Face presentation at term

A retrospective study was conducted of 50,300 consecutive deliveries between July of 1973 and January of 1978. There were 40 instances of face presentation with gestational age greater than 36 weeks and fetal weight greater than 2500 g for an incidence of 1 per 1250 deliveries. Cesarean section was performed in 50% of cases. Spontaneous vaginal delivery occurred with mentum anterior presentation 88% of the time, with mentum transverse presentation 45% of the time, and with mentum posterior presentation 25% of the time. Fetal heart rate (FHR) monitoring was available for review in 29 of the 38 (76%) live births. Internal techniques were used in 79% and external techniques in 21% of the cases. The FHR patterns were classified according to the predominant pattern seen in the first stage of labor. In 59% (17 of 29), variable decelerations were noted, and severe variable decelerations were present in 29% (8 of 29). Late decelerations were noted in 24% (7 of 29) of cases. Only 4 patients completed labor without variable or late decelerations. There were 38 live births and 2 stillbirths. Both of the stillborns were noted to have tight nuchal cords which were believed to be the cause of death. One death occurred intrapartum. Of the 38 live births, there were 14 (37%) with 1-minute Apgar scores of 6 or less and 5 (13%) with 5-minute Apgar scores less than 7. Four of the 5 low 5-minute Apgar scores occurred in babies with mentum posterior position. Of the 23 patients monitored by internal electrodes, no serious trauma was noted as a result of the electrode placement.