II. Definitions
- Face Presentation
- Head hyperextended, with face as presenting part
III. Epidemiology
- Incidence: 0.1 to 0.2% of singleton deliveries (1 in 550 live births)
IV. Pathophysiology
- Normal Attitude: Fetus is in full flexion
- Smallest fetal head diameter: Suboccipitobregmatic
- Face Presentation is an extended attitude
- Full extension of fetal head with occiput against upper back
- Results in largest head diameter: Occipitomental
- Increases diameter 3 cm (24%) over flexed head
- May results in Failure to Progress
V. Causes
- Grand Multiparous patients
- Large fetus and contracted Pelvis
- Neck swelling (e.g. Cystic Hygroma, Thyroid Goiter)
- Anencephaly
VI. Signs
- Digital cervical exam
- Facial features palpable (mouth, nose)
VII. Differential Diagnosis
- Breech Presentation (much more common than face)
VIII. Management
- Do not attempt to convert Face Presentation to vertex
- Never apply vacuum extractor to Face Presentation
- Do not apply internal scalp electrodes
- Avoid Oxytocin in most cases
- Consider large episiotomy if fetus delivers vaginally
IX. Associated Conditions
X. Complications
- Increased perinatal mortality: 2-3%