Brow presentation

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Brow presentation

  1. 1. Brow Presentation<br />www.freelivedoctor.com<br />
  2. 2. Brow Presentation<br />Definition<br />It is a cephalic presentation in which the head is midway between flexion and extension.<br />Incidence<br />About 1:1000 labour.<br />www.freelivedoctor.com<br />
  3. 3. Diagnosis<br />During pregnancy:<br /> It is difficult.<br />The occiput and sinciput may be felt at the same level.<br />Ultrasonography and X-ray may be helpful.<br />www.freelivedoctor.com<br />
  4. 4. Diagnosis<br />During labour:<br />In addition to the previous findings, vaginal examination reveals the following features:<br />> frontal bones,<br />> supra-orbital ridges, and<br />>root of the nose but not the chin.<br />www.freelivedoctor.com<br />
  5. 5. Mechanism of Labour<br />* Persistent brow:<br /> The engagement diameter is the mento-vertical 13.5 cm which is longer than any diameter of the inlet so there is no mechanism of labour and labour is obstructed.<br />* Transient brow:<br /> may occur during conversion of vertex into face presentation. So if brow is flexed to become vertex or extended to become face it may be delivered.<br />www.freelivedoctor.com<br />
  6. 6. Management<br />* Early in the first stage:<br />> Exclude contracted pelvis, if present do caesarean section.<br />> The case is considered as transient brow, observed carefully and given a chance for spontaneous conversion into either face or vertex.<br />>The rest of management as other malpresentation.<br />www.freelivedoctor.com<br />
  7. 7. Management<br /> * Early in the first stage:> Exclude contracted pelvis, if present do caesarean section.<br /> >The case is considered as transient brow, observed carefully and given a chance for spontaneous conversion into either face or vertex.<br /> > The rest of management as other malpresentation.<br />www.freelivedoctor.com<br />
  8. 8. Management<br />In the second stage: The case is considered as persistent brow so:<br />> Caesarean section is done if the foetus is living.<br />> Craniotomy if the foetus is dead.<br />www.freelivedoctor.com<br />

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