Hyperextension of Cervical Spines in Face Presentation Diagnosed by Fetal Sonography

Summary 

Objective

Traditionally, face presentation is diagnosed by palpation of the fetal nose, chin, mouth and orbital ridges. The fetal occiput is usually in contact with the back because of the hyperextensive posture of the fetus. We report a case of face presentation which was diagnosed by the demonstration of hyperextension of the cervical spines on fetal sonography.

Case Report

A 28-year-old woman (gravida 1, para 0) who had been pregnant for 41 and 1/7 weeks was admitted for induction of labor due to over-term pregnancy. The cephalic presentation had already been reported to her in her regular antenatal clinic. Fetal sonography revealed hyperextension of the cervical spines. During vaginal examination, the fetal nose was palpated and the mentoposterior position was identified. A female baby (4,150 g) was delivered via cesarean section. Apart from the edematous distorted face, the baby did not experience any swelling of the larynx or respiratory difficulty.

Conclusion

Obstetricians should remain alert for the possibility of malpresentation in cephalic lies. Although it is rare to see a face presentation, fetal sonography is an effective tool to provide an early diagnosis of it. Delivery via cesarean section is inevitable if the fetus is in the mentoposterior position.

Key Words:  cervical spines , face presentation , hyperextension

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