A brow presentation occurs when the fetal head is midway between flexion and extension during labor. It is diagnosed by feeling the occiput and sinciput at the same level during pregnancy or seeing the frontal bones, supra-orbital ridges, and root of the nose but not the chin during vaginal exams. A persistent brow presentation has no mechanism for labor due to a longer engagement diameter, so cesarean section is required if in the second stage or living, while craniotomy is needed if deceased. Transient brow may convert allowing vaginal delivery, so careful observation is given in early labor before deciding on surgery.

1. Brow Presentationwww.freelivedoctor.com

2. Brow PresentationDefinitionIt is a cephalic presentation in which the head is midway between flexion and extension.IncidenceAbout 1:1000 labour.www.freelivedoctor.com

3. DiagnosisDuring pregnancy: It is difficult.The occiput and sinciput may be felt at the same level.Ultrasonography and X-ray may be helpful.www.freelivedoctor.com

4. DiagnosisDuring labour:In addition to the previous findings, vaginal examination reveals the following features:> frontal bones,> supra-orbital ridges, and>root of the nose but not the chin.www.freelivedoctor.com

5. Mechanism of Labour* Persistent brow: 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.* Transient brow: 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.www.freelivedoctor.com

6. Management* Early in the first stage:> Exclude contracted pelvis, if present do caesarean section.> The case is considered as transient brow, observed carefully and given a chance for spontaneous conversion into either face or vertex.>The rest of management as other malpresentation.www.freelivedoctor.com

7. Management * Early in the first stage:> Exclude contracted pelvis, if present do caesarean section. >The case is considered as transient brow, observed carefully and given a chance for spontaneous conversion into either face or vertex. > The rest of management as other malpresentation.www.freelivedoctor.com

8. ManagementIn the second stage: The case is considered as persistent brow so:> Caesarean section is done if the foetus is living.> Craniotomy if the foetus is dead.www.freelivedoctor.com