![]() In brow presentation, anterior fontanelle and face can be palpated except for the mouth and the chin. Based on the position of the chin, face presentation can be further divided into mentum anterior, posterior, or transverse. It is possible to palpate orbital ridges, nose, malar eminences, mentum, mouth, gums, and chin in face presentation. These malpresentations are usually diagnosed during the second stage of labor when performing a digital examination. Fetal risk factors include anencephaly, multiple loops of cord around the neck, masses of the neck, macrosomia, polyhydramnios. Maternal risk factors are preterm delivery, contracted maternal pelvis, platypelloid pelvis, multiparity, previous cesarean section, black race. These risk factors may be related to either the mother or the fetus. ![]() īoth face and brow presentations occur due to extension of the fetal neck instead of flexion therefore, conditions that would lead to hyperextension or prevent flexion of the fetal neck can all contribute to face or brow presentation. Brow presentation is considered the rarest of all malpresentation with a prevalence of 1 in 500 to 1 in 4000 deliveries. ![]() In brow presentation, the neck is not extended as much as in face presentation, and the leading part is the area between the anterior fontanelle and the orbital ridges. Incidence of face presentation is rare, accounting for approximately 1 in 600 of all presentations. This typically occurs because of hyperextension of the neck and the occiput touching the fetal back. The most common presentation in term labor is the vertex, where the fetal neck is flexed to the chin, minimizing the head circumference.įace presentation – an abnormal form of cephalic presentation where the presenting part is mentum. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. The term presentation describes the leading part of the fetus or the anatomical structure closest to the maternal pelvic inlet during labor. The critical distance to keep in mind is a. This distance corresponds with the true conjugate and is approximately 11 cm ( Figure 131-1A). The obstetric conjugate is the distance from the sacral promontory to a point on the inner surface of the pubic symphysis that is a few millimeters from the upper margin of the pubic symphysis ( Figure 131-1A). ![]() This distance represents the smallest diameter of the inlet and is normally 11 cm or more ( Figure 131-1A). The true conjugate can be estimated by subtracting 1.5 to 2 cm from the diagonal conjugate. However, this measurement cannot be made clinically. The true conjugate, a radiographic measurement of the pelvic inlet, is the distance from the sacral promontory to the superior aspect of the pubic symphysis ( Figure 131-1A). To measure the diagonal conjugate place the tip of the middle finger at the sacral promontory and note the point on the hand that contacts the pubic symphysis ( Figure 131-1B). A normal diagonal conjugate measures approximately 12.5 cm, with the critical distance being 10 cm. The diagonal conjugate refers to the distance from the inferior border of the pubic symphysis to the sacral promontory ( Figure 131-1A). ![]()
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