SEPTEMBER JOGC SEPTEMBRE 2012 l 801

IMAGE OF THE MONTH

Mento-Anterior Face Presentation in a PrimigravidaAllison Thiele, MD, PhD,1 Karen Fordham, MD,2 Olanrewaju Onasanya, MD, FRCSC3

1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Regina SK2College of Medicine, University of Saskatchewan, Regina SK3Department of Obstetrics and Gynecology, Regina Qu’Appelle Health Region, Regina SK

J Obstet Gynaecol Can 2012;34(9):801

A 23-year-old primigravida presented at 40+1 weeks’ gestation in spontaneous labour after an

uncomplicated pregnancy. Electronic fetal monitoring remained normal throughout labour. With active pushing in the second stage of labour it became clear that the fetus was in face presentation, mento-anterior (Figure). Shortly afterwards the patient spontaneously delivered a female infant weighing 3240 g, with Apgar scores of 8 at one minute and 9 at five minutes.

Face presentations can occur in the mentum anterior, transverse, or posterior positions. The incidence is 0.125% to 0.3% of vaginal deliveries.1 Associated factors include anencephaly, prematurity, fetal macrosomia, cephalo-pelvic disproportion, and high parity.2,3 They are associated with a higher incidence of intrapartum fetal distress, failure to progress in labour, and Caesarean section.3 Rates of vaginal delivery vary between 30% and 90%.2–4

Consent to publish this image has been obtained from the patient.

REFERENCES

1. Duff P. Diagnosis and management of face presentation. Obstet Gynecol 1981;57(1):105–12.

2. Stitely ML, Gherman RB. Labor with abnormal presentation and position. Obstet Gynecol Clin North Am 2005;32(2):165–79.

3. Bashiri A, Burstein E, Bar-David J, Levy A, Mazor M. Face and brow presentation: independent risk factors. J Matern Fetal Neonatal Med 2008;21(6):357–60.

4. Bhal PS, Davies NJ, Chung T. A population study of face and brow presentation. J Obstet Gynaecol 1998;18(3):231–5.