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Face Presentation
Aka: Face Presentation
- Pathophysiology
- Normal Attitude: Fetus is in full flexion
- Smallest fetal head diameter: Suboccipitobregmatic
- Face Presentation is an extended attitude
- Results in largest head diameter: Occipitomental
- Increases diameter 3 cm (24%) over flexed head
- May results in Failure to Progress
- Epidemiology
- Incidence: 0.1 to 0.2% of singleton deliveries
- Definition
- Head hyperextended, with face as presenting part
- Causes
- Grand multiparous patients
- Large fetus and contracted Pelvis
- Neck swelling (e.g. Cystic Hygroma, ThyroidGoiter)
- Anencephaly
- Signs
- Digital cervical exam
- Facial features palpable (mouth, nose)
- Differential Diagnosis
- Breech Presentation (much more common than face)
- 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
