely (Fig. 45.2) . Moulding should be distinguished from caput succedaneum, which refers to oedema of the presenting part of the scalp. Both moulding and caput can occur in any cephalic presentation, but are more likely to occur in malpresentation. The presence or absence of moulding and caput should be documented during each vaginal examination in labour; excessive moulding and caput are suggestive of an obstructed labour due to cephalopelvic disproportion.

face presentation define medical

Fig. 45.2 ‘Moulding’ refers to the change in shape of the fetal skull during labour as it ‘moulds’ to the birth canal.

Caput refers to oedema of the presenting part of the scalp.

Face presentation

This occurs in about 1:500 births and occurs when the fetal head extends right back (hyperextended so that the occiput touches the fetal back) (Fig. 45.3 A) . It is associated with prematurity, tumours of the fetal neck, loops of cord around the fetal neck, fetal macrosomia and anencephaly. Face presentation is usually only recognized after the onset of labour and, if the face is swollen (Fig. 45.3 B) , it is easy to confuse this presentation with that of a breech. The position of the face is described with reference to the chin, using the prefix ‘mento’. The presenting diameter is submentobregmatic (9.5 cm) (Fig. 45.1) .

face presentation define medical

Fig. 45.3 Face presentation.

(A) The head enters the pelvic brim in the transverse position. (B) Most rotate to the mentoanterior position and deliver without problems. (C) Those that rotate to mentoposterior will obstruct. (D) Face presentation is often associated with oedema and bruising. This baby recovered without problems.

The face usually enters the pelvis with the chin in the transverse position (mentotransverse) and 90% rotate to mentoanterior so that the head is born with flexion (Fig. 45.3 C) . If mentoposterior, the extending head presents an increasingly wider diameter to the pelvis, leading to worsening relative cephalopelvic disproportion and impacted obstruction (Fig. 45.3 D) . A caesarean section is usually required.

Brow presentation

This occurs in only approximately 1:700 and 1:1500 births and is the least favourable for delivery (Fig. 45.4) . The presenting diameter is mentovertical, measuring 14 cm. The supraorbital ridges and the bridge of the nose will be palpable on vaginal examination. The head may flex to become a vertex presentation or extend to a face presentation in early labour. If the brow presentation persists, a caesarean section will be required.

face presentation define medical

Fig. 45.4 Brow presentation.

Breech presentation

Breech presentation describes a fetus presenting bottom first. The incidence is around 40% at 20 weeks, 25% at 32 weeks and only 3–4% at term. The chance of a breech presentation turning spontaneously after 38 weeks is < 4%. Breech presentation is associated with multiple pregnancy, bicornuate uterus, fibroids, placenta praevia, polyhydramnios and oligohydramnios. It may also rarely be associated with fetal anomaly, particularly neural tube defects, neuromuscular disorders and autosomal trisomies. At term, 65% of breech presentations are frank (extended) with the remainder being flexed or footling (Fig. 45.5) . Footling breech carries a 5–20% risk of cord prolapse ( p. 367 ).

face presentation define medical

Fig. 45.5 Breech presentation.

Those presenting by the breech may be (A) extended (or frank); (B) flexed; or (C) footling.

Mode of delivery

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  • Pregnancy week by week
  • Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Illustration of the head-down, face-down position

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Illustration of the head-down, face-up position

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Illustration of the frank breech position

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

Illustration of a complete breech presentation

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

  • Down, with the back facing the birth canal.
  • Sideways, with one shoulder pointing toward the birth canal.
  • Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

Illustration of baby lying sideways

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

  • An attempt to deliver the baby in the breech position is not successful.
  • You do not want to try to have the baby delivered vaginally in the breech position.
  • An attempt to move the baby into a head-down position is not successful.
  • You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

Illustration of twins before birth

  • Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
  • Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
  • Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
  • Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
  • Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
  • Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
  • Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
  • Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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Home > Definitions > Birth Injury > Face Presentation

Face Presentation

face presentation define medical

Face presentation describes one way a baby may be positioned during delivery. In this article, we’ll define the term “face presentation” and explain how it relates to birth injury law.

Key Takeaways

  • Face presentation is when a baby is born with its face exposed
  • There are three types of face presentation: mentum anterior, mentum posterior, and mentum transverse
  • Risks associated with face presentation include breathing problems, brain damage, spinal cord injuries, and more
  • Risk factors of face presentation include premature birth, very low birth weight, cephalopelvic disproportion, and more
  • If a doctor’s improper handling of face presentation leads to birth injury, it may be considered medical malpractice 

What Is Face Presentation?

Face presentation is when babies are born with their face exposed. Typically, when a baby is born headfirst, its chin is tucked in toward its chest. This is called vertex presentation. In face presentation, the chin is not tucked and the neck is hyperextended, exposing the face. This can complicate the labor process and can potentially make vaginal delivery difficult and dangerous. 

Typically, medical staff will perform a vaginal examination to determine the position of the baby. If they suspect face presentation, they can confirm with an ultrasound scan. In order to properly handle the delivery of a fetus in face presentation, it is often required to do additional monitoring and sometimes an emergency cesarean section . They must also be ready to intubate the baby immediately upon delivery, as face presentation is associated with ventilation issues. 

Types of Face Presentation

There are three types of face presentation.

  • Mentum anterior (MA) - The chin is facing the front of the birthing parent and will be the presenting part of the face. Babies in the mentum anterior position are usually delivered vaginally.
  • Mentum posterior (MP) - The chin is facing the back of the birthing parent. The head, neck, and shoulders enter the pelvis at the same time, which is typically not large enough to accommodate it. Typically, a cesarean section is required.
  • Mentum transverse (MT) - The chin is facing the side of the birth canal. Vaginal birth is possible but a cesarean section is indicated if there are issues. 

Risks of Face Presentation

The risks associated with face presentation include:

  • Facial edema
  • Skull molding
  • Breathing problems
  • Prolonged labor
  • Fetal distress
  • Spinal cord injuries
  • Permanent brain damage
  • Neonatal death
  • Facial trauma
  • Low Apgar score

Risk Factors of Face Presentation

Some factors that may increase the risk of face presentation include:

  • When the birthing parent has previously given birth
  • Obesity of the birthing parent
  • Cephalopelvic disproportion , a mismatch in size between the parent’s pelvis and the baby’s head
  • Pelvis abnormalities in the birthing parent
  • Anterior neck mass
  • Prematurity
  • Anencephaly, a birth defect in which the baby is missing part of the brain and skull
  • Polyhydramnios, too much amniotic fluid
  • Very low birth weight
  • Previous cesarean delivery
  • Severe hydrocephalus with enlargement of the head
  • A large baby
  • The umbilical cord wrapped around the baby’s neck more than once

Face Presentation and Birth Injury Law

Because face presentation is associated with many complications, healthcare professionals must closely monitor the baby and be ready to proceed to cesarean section if there are signs of fetal distress or labor is not progressing. They must also be prepared to intubate the baby upon birth. If they fail to do any of these, it is considered negligence, and if it causes a birth injury , it may be deemed medical malpractice.

If your baby experienced a birth injury because your doctors didn’t adequately handle face presentation, you may be entitled to compensation. It is recommended that you speak with an experienced birth injury attorney to explore your options for proceeding with a lawsuit.

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Face presentation

Sudha Gayatri Konijeti

this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you. Read less

face presentation define medical

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  • 1. k.gayatri
  • 2.  DEFINITION: This is a rare variety of cephalic presentation where presenting part: is face attitude: complete flexion of limbs with extension of spine so that occiput is in contact with back denominator: mentum
  • 3. RIGHT OCCIPITO POSTERIOR LEFT MENTO ANTERIOR LEFT OCCIPITO POSTERIOR RIGHT MENTO ANTERIOR RIGHT OCCIPITO ANTERIOR LEFT MENTO POSTERIOR LEFT OCCIPITO ANTERIOR RIGHT MENTO POSTERIOR THE MOST COMMON POSITION IS left mento anterior AS RIGHT OCCIPITO POSTERIOR IS 5 TIMES MORE COMMON THAN LEFT OCCIPITO POSTERIOR
  • 4. MENTO ANTERIOR MENTOPOSTERIOR LEFTRIGHT
  • 5. Primary- during pregnancy Secondary- onset of labor Fetal : 1.congenital malformations a) anencephaly b) goitre c) dolichocephalic head d) bronchocoele 2.Twist of cord round the neck 3.Hypertonicity of extensor group of neck muscles Maternal: 1. Multiparity with pendulous abdomen 2. Lateral obliquity of uterus 3. Contracted pelvis 4. Flat pelvis 5. Pelvic tumours ETIOLOGY:
  • 6. PRODUCTION OF FACE PRESENTATION BY LATERAL OBLIQUITY OF UTERUS PRODUCTION OF FACE PRESENTATION IN FLAT PELVIS
  • 7. OCCIPITO ANTERIOR MENTO ANTERIOR Engagement Engagement Descent Descent Flexion Extension Internal rotation Internal rotation Extension Flexion Restitution Restitution External rotation External rotation Expulsion by lateral flexion Expulsion by lateral flexion
  • 9.  Diameter of engagement: OBLIQUE DIAMETER Right in LMA LEFT IN RMA MENTUM One pubic eminence GLABELLA Opposite sacro iliac joint ENAGAGING DIAMETER is SUBMENTOBREGMATIC-9.5CM Engagement is delayed because of long distance between mentum and biparietal plane i.e. 7cm where as to that of occiput is 3cm
  • 10.  Further descent occurs till submentum hinges under the pubic arch  INTERNAL ROTATION: occurs through 1/8th of the circle anteriorly placing mentum bheind the pubic symphysis
  • 11.  HEAD IS BORN BY  Diameter distending the vulval outlet is submentovertical-11.5cm RESTITUTION: occurs through 1/8th of circle Opposite to direction of internal rotation EXTERNAL ROTATION: occurs further 1/8th of the circle to the same side of restitution so that face looks left thigh right thigh in LMA In RMA FLEXION •CHIN •FACE •BROW •VERTEX •OCCIPUT •ANTERIOR •SHOULDER •POSTERIOR •SHOULDER •TRUNK BY •LATERAL •FLEXION DELIVERING
  • 13.  The principle differences between occipitoposterior and mentoposterior are 20-30%cases -anterior rotation of mentum occurs 70-80% cases INCOMPLETE ANTERIOR ROTATION NON ROTATION SHORT POSTERIOR ROTATION ANTERIOR ROTATION OF THE FETUS FROM RIGHT MENTOPOSTERIOR POSITION
  • 14.  Arrest occurs in all these positions with average size pelvis and foetal head  In short posterior rotation delivery there is no possibility of spontaneous delivery in mento posterior because short neck cannot clear off the total length of the sacrum i.e.12cm
  • 15.  As such thorax is thrust in resulting BREGAMTICO STERNAL DIAMETER-18CM to occupy the pelvis as a result labour is obstructed

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Obstetrics Simplified - Diaa M. EI-Mowafi

Face Presentation

It is a cephalic presentation in which the head is completely extended.

About 1:300 labours.

  • It is less common.
  • It occurs during pregnancy.
  • Anencephaly: due to absence of the bony vault of the skull and the scalp while the facial portion is normal.
  • Loops of the cord around the neck.
  • Tumours of the foetal neck e.g. congenital goitre.
  • Hypertonicity of the extensor muscles of the neck.
  • Dolicocephaly: long antero-posterior diameter of the head, so as the breadth is less than 4/5 of the length.
  • Dead or premature foetus.
  • Idiopathic.
  • It is more common. 
  • It occurs during labour.
  • Contracted pelvis particularly flat pelvis which allows descent of the bitemporal but not the biparietal diameter leads to extension of the head.
  • Pendulous abdomen or marked lateral obliquity of the uterus.
  • Further deflexion of brow or occipito - posterior positions.
  • Other causes of malpresentations as polyhydramnios and placenta praevia.
  • Right mento-posterior (RMP).           
  • Left mento-posterior (LMP).
  • Left mento-anterior (LMA).
  • Right mento-anterior (RMA), are the more common positions.
  • Right mento-transverse (lateral), left mento-transverse, direct mento-posterior and direct mento-anterior are rare and usually transient positions.

The first position (RMP) corresponds to the first normal position (LOA) as the back should be to the left and anterior in the first position. Mento-anterior are more common than mento-posterior as most cases arise from more deflexion of the head in occipito-posterior position usually in flat contracted pelvis.

During pregnancy (difficult)

  • The back is difficult to feel.
  • The limbs are felt more prominent in mento-anterior position.
  • The chin may be felt on the same side of the limbs as a horseshoe-shaped rim in mento-anterior position.
  • In mento-posterior, a groove may be felt between the occiput and the back particularly after rupture of the membranes.
  • Second pelvic grip: the occiput is at a higher level than the sinciput.
  • The FHS are heard below the umbilicus through the foetal chest wall in mento-anterior position.
  • Ultrasound or X-ray: confirms the diagnosis and may identify associated foetal anomalies as anencephaly.

During labour

Vaginal examination shows the following identifying features for face:

  • supra-orbital ridges,
  • the malar processes,
  • the nose (rubbery and saddle shaped),
  • the mouth with hard areolar ridges.

Late in labour, the face becomes oedematous (tumefaction) so it can be misdiagnosed as a buttock (breech presentation) where the two cheeks are mistaken with buttocks and the mouth with anus and the malar processes with the ischial tuberosities. The following points can differentiate in-between:

Mechanism of Labour

Mento-anterior position

  • Engagement by submento-bregmatic diameter 9.5 cm.
  • Increased extension.
  • Internal rotation of chin 1/8 circle anteriorly.
  • Flexion: is the movement by which the head is delivered in mento-anterior position when the submental region hinges below the symphysis. The vulva is much distended by the submento-vertical diameter 11.5 cm.
  • Restitution.
  • External rotation.

Engagement is delayed because:

  • The biparietal diameter does not pass the plane of pelvic inlet until the chin is below the level of the ischial spines and the face begins to distend the perineum.
  • Moulding does not occur as in vertex presentation.

Mento-posterior position

  • so the head is delivered as mento-anterior.
  • Deep transverse arrest of the face: when the chin rotates 1/8 circle anteriorly.
  • Persistent mento-posterior: when no rotation occurs.
  • Direct mento-posterior: When the chin rotates 1/8 circle posteriorly.

In the last 3 conditions no further progress occurs and labour is obstructed.

Direct mento-posterior, unlike direct occipito-posterior, cannot be delivered because:

  • Delivery should occur by extension while the head is already maximally extended.
  • As the length of the sacrum is 10 cm and that of neck is only 5 cm, the shoulders enter the pelvis and become impacted while the head still in the pelvis, thus the labour is obstructed.

Management of Labour

Exclude: - Foetal anomalies and - Contracted pelvis.

Mento-anterior

  • First stage: as in occipito-posterior.
  • Spontaneous delivery usually occurs.
  • Forceps delivery may be indicated in prolonged 2nd stage.
  • Episiotomy is necessary because of over distension of the vulva.

Mento-posterior

  • First stage: as mento-anterior.
  • Wait for long anterior rotation of the mentum 3/8 circle and the head will be delivered as mento-anterior. During this period oxytocin is used to compete inertia which is common in such conditions as long as there is no contraindication. Failure of this long rotation is more common than in occipito-posterior position so earlier interference is usually indicated.
  • Caesarean section: which is the safest and the current alternative in modern obstetrics.
  • Manual rotation and forceps extraction as mento-anterior, or
  • Rotation and extraction by Kielland forceps.
  • In the last 2 methods the head should be engaged but they are hazardous to both the mother and foetus so they are nearly out of modern obstetrics.
  • Craniotomy: if the foetus is dead.

The face of the foetus is oedematous after delivery so the mother is assured that this will be spontaneously relieved within few days.

Complications

See complications of malpresentations and malposition.

  • Dystocia : Guidelines, reviews

face presentation define medical

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

, MD, Children's Hospital of Philadelphia

Variations in Fetal Position and Presentation

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face presentation define medical

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

Uterine Fibroids

The fetus has a birth defect Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more .

There is more than one fetus (multiple gestation).

face presentation define medical

Position and Presentation of the Fetus

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

Sometimes the doctor can turn the fetus to be head first before labor begins by doing a procedure that involves pressing on the pregnant woman’s abdomen and trying to turn the baby around. Trying to turn the baby is called an external cephalic version and is usually done at 37 or 38 weeks of pregnancy. Sometimes women are given a medication (such as terbutaline ) during the procedure to prevent contractions.

Other presentations

In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.

In brow presentation, the neck is moderately arched so that the brow presents first.

Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor. If they do not, a cesarean delivery is usually recommended.

In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.

face presentation define medical

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  2. Basics to Facial Esthetics

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  3. Face presentation

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  4. Face Presentation: Causes, Diagnosis, Management, Complications by

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  5. Face presentation

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  6. Face presentation in delivery room: what is strategy?

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VIDEO

  1. Normal birth/face presentation

  2. Labour

  3. SEMINAR IN MANAGEMENT ACCOUNTING PART3

  4. The Face Lecture 2

  5. Presentation of fetus

COMMENTS

  1. Delivery, Face and Brow Presentation

    The term presentation describes the leading part of the fetus or the anatomical structure closest to the maternal pelvic inlet during labor. The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. The most common ...

  2. Face and Brow Presentation

    In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin. The fetal chin (mentum) is the point designated for reference during an ...

  3. Face and brow presentations in labor

    The vast majority of fetuses at term are in cephalic presentation. Approximately 5 percent of these fetuses are in a cephalic malpresentation, such as occiput posterior or transverse, face ( figure 1A-B ), or brow ( figure 2) [ 1 ]. Diagnosis and management of face and brow presentations will be reviewed here.

  4. Delivery, Face Presentation, and Brow Presentation ...

    Face Presentation: Definition: Face presentation occurs when the baby's face is positioned to lead the way through the birth canal instead of the vertex (head). ... We are an online medical resource dedicated to providing you with accurate and up-to-date information on a wide range of medical topics. But we're more than just an information hub ...

  5. Face Presentation

    Face presentation increases the risk of facial edema, skull molding, breathing problems (due to tracheal and laryngeal trauma), prolonged labor, fetal distress, spinal cord injuries, permanent brain damage, and neonatal death. Usually, medical staff conduct a vaginal examination to determine the position of the baby.

  6. Management of face presentation, face and lip edema in a primary

    Introduction. Face presentation is a rare unanticipated obstetric event characterized by a longitudinal lie and full extension of the foetal head on the neck with the occiput against the upper back [1-3].Face presentation occurs in 0.1-0.2% of deliveries [3-5] but is more common in black women and in multiparous women [].Studies have shown that 60 per cent of face presentations have one or ...

  7. Face presentation

    face presentation: presentation of any part of the fetal head, usually the upper and back part, as a result of flexion such that the chin is in contact with the thorax in vertex presentation; there may be degrees of flexion so that the presenting part is the large fontanel in sincipital presentation, the brow in brow presentation, or the face ...

  8. Face Presentation

    1 Definition. A type of cephalic presentation in which the presenting part is the face, the area between chin and glabella. The incidence varies from 1 in 500 to 1 in 1000 deliveries. Primary face presentation is rare. Secondary face presentation caused by extension of head during labor is common.

  9. Diagnosis and management of face presentation

    Abstract. Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different ...

  10. Face presentation

    Face presentation and transverse (cross) presentation are rare. In vertex presentations the head of the fetus most commonly faces to the right and slightly to the rear. This position is said to be the most usual one because the fetus is thus best accommodated to the shape of the uterus. In breech presentation the buttocks or the legs are the ...

  11. Malpresentations and Malpositions Information

    Malpresentation. Malposition. Usually the fetal head engages in the occipito-anterior position (more often left occipito-anterior (LOA) rather than right) and then undergoes a short rotation to be directly occipito-anterior in the mid-cavity. Malpositions are abnormal positions of the vertex of the fetal head relative to the maternal pelvis.

  12. Face presentation: Predictors and delivery route

    Cesarean delivery. Ethnicity. Face presentation occurs in approximately 1 in 600 to 1 in 800 deliveries at term. 1. and is associated with multiparity, cephalopelvic disproportion, macrosomia, and platypelloid pelvic anatomy. 2. , 3. Additionally, increased rates of fetal heart rate tracing abnormalities and trauma (eg, face, cervical spine ...

  13. 7.9 Face presentation

    Flex the head to obtain a vertex presentation: with one hand in the vagina, grasp the top of the skull and flex the neck, using the other hand, on the abdomen, to apply pressure to the foetal chest and buttocks. Obviously, the presenting part must not be engaged, and it is often hard—or impossible—to keep the head flexed (Figures 7.6).

  14. Malpresentations and malpositions

    Face presentation is usually only recognized after the onset of labour and, if the face is swollen (Fig. 45.3 B), it is easy to confuse this presentation with that of a breech. The position of the face is described with reference to the chin, using the prefix 'mento'. The presenting diameter is submentobregmatic (9.5 cm) (Fig. 45.1).

  15. Fetal presentation before birth

    When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

  16. Face Presentation

    In face presentation, the chin is not tucked and the neck is hyperextended, exposing the face. This can complicate the labor process and can potentially make vaginal delivery difficult and dangerous. Typically, medical staff will perform a vaginal examination to determine the position of the baby.

  17. Brow presentation

    brow presentation: presentation of any part of the fetal head, usually the upper and back part, as a result of flexion such that the chin is in contact with the thorax in vertex presentation; there may be degrees of flexion so that the presenting part is the large fontanel in sincipital presentation, the brow in brow presentation, or the face ...

  18. Face presentation

    The infrequency of face presentation in the practice of the average physician renders it difficult for him to formulate a definite plan of management on the basis of personal experience. Many excellent reviews on face presentation and its management have appeared in the literature in the past few years. Since most of the articles on this abnormal presentation, with its attendant difficult ...

  19. Face presentation

    Face presentation. May 2, 2016 •. 55 likes • 27,214 views. Sudha Gayatri Konijeti Follow. this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers ...

  20. Human face: anatomy, structure and function

    The human face is the most anterior portion of the human head. It refers to the area that extends from the superior margin of the forehead to the chin, and from one ear to another. The basic shape of the human face is determined by the underlying facial skeleton (i.e. viscerocranium ), the facial muscles and the amount of subcutaneous tissue ...

  21. Face Presentation

    Definition. It is a cephalic presentation in which the head is completely extended. Incidence. About 1:300 labours. Aetiology. Primary face: It is less common. It occurs during pregnancy. It is usually due to foetal causes which may be: Anencephaly: due to absence of the bony vault of the skull and the scalp while the facial portion is normal.

  22. The Trusted Provider of Medical Information since 1899

    The Trusted Provider of Medical Information since 1899

  23. Presentation

    presentation. (prĕz′ən-tā′shən, prē′zən-) n. Medicine. a. The position of the fetus in the uterus at birth with respect to the mouth of the uterus. b. A symptom or sign or a group of symptoms or signs that is evident during a medical examination: The patient's presentation was consistent with a viral illness. c.

  24. cephalic presentation

    cephalic presentation: [ prez″en-ta´shun ] that part of the fetus lying over the pelvic inlet; the presenting body part of the fetus. See also position and lie . breech presentation presentation of the fetal buttocks, knees, or feet in labor; the feet may be alongside the buttocks (complete breech presentation); the legs may be extended ...

  25. GHP Colloquium

    The infant mortality rate, or the probability that a child will not live to their first birthday, and maternal mortality rate are widely accepted indicators of population health and wellbeing. A greater proportion of people die from pregnancy and childbirth-related causes in the United States than any other high-income country in the world. Despite significant efforts, perinatal health ...