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Zhang Y, Fu T, Chen L, Ouyang Y, Han X, Chen D. Face presentation at term: incidence, risk factors and influence on maternal and neonatal outcomes. Arch Gynecol Obstet 2024:10.1007/s00404-024-07406-4. [PMID: 38594406 DOI: 10.1007/s00404-024-07406-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES The incidence, diagnosis, management and outcome of face presentation at term were analysed. METHODS A retrospective, gestational age-matched case-control study including 27 singletons with face presentation at term was conducted between April 2006 and February 2021. For each case, four women who had the same gestational age and delivered in the same month with vertex position and singletons were selected as the controls (control group, n = 108). Conditional logistic regression was used to assess the risk factors of face presentation. The maternal and neonatal outcomes of the face presentation group were followed up. RESULTS The incidence of face presentation at term was 0.14‰. After conditional logistic regression, the two factors associated with face presentation were high parity (adjusted odds ratio [aOR] 2.76, 95% CI 1.19-6.39)] and amniotic fluid index > 18 cm (aOR 2.60, 95% CI 1.08-6.27). Among the 27 cases, the diagnosis was made before the onset of labor, during the latent phase of labor, during the active phase of labor, and during the cesarean section in 3.7% (1/27), 40.7% (11/27), 11.1% (3/27) and 44.4% (12/27) of cases, respectively. In one case of cervical dilation with a diameter of 5 cm, we innovatively used a vaginal speculum for rapid diagnosis of face presentation. The rate of cesarean section and postpartum haemorrhage ≥ 500 ml in the face presentation group was higher than that of the control group (88.9% vs. 13.9%, P < 0.001, and 14.8% vs. 2.8%, P = 0.024), but the Apgar scores were similar in both sets of newborns. Among the 27 cases of face presentation, there were three cases of adverse maternal and neonatal outcomes, including one case of neonatal right brachial plexus injury and two cases of severe laceration of the lower segment of the uterus with postpartum haemorrhage ≥ 1000 ml. CONCLUSIONS Face presentation was rare. Early diagnosis is difficult, and thus easily neglected. High parity and amniotic fluid index > 18 cm are risk factors for face presentation. An early diagnosis and proper management of face presentation could lead to good maternal and neonatal outcomes.
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Affiliation(s)
- Yongqing Zhang
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Tiantian Fu
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Luping Chen
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Yinluan Ouyang
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Xiujun Han
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China.
| | - Danqing Chen
- Department of Obstetrics, School of Medicine, Women's Hospital, Zhejiang University, 1st Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China.
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Arsène E, Langlois C, Clouqueur E, Deruelle P, Subtil D. Prognosis for deliveries in face presentation: a case-control study. Arch Gynecol Obstet 2019; 300:869-874. [PMID: 31302733 DOI: 10.1007/s00404-019-05241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/02/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To estimate the maternal and fetal prognosis for attempted vaginal deliveries of fetuses in face compared with vertex presentations. To evaluate the factors associated with a cesarean during labor for fetuses in face presentation. METHODS This case-control study collected all the cases of face presentation in a university hospital level-3 maternity ward between 22 and 42 weeks of gestation over a 16-year period. For each case, we selected three control cases with vertex presentations delivered the same day. Cesareans before labor were excluded. RESULTS We compared 60 attempted vaginal deliveries of fetuses in face presentation with 174 of fetuses in vertex presentation. The cesarean rate during labor was more than three times higher for the face presentations (31.7 vs 9.2%, P < 0.0001). Arterial pH values and Apgar scores were similar in both sets of newborns. After logistic regression, the factors associated with a cesarean during labor were nulliparity and early diagnosis of the presentation (i.e., before 5 cm dilatation). The initial position (mentum-anterior vs. transverse or posterior) was not significantly associated with the mode of delivery. CONCLUSIONS In face presentations, attempted vaginal delivery triples the cesarean risk. Nonetheless, more than two-thirds of these women give birth vaginally without any impairment of neonatal condition.
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Affiliation(s)
- Emmanuelle Arsène
- Pôle Femme Mère Enfant, Centre Hospitalier de Calais, Boulevard des Justes, 62100, Calais, France.
| | - C Langlois
- Unité de Biostatistiques, MRRC, CHRU Lille, 6, rue du Professeur Laguesse, 59045, Lille cedex, France
| | - E Clouqueur
- Pôle Femme Mère Nouveau-né, Clinique d'Obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, 59037, Lille cedex, France
| | - P Deruelle
- Pôle Femme Mère Nouveau-né, Clinique d'Obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, 59037, Lille cedex, France.,EA 4489, Environnement périnatal et croissance, PRES Université Lille Nord de France, 59000, Lille, France
| | - D Subtil
- Pôle Femme Mère Nouveau-né, Clinique d'Obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, 59037, Lille cedex, France.,EA 2694, PRES Université Lille Nord de France, 59000, Lille, France
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De Bernardo G, Svelto M, Giordano M, Sordino D. Face presentation in delivery room: what is strategy? BMJ Case Rep 2017; 2017:bcr-2016-219114. [PMID: 28325723 DOI: 10.1136/bcr-2016-219114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Giuseppe De Bernardo
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
| | - Maria Svelto
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
| | - Maurizio Giordano
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
| | - Desiree Sordino
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
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