This is the second part of my FACE PRESENTATION ppt .look at this and give me your comments below, thankyou.

1. DIAGNOSIS &
MANAGEMENT OF FACE
PRESENTATION
k.gayatri

2. ANTENATAL DIAGNOSIS – RARELY MADE
DURING LABOUR ONLY DIAGNOSIS CAN BE MADE BUT
SOMETIMES AT THE TIME OF DELIVERY ALSO
DIAGNOSIS
1.ABDOMINAL EXAMINATION
2.VAGINAL EXAMINATION
3.RADIOGRAPHY/SONOGRAPHY

3. Diagnosis is made by
position of the chin.
It is necessary to
distinguish between
mento anterior and
mento posterior
positions

4. ABDOMINAL EXAMINATION
INSPECTION:
S shaped spine
No visible bulging of the
flanks
AUSCULATATION:
FHS is directly audible
anteriorly through the
chest wall –MA
FHS is not so distinct and
is audible on the flank
towards the side of
limbs-MP
PALPATION:
MENTOANTERIOR MENTOPOSTERIO
R
Lateral grip • Foetal limbs are felt
anteriorly
• Back is on the flank
• Chest is thrown
anteriorly against
uterine wall and
mistaken for back
• Back is felt to
the front
Pelvic grip • Head seems big and
not engaged
• Cephalic prominence
is towards the side
which back lies
• Groove between head
• Same
• Same
• prominent

5. MENTO
ANTERIOR
MENTOPOSTERIO
R
PALPATION

6. VAGINAL EXAMINATION
Palpation:
mouth with hard alveolar ridges
nose
malar eminences
supraorbital ridges
mentum

7. IT IS OFTEN CONFUSED WITH
BREECH PRESENTATION
Late in labour the face become edematous
(TUMEFACTION), so it can be misdiagnosed as breech
presentation where
 THE CHEEKS ARE MISTAKEN FOR BUTTOCKS
 MOUTH WITH ANUS
MALAR PROCESS WITH ISCHIAL TUBEROSITIES
Differences are:
Face presentation Breech
presentation
Mouth and malar eminences are not
in line
They form a triangle
Anus and ischial
tuberosities are in line
Finger is sucked in during Not sucked
Mouth and malar
eminenences form a
triangle

8. ULTRASOUND TO CONFIRM THE
DIAGNOSIS, EXCLUDE ANY BONY
MALFORMATIONS OF THE BABY, SIZE
OF THE BABY
CLINICAL COURSE:
It is adversely affected because
Irregular face
ill fits
Chance of
cord
prolapse
Delay of
labour
• Weak uterine
contracations
• Absence of
moulding action
of facial bones
• Delayed
engagement
• Late internal
rotation
• Arrest in mento
Chance of
perineal
damage
Post partum
haemorrhage

9. PERINEAL DAMAGE: IT is more because the wide BIPARIETAL
DIAMETER(9.5cm) stretches the perineum and SUBMENTOVERTICAL
DIAMETER(11.5cm) emerges out of the introitus.
11.5c
m

10. PROGNOSIS
MATERNAL
1. In mento anterior-good
prognosis
2. In mento posterior-
obstructed labour and
rupture of the uterus
FOETAL
Adversely affected due to
1. Cord prolapse
2. Increased time of delivery
3. Cerebral congestion due
topoor venous return from the
head and neck due to
extension of the neck
4. Neonatal infection due to
bacterial contamination within
the vagina

11. MANAGEMENT
MENTOANTERIOR
FIRST STAGE :WATCHFUL
EXPECTANCY LABOUR IS
CONDUCTED IN THE USUAL
PROCEDURE.
SECOND STAGE: LIBERAL
MEDIOLATERAL EPISOTOMY TO
PREVENT PERINEAL DAMAGE
FORCEPS DELIVERY CAN BE DONE
MENTOPOSTERIOR
FIRST STAGE: IN UNCOMPLICATED CASES
VAGINAL DELIVERY IS ALLOWED UNDER STRICT
VIGILANCE HOPING FOR SPONTANEOUS ANTERIOR
ROTATION OF THE BABY
SECOND STAGE:
IF ROTATION OCCURS: SPONTANEOUS OR
FORCEPS DELIVERY CAN BE DONE
IN INCOMPLETE ROTATION OR MALROTATION:
LSCS
MANUAL ROTATION NOT DONE USUALLY THESE
DAYS