Face Presentation

Compound Presentation
Face Presentation -occurs when an arm prolapses alongside the

presenting part. Both the prolapsed arm and
-caused by hyperextension of theftal head so the fetal head present in the pelvis
that neither the occipit nor the sinciput are simultaneously.
palpable on vaginal examination
MANAGEMENT
-abdominal examination a groovemay be felt
between the occipit and the back. 1.Replacement of the prolapsed arm
-on vaginal examination the face is aplapated  Assist the woman to assume the knee-
the examniners fingers enter the mouth easy chest position.
and bonyjaws are felt.  Push the arm above the pelvic brim and
hold it there until a contraction pushes
DIAGNOSIS the head into the pelvis.
 Chin serves as as the referece point in  Proceed with management for normal
describing the position of he head. Childbirth.
 It is necessary to distuinguish only chin- 2.If the procedurefails or cord prolapses, deliver
anteriorpositions in which the chin is by CS.
anterior in relation to the maternal
pelvis from chin posterior positions.
MANAGEMENT
 Prolonged labor is common.
 Descent and dlivery of the head by
flexionmay occur in the chin-anterior
position.
 In the chin-posterior position however
the fully extended head is blocked by DEFINITIONS
the sacrum. This prevents descent and
labouris impossible caesarean section  ABNORMAL LIE where the ong axis of
the fetus is not lying along the long axis
Shoulder Presentation of the mothere’s uterus.
-Occurs as a result of transverse lie or 1. TRANSVERSE
oblique lie. 2. OBLIQUE
3. UNSTABLE
-Predisposing factors= placenta previa,  Longitudal (may be either cephalic or
high parity, pelvic umor and uterine anomaly. breech) is NORMAL.
-Delivery should be CS.
-On abdominal examination neither the
head and the buttocks can be felt at the
symphysis pubis and the head is usuallyfelt in
the flank.
-On Vaginal examination a shoulder may
befelt but not always. Delay in diagnosis risk
cord prolapse and uterine rupture.
MALPOSITIONS  Especially in good uterine contraction,
spacious pelvis, average size fetus
 If arrest of labour occur in second stage
of labour
1. Emergency CS
2. Ventouse delivery.
Prolapse of the Umbilical Cord

FAC
TORS THAT FAVOUR MALPOSITION 1.Prolapse of the Umbilical Cord- a loop of the
umbilical cord slips down in front of the
presenting fetal part.
2.Prolapse may occur at any time after the
membranes rupture if the presenting fetal part
is not fitted firmly into the cervix.
Prolapse of the Umbilical Cord tent to occur
most often with:
 PROM
HOW TO DIAGNOSE:  Fetal presentation other than cephalic
 Course of labour is usually  Placena previa
normal,except for prolonged second
stage (>2hours)  Intrauterine tumors preventing the
 ABDOMINAL EXAMINATION presenting part from engaging
a) Lower part of the abdomen is  A small fetus
flattened
b) Difficult to palpate fetal back  CPD preventing firm engagement
c) Fetal limbs are palpable
 Hydramnios
anteriorly.
d) Fetal heart may be heard in the  Multiple gestation
flanks.
 Vaginal Examinations The incidence is about 0.5% of cephalic birth.
a) Posterior fontanelle towards Can rise aas high as 15% to 20 % with breech or
the sacral iliac joint (difficult) tranverse lies.
b) Anterior fontanelle is easily
feltif head deflexed. ASSESSMENT
c) Fetal head may be markedly
• Cord can be felt as the presenting part
molded with extensive caput,
on the initial vaginal examination
making diagnosing correct
during labor or can visualized on
stationand position difficult.
ultrasound.
MANAGEMENT
• Cord prolapse is first discovered only
 Spontaneous rotation to occiput after the membrane has ruptured.
anterior occur in 90% of cases.
• To rule out cord prolapse, always
assess fetal heart sounds immediately
after rupture of the membraners, vessel. Do not attempt to push any exposed
whether this occurs spontaneously or cord
by amniotomy.
back into the vagina because this could add to
Therapeutic Management the compression by causing knotting or kinking.
• Relieving pressure on the cord, thereby Multiple gestation
relieving the compression and the
resulting fetal anoxia. • Pregnancies with two or more fetuses.
• Have increases substantially over the
*Placing a gloved hand in the vagina
last 10 years as in vitro fertilization has
and manually elevating the fetal head off the become more popular and often
cord. produces a multiple pregnancy.
*Placing tn in a knee-chest or trendelenburg Abnormalities of the Passage
position.
Inlet Contraction- is the narrowing of the
*Administer oxygen at 10 l/min by face mask anteroposterior diameter of the pelvis to less 11
cm, or the tranverse diameter to 12 cm or less.
*A tocolytic agent may be prescribed
 Diagonal conjugate of less than 11.5
• Amnioinfusion = is the addition of a cm.
sterile fluid into the uterus.
– Asterile double lumen catheter
is introduced through the
cervix into the uterus.Is then
attached to IV tubing.
– A solution of warmed normal
saline or Lactated Ringers
solution is rapidly infused
– Initially, approximately 500ml is
infused and then the rate is
adjusted to infuse the least
amount necessary to maintain
an FHR monitor pattern Midpelvic contraction
without variable decelerations.
 Likely if:
Fetal Blood Sampling = Obtaining the fetal -ischial spines prominent
oxygen saturation level by inserting (interischial diam. <10 cm.)
fetal Pulse oximeter into the uterus to rest next -sidewalls convergent
to the fetal cheek or obtaining a positive -shallow sacral concavity
response to scalp stimulation usually supplies -narrow sacro-sciatic notch
the information as to whether a fetus is
becoming acidotic
If the cord has prolapsed to the extent it is
exposed to room air, drying will begin, leading
to constriction and atrophy of the umbilical
OUTLET
Pelvic outlet
Outlet contraction
*diminution of the interischial tuberous
diameter to 8 cm. or less
*sub-pubic angle < 90˚
*mobility of coccyx

Face Presentation

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Face Presentation

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Compound Presentation

Face Presentation -occurs when an arm prolapses alongside the

Prolapse of the Umbilical Cord

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