Face, Forehead, and Transverse Presentations

Face Presentation

• Definition: A longitudinal presentation where the fetal head is tilted maximally backward, with the chin presenting.

• Causes:

• Primary: Narrow pelvis, uterine anomalies, large fetus.

• Secondary: Failure of the vertex presentation to descend well.

• Signs:

• External examination: Chin-jaw sign.

• Internal examination: Nose, mouth, and chin can be felt.

• Prognosis: Labor is more difficult than with a vertex presentation.

• Management:

• If the chin faces forward: Vaginal delivery may be possible.

• If the chin faces backward: Cesarean delivery is usually necessary.

• Note:

• The perineum is often subjected to complex lacerations due to the final descent of the chin-suboccipital diameter.

• Diagnosis is confirmed when the presenting part is felt at the cervical os.

Forehead Presentation

• Definition: A head presentation where the forehead is presenting before the superior strait.

• Signs:

• External examination: Chin-jaw sign.

• Internal examination: The forehead prominence is higher than the occiput.

• Prognosis: Vaginal delivery is not possible with a full-term fetus.

• Management: Cesarean delivery.

• Note: Diagnosis is confirmed when the presenting part is felt at the cervical os.

Transverse Presentation

• Definition: A presentation where the fetal axis is perpendicular to the uterine axis, with the shoulder presenting.

• Causes:

• Multiparity.

• Uterine anomalies.

• Narrow pelvis.

• Signs:

• The uterus is transversely enlarged.

• Internal examination: Feet or the shoulder can be felt.

• Prognosis:

• Risk of cord prolapse when the membranes rupture.

• Risk of uterine rupture during labor.

• Management:

• During the second trimester: Continue pregnancy monitoring.

• During labor: Cesarean delivery.

General Notes on Abnormal Presentations:

• Abnormal presentations may be managed in hospitals with surgical capabilities.

• A brow presentation can sometimes become a vertex presentation if the head flexes better.

Distinguishing Between Presentations:

• Forehead presentation can be confused with vertex, face, and brow presentations.

• Transverse presentation can be confused with a vertex presentation with a limb prolapse or a complete breech presentation.

Conclusion:

Face, forehead, and transverse presentations are abnormal presentations that often cause difficulties during labor and delivery. Understanding these presentations helps physicians make accurate diagnoses and provide timely management, ensuring the safety of both the mother and fetus.