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Face presentation

  1. The attitude of the fetus shows complete flexion of the limbs with extension of the spine. There is complete extension of the head so that the occiput is in contact with the back.
  2. The denominator is mentum.
  3. The commonest position is left mento-anterior (LMA)
  4. Face presentation present during pregnancy (primary) is rare, while that developing after the onset of labor (secondary) is common. It occurs more frequently seen in multiparae (70%).
  5. Most common maternal cause is contracted pelvis and most common fetal cause is anencephaly
  6. The diameter of engagement is the oblique diameter-right in LMA, left in RMA
  7. The engaging diameter of the head is submento-bregmatic 9.5 cm (3 3/4") in fully extended head or submentovertical 11.5 cm (4 1/2")
  8. Engagement is delayed because of long distance between the mentum and biparietal plane (7 cm)
  9. The head is born by flexion delivering the chin, face, brow, vertex and lastly the occiput.
  10. The diameter distending the vulval outlet is submento-vertical-11.5 cm (4 1/2")
  11. Moulding: Due to poor venous return from the head and neck, marked caput forms, distorting the entire face
  12. There is no compression of the facial bones but there is elongation of occipito-frontal diameter


  1. Brow is the rarest presentation.
  2. Most common cause - Flat pelvis
  3. Engaging diameter – Mentovertical (14 cm)
  4. Brow is commonly unstable and converts into either vertex or face.
  5. Supraorbital ridges and anterior fontanelle can be palpated on P /v examination.
  6. There is no mechanism of labor in persistent brow presentation. Delivery is by LSCS.
  7. It is associated with contracted pelvis or fetal macrosomia.

Extra Edge: Common causes in face, brow, breech presentation









Engaging Diameters


Engaging diameter

• Occipito posterior

• Sub occipito frontal (deflexed head)

• Occipito frontal (Further deflexed head)

• Face

• Submentovertical (Partially extended head)

• Submentobregmatic (In fully extended head)

• Brow

• Mentovertical

• Breech

- Of breech

- Of shoulder

- Of head


- Bitrochanteric

- Bisacromial

- Suboccipito-frontal


Transverse Lie

  1. The dorsoanterior position is most common (60%).
  2. In dorsoposterior, the chance of fetal extension is common with increased risk of arm prolapse and cord prolapse.


  1. Multiparity
  2. Prematurity
  3. Multiple pregnancy
  4. Polyhydramnios
  5. Uterine anomalies
  6. Placenta previa
  7. Pelvic tumors (fibroids/ovarian cysts)
  8. CPD

There is no mechanism of labor in transverse lie. Delivery is by LSCS.


If the fetus is small (usually <800 g) and the pelvis is large, spontaneous delivery is possible in transverse lie. The fetus is compressed with the head forced against the abdomen. A portion of the thoracic wall below the shoulder thus becomes the most dependent part, appearing at the vulva. The head and thorax then pass through the pelvic cavity at the same time, and the fetus, which is doubled upon itself, is expelled-this is referred to as conduplicato corpora.

Guidelines for the management of transverse lie



During labour

External cephalic version in all cases beyond 35 weeks


If version fails or is contraindicated


Cesarean section at 38 weeks

Before / Early labour


When liquor is adequate


External cephalic version


If version fails/contra-indicated


Cesarean section

Active / Late labour with membranes ruptured and inadequate liquor


Cesarean section


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