Module 3 Malpresentation

Face presentation
Definition
 Face presentation is common than brow
 Mentum is the denominator
 Head is in total extension
 Baprietal diameter is 9,5cm
 Submentobregmatic is 9,5 cm
 Second stage of labour is difficult
 Mento posterior position cannot be delivered
Causes
 Anterior obliquity of the uterus
 Contracted pelvis
 Polyhydramnios
 Congenital abnormality
Diagnosis
 Antenatal presentation –rare since face presentation develops
during labour.
 Intrapartum
Abdominal palpation- limbs may be palpated on opposite to
occiput
-in posterior position , Fetal heart is difficult to hear
Vaginal examination
-presenting part is high, soft and irregular
- On sufficient dilatation, orbital ridges, eyes,nose & mouth may be
felt
- Fetus may suck the finger
- Face becomes oedematous
Mechanism of labour
 Lie is longitudinal
 Attitude is one of extension of head and neck
 Presentation is face
 Position is left mentoanterior
 Denominator is mentum
 Presenting part is left malar bone
 Nb: read through mechanism of labour (myles
for midwives, 579)
Possible course & outcome
 Prolonged labour
 Mento posterior position
 Mento anterior positions
 Persistent mento posterior position
 Reversal of face presentation
Management of labour
• First stage
Inform the doctor about abnormality
Monitor maternal and fetal well being
Exclude cord prolapse after rupture of
membranes
Perform vaginal examination 2-4 hourly
If head remains high , C/S is likely
Birth of the head
 Maintain extension of face by holding back
the sinciput
 Permitting the mentum to escape under
symphysis pubis before occiput
 Elective episiotomy may be performed
 If no descend inform doctor
 Forcep delivery may be conducted
 C/S if face is impacted
Maternal Complications
 Prolonged labour & maternal distress
 Presentation and prolapse of the umbilical cord
 Obstructed labour
 Uterine rupture and trauma to bladder
 Maternal death
 Puerperal infections
Fetal complications
 Fetal distress
 Intrauterine death (IUD)
 Asphyxia neonatorum
 Birth injuries
 Neonatorum infections
 Neonatal death
 Obstructed labour
 Cord prolapse
 Face bruising
 Cerebral haemorrhage
 Maternal trauma
 Module 3

Brow presentation
Definition
 Fetal head is partially extended with frontal
bone
 Bounded by anterior fontanelle & orbital
ridges, lying at pelvic brim
 Presenting diameter of 13,5 cm in an
average sized pelvis
 Incidence 1:1 000 deliveries
Causes
 Same as for secondary face presentation
 During the process of extension from a
vertex to a face presentation
 Brow will present temporarily
 Few cases persist
Diagnosis
 Brow is not detected before onset of labour
 Abdominal palpation- head is high & no
descent despite good contractions
 Vaginal examination-presenting part is high
- anterior fontanelle
may be felt on one side of pelvis & orbital
ridges
-large caput may mask landmarks
Management
 Inform doctor immediately
 Woman with large pelvis and small baby may give
birth vaginally
 When brow reaches the pelvic floor , maxilla
rotates forward
 Head is born by a mechanism of a persistent OPP
 Inform mother about possible course of labour
 Vaginally birth is unlikely
Complications
 Same as face presentation
 C/S is probable
References
 See prescribed books