Malpresentations and Positions & Operative Obstetrics
Which of the following is the most appropriate management of a face presentation with no fetal distress and an adequate pelvis, as determined by digital examination?
|A||Perform immediate cesarean section without labor|
|B||Allow spontaneous labor with vaginal delivery|
|C||Perform forceps rotation in the second stage of labor to convert mentum posterior to mentum anterior and to allow vaginal delivery|
|D||Allow to labor spontaneously until complete cervical dilation is achieved and then perform internal podalic version with breech extraction|
Allow spontaneous labor with vaginal delivery
a. In the event of a face presentation, successful vaginal delivery will occur the majority of the time with an adequate pelvis. Spontaneous internal rotation during labor is required to bring the chin to the anterior position, which allows the neck to pass beneath the pubis.
b. Therefore, the patient is allowed to labor spontaneously; a cesarean section is employed for failure to progress or for fetal distress.
c. Manual conversion to vertex, forceps rotation, and internal version are no longer employed in obstetrics to deliver the face presentation because of undue trauma to both the mother and the fetus.