Other malpresentaton

Question 1

What other forms of malpresentation are there?

Answer 1

Face presentation

Brow presentation

Question 2

What is the incidence of

a) face?
b) brow?

Answer 2

a) 1 in 600-1500

b) 1 in 1000-3500

Question 3

What is brow presentation?

Answer 3

Head between full flexion and full extension (may revert to either)

Question 4

Is a vaginal delivery possible in brow presentation?

Answer 4

If it persists, no

Question 5

How is brow presentation diagnosed?

Answer 5

On vaginal exam, anterior fontanelle and supraorbital ridges may be palpated
Often diagnosed in advanced labour

Question 6

How is brow presentation managed?

Answer 6

Expectant

If progress or slow/presentation persists, LSCS indicated

Question 7

What are the main causes of face presentation?

Answer 7

Idiopathic extension of neck on engagement
Congential abnormalities (15%)
-Anencephaly
-Tumour
-Shortened foetal neck muscles

Question 8

What is felt on vaginal examination in face presentation?

Answer 8

Early - nose and eyes

Late - nothing notable (due to oedema)

Question 9

How do most face presentations engage?

Answer 9

Transverse (mentobregmatic diameter around 9.5cm)
90% rotate so chin lies behind symphysis (mentoanterior) and head can be born by flexion
If chin rotates to sacrum (mentoposterior), LSCS indicated

Question 10

Is operative delivery recommended?

Answer 10

Ventouse contraindicated

Forceps delivery possible as long as head is well below spines