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Face Presentation

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Face Presentation

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