OB/GYN
A 25-year-old woman G2 P1001 was admitted at 39 weeks' gestation in Labor Suite with labour pains.
On Abdominal examination, 3 moderate contractions every 10 minutes. The cervix was 6 cm dilated, 80% effaced. Mouth, lips, nose and orbital hollows were palpable. Which of the following is the most appropriate next step in management?
Explanation
Core Concept: Face presentation occurs when the fetal head is hyperextended, and the face is the presenting part. Vaginal delivery is possible if the fetal chin (mentum) is anterior (mento-anterior).
Clinical Presentation:
- Prolonged labor or abnormal fetal lie
- Palpation of facial features (mouth, nose, orbital ridges) on vaginal examination
Diagnosis:
- First-line diagnostic plan: Vaginal examination identifying facial landmarks and determining the position of the mentum (chin).
- Gold standard: Ultrasound to confirm face presentation and fetal position.
Management:
- Acute management: If the mentum is anterior and there is no cephalopelvic disproportion, a trial of labor is appropriate.
- Gold standard long-term management: Monitor partographic progress closely. If the mentum is posterior (mento-posterior) and does not rotate, or if there is fetal distress/arrest of descent, a Cesarean section is indicated. Since the presentation just identified and labor is progressing (6 cm), monitoring progress is the correct next step.