I. Pathophysiology

  1. Normal Attitude: Fetus is in full flexion
    1. Smallest fetal head diameter: Suboccipitobregmatic
  2. Face Presentation is an extended attitude
    1. Results in largest head diameter: Occipitomental
    2. Increases diameter 3 cm (24%) over flexed head
    3. May results in Failure to Progress

II. Epidemiology

  1. Incidence: 0.1 to 0.2% of singleton deliveries

III. Definition

  1. Head hyperextended, with face as presenting part

IV. Causes

  1. Grand multiparous patients
  2. Large fetus and contracted Pelvis
  3. Neck swelling (e.g. Cystic Hygroma, ThyroidGoiter)
  4. Anencephaly

V. Signs

  1. Digital cervical exam
    1. Facial features palpable (mouth, nose)

VI. Differential Diagnosis

  1. Breech Presentation (much more common than face)

VII. 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

Images: Related links to external sites (from Google)

Ontology: Face presentation (C0233269)

Definition (NCI) A fetal position during delivery in which the face of the fetus is first to descend into the birth canal.
Concepts Finding (T033)
SnomedCT 199368006, 21882006, 156159007, 267327001
English Face presentation NOS, face presentation of fetus (diagnosis), face presentation of fetus, face presentation, face presentation (physical finding), Face presentation NOS (finding), Face Presentation, Face presentation, Face presentation (finding), presentation; face
Italian Presentazione di faccia
Japanese 顔位, ガンイ
Spanish Face presentation, presentación de cara (hallazgo), presentación de cara, SAI (hallazgo), presentación de cara, SAI, presentación de cara, Presentación de cara
Czech Obličejová poloha
Hungarian Arctartás
Dutch ligging; aangezicht, aangezichtsligging
Portuguese Apresentação de face
French Présentation de la face
German Gesichtslage