This document discusses face presentation during childbirth. It begins by defining face presentation and listing the possible positions including right and left mento anterior and posterior. It then discusses the incidence, etiology, and maternal and fetal causes. It provides details on the two most common positions, left mento anterior and mento posterior, including engaging diameters, likelihood of vaginal delivery, and cardinal movements. It concludes by outlining the management approaches for mento anterior and mento posterior presentations during the first and second stages of labor, including options like cesarean section or manual rotation and forceps delivery if needed.
2. • Lie : longitudinal
• Presentation : cephalic
• Presenting part : face
• Abnormal attitude : complete extension
• position : 1) right mento posterior
2) left mento posterior
3) left mento anterior (most common)
4) right mento anterior
3. Incidence : 1in 500 births
Etiology: Extreme extension of the head
Factors associated are
MATERNALCAUSE
• Multiparity with pendulous
abdomen
• Contracted pelvis
• Lateral obliquity of uterus
• Pelvic tumors
FETAL CAUSE
• Twist of cord
• Increased tone of the extensor
group of neck muscles
• Congenital malformations
• Anencephaly
• Congenital goiter
4. MENTO ANTERIOR (60-80%)
• MOST COMMON POSITION- Left mento anterior
• ENGAGING DIAMETER- Submentobregmatic (9.5 cm)
• Vaginal delivery is possible
• Head is delivered by the movement of flexion
5. MENTO POSTERIOR (20-25%)
• The cardinal movements in the mechanism
of mentoposterior are similar to those of
occipitoposterior position.
• In mentoposterior position anterior rotation
of the mentum occurs only in 20-30% cases.
• The rest 70-80% incomplete anterior
rotation.
6. Diagnosis
• VAGINAL EXAMINATION -Palpation of mouth with hard alveolar
margins, nose, mentum.
• SONOGRAPHY- Done to confirm the diagnosis and to exclude bony
congenital malformations.
• ABDOMINAL FINDINGS- Palpation
7. MANAGEMENT
MENTOANTERIOR
• FIRST STAGE
Wait and watch policy
Labour is conducted in
usual procedure and special
instructions
• SECOND STAGE
Wait for spontaneous
delivery to occur.
Perineum shouldbe protected
with liberal mediolateral
episiotomy.
8. MENTOPOSTERIOR
FIRST STAGE
• In uncomplicated cases,
vaginal delivery is allowed
with strict vigilance.
SECOND STAGE
• If anterior rotation of chin
occurs- spontaneous or forceps
delivery with episiotomy.
• If malrotation of the chin
occurs
-Cesarean section(preferred)
-Manual rotation of the chin
anteriorly followed by immediate
forceps extraction.
