Face Presentation

Subject: Midwifery II (Theory)

Overview

When the head is fully extended, the occiput of the fetus comes into touch with its spine, and the face appears. The denominator is mentum. Multiparity with the pendulous abdomen, anterior obliquity of the uterus, constricted pelvis, and Polyhydramnios is the maternal reasons for Face presentation. And the fetal cause is congenital anomalies, cord twisting, and increased tone of the extensor group of neck muscles. Management is the standard method for occipito anterior positions, while additional instructions for occipito posterior positions must be followed. When the face appears at the vulva, the extension must be maintained by holding back the sinciput and allowing the mentum to escape under the symphysis pubis before the occiput is permitted to move.

The occiput of the fetus will be in contact with its spine and the face will be seen when the head is fully extended. The common denominator is mentum.

Causes

Maternal Causes

  • Pendulous abdomen and multiparity
  • Contracted pelvis 
  • Anterior obliquity of the uterus
  • Polyhydramnios

Fetal Causes

  • Congenital abnormalities
  • Twist of the cord
  • Increased tone of the extensor group of neck muscles

Management

1st stage

  • Management is the standard technique for occipito anterior positions, with special instructions for occipito posterior positions to be followed.
  • Immediately following membrane rupture, a PV exam should be undertaken to rule out cord prolapse due to an ill-fitting presenting component.

2nd stage: should wait for spontaneous delivery

  • Extension must be maintained when the face appears at the vulva by holding back the sinciput and allowing the mentum to escape under the symphysis pubis before allowing the occiput to sweep the perineum.
  • Instead of the mento vertical diameter, the sub mento vertical diameter (11.5cm) dilates the vaginal opening (13.5) To avoid significant perineal injury, an elective episiotomy may be performed.
  • If the head is not engaged in the second stage and rotation is insufficient, the patient should be prepared for a cesarean section.

3rd stage

  • The same precautions as in the occipito posterior position must be taken.

References

 
Things to remember
  • The occiput of the fetus will be in contact with its spine and the face will be seen when the head is fully extended.
  • The common denominator is mentum. Face presentation is caused by multiparity with the pendulous abdomen, anterior obliquity of the uterus, restricted pelvis, and Polyhydramnios.
  • Congenital anomalies, cord twisting, and elevated tone of the extensor group of neck muscles are the fetal causes.
  • Management is the standard technique for occipito anterior positions, with special instructions for occipito posterior positions to be followed.
  • Extension must be maintained when the face appears at the vulva by holding back the sinciput and allowing the mentum to escape under the symphysis pubis before allowing the occiput to sweep the perineum.
  • If the head is not engaged in the second stage and rotation is insufficient, the patient should be prepared for a cesarean section.
Questions and Answers

Face Presentation

When the attitude of the head is one of the complete extension the occiput of the fetus will be in contact with its spine and the face will present. The denominator is mentum.

Causes

Maternal causes

  • Multiparity with pendulous abdomen,
  • Anterior obliquity of the uterus,
  • Contracted pelvis,
  • Polyhydramnios.

Management

1st Stage

  • Following the specific instructions outlined in the occipito posterior positions is standard procedure for management in the occipito anterior positions.
  • PV examination should be carried out as soon as the membrane ruptures to rule out cord prolapse caused by an improperly fitting presenting part.

2nd Stage : Should wait for spontaneous delivery

  • Extension must be kept when the face appears at the vulva by holding back the sinciput and allowing the mentum to escape under the symphysis pubis before allowing the occiput to sweep the perineum.
  • Thus, rather than the mento vertical diameter, the vaginal orifice is dilated by the sub mento vertical diameter (11.5 cm). To prevent a significant amount of perineal laceration, an elective episiotomy may be performed.
  • The patient needs to be ready for a caesarean section if the head is not engaged during the second stage and when rotation is not complete.

3rd Stage

  • Same precautions like those observed in occipito posterior position are to be taken.

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