2. Definition
• All presentations of the fetus other than
vertex are called malpresentations
Presentation Incidence
Vertex 96%
Breech 3-4%
Shoulder 1:300
Face 1:500
Brow 1:1500
Compound 1:1200
4. Definition
• Face presentation is a type of cephalic
presentation in which the presenting part is
the face
• Head is hyperextended such that occiput is in
contact with fetal back and the chin is the
denominator
• Primary face presentations are present before
onset of labour. Secondary face presentations
are caused by extension during labour
5. Etiology
Factors which favour extension of head or
prevent flexion of head
Maternal causes Fetal causes
High parity with lax abdomen Congential malformations
Inlet pelvic contraction Congenital goitre
Obliquity of uterus Macrosomic fetus
Advanced maternal age Prematurity
Multiple pregnancy Increased tone of extensor
group of neck muscles
Polyhydramnios Loops of cord around neck
Cornual implantation of
placenta
Long AP diameter of skull
( Dolicocephaly)
Any pelvic mass
7. Face presentation Breech Presentation
Mouth and malar eminence form
a triangle
Ischial tuberosities and anus are
in line
Alveolar margins are hard Anal margins are soft to feel
Sucling effect of mouth Grip of anal sphincter is felt
No meconium staining on finger Meconium staining on finger
9. • Mento posterior presentation in labour is an
indication for caesarean delivery
10. Complications
Maternal Fetal
Prolonged labour Edematous and swollen face after delivery
Maternal morbidity due to operative
delivery
Laryngeal edema
Obstructed labour Cord prolapse
Post partum uterus Neonatal sepsis
Rarely rupture uterus Birth asphyxia
12. Definiton
• Attitude of fetus is that of partial extension in
which denominator is
brow/sinciput/frontum/froehead
• This is the least common type
• Presenting diameter is mento- vertical (14cm)
which is the largest
16. Definition
• In Transverse lie, longitudinal axis of fetus is
approximately at right angle to long axis of
maternal spine or centralised uterine axis
• In Oblique lie, longitudinal axis of fetus forms
an acute angle with the maternal spine
• Unstable lie is also used for this presentation
• Both these lie result in shoulder presentation
17. Etiology
• Factors which prevent engagement of fetal
head or breech
Maternal causes Fetal causes
Multiparity (80%) Prematurity
Placenta previa Multiple pregnancy (more in second
twin)
Contracted pelvis in primigravidas Fetal malformations
Hydramnios Fetal death ( lack of muscle tone)
Uterine malformations (bicornate,
arcuate, septate, sub septate uterus)
Any Pelvic mass (fibroid, ovarian mass)
Fundal insertion of placenta
