Face presentation

this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.

1. FACE PRESENTATION k.gayatri

2. DEFINITION: This is a rare variety of cephalic presentation where presenting part : is face attitude: complete flexion of limbs with extension of spine so that occiput is in contact with back denominator: mentum

3. POSITION RIGHT OCCIPITO POSTERIOR LEFT MENTO ANTERIOR LEFT OCCIPITO POSTERIOR RIGHT MENTO ANTERIOR RIGHT OCCIPITO ANTERIOR LEFT MENTO POSTERIOR LEFT OCCIPITO ANTERIOR RIGHT MENTO POSTERIOR THE MOST COMMON POSITION IS left mento anterior AS RIGHT OCCIPITO POSTERIOR IS 5 TIMES MORE COMMON THAN LEFT OCCIPITO POSTERIOR

4. MENTO ANTERIOR MENTOPOSTERIOR LEFT RIGHT

5. INCIDENCE : 1 in 500 births Primary- during pregnancy Secondary- onset of labor Fetal : 1.congenital malformations a) anencephaly b) goitre c) dolichocephalic head d) bronchocoele 2.Twist of cord round the neck 3.Hypertonicity of extensor group of neck muscles Maternal: Multiparity with pendulous abdomen Lateral obliquity of uterus Contracted pelvis Flat pelvis Pelvic tumours ETIOLOGY:

6. PRODUCTION OF FACE PRESENTATION BY LATERAL OBLIQUITY OF UTERUS PRODUCTION OF FACE PRESENTATION IN FLAT PELVIS

7. MECHANISM OF LABOUR The principle differences between occipitoanterior and mentoanterior are: OCCIPITO ANTERIOR MENTO ANTERIOR Engagement Engagement Descent Descent Flexion Extension Internal rotation Internal rotation Extension Flexion Restitution Restitution External rotation External rotation Expulsion by lateral flexion Expulsion by lateral flexion

8. engagement Diameter of engagement: OBLIQUE DIAMETER Right in LMA LEFT IN RMA MENTUM One pubic eminence GLABELLA Opposite sacro iliac joint ENAGAGING DIAMETER is SUBMENTOBREGMATIC -9.5CM Engagement is delayed because of long distance between mentum and biparietal plane i.e. 7cm where as to that of occiput is 3cm

9. Descent: with increasing extension descent occurs till chin touches the pelvic floor Further descent occurs till submentum hinges under the pubic arch INTERNAL ROTATION : occurs through 1/8 th of the circle anteriorly placing mentum bheind the pubic symphysis

10. DELIVERY OF HEAD HEAD IS BORN BY Diameter distending the vulval outlet is submentovertical-11.5cm RESTITUTION: occurs through 1/8 th of circle Opposite to direction of internal rotation EXTERNAL ROTATION : occurs further 1/8 th of the circle to the same side of restitution so that face looks left thigh right thigh in LMA In RMA FLEXION CHIN FACE BROW VERTEX OCCIPUT ANTERIOR SHOULDER POSTERIOR SHOULDER TRUNK BY LATERAL FLEXION DELIVERING

11. Mentoposterior : 20-25% RMP OR LMP The principle differences between occipitoposterior and mentoposterior are 20-30%cases -anterior rotation of mentum occurs 70-80% cases INCOMPLETE ANTERIOR ROTATION NON ROTATION SHORT POSTERIOR ROTATION ANTERIOR ROTATION OF THE FETUS FROM RIGHT MENTOPOSTERIOR POSITION

12. Arrest occurs in all these positions with average size pelvis and foetal head In short posterior rotation delivery there is no possibility of spontaneous delivery in mento posterior because short neck cannot clear off the total length of the sacrum i.e.12cm

13. As such thorax is thrust in resulting BREGAMTICO STERNAL DIAMETER-18CM to occupy the pelvis as a result labour is obstructed 18CMS