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Brow Presentation

Brow presentation occurs when the baby's head is extended slightly, with the forehead presenting first instead of the crown of the head (vertex presentation) or the back of the head (face presentation). This position is rare and can make vaginal delivery more challenging. In some cases, a cesarean section might be necessary to safely deliver the baby. In brow presentation, the baby's head is neither fully flexed (as in vertex presentation) nor fully extended (as in face present

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32 views8 pages

Brow Presentation

Brow presentation occurs when the baby's head is extended slightly, with the forehead presenting first instead of the crown of the head (vertex presentation) or the back of the head (face presentation). This position is rare and can make vaginal delivery more challenging. In some cases, a cesarean section might be necessary to safely deliver the baby. In brow presentation, the baby's head is neither fully flexed (as in vertex presentation) nor fully extended (as in face present

Uploaded by

khadija falak
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Brow Presentation

Definition
It is a cephalic presentation in which the
head is midway between flexion and
extension.
Incidence
About 1:1000 labour.
Aetiology
The causes of a persistent brow presentation
include cephalopelvic disproportion or
pelvic contracture and increasing parity and
prematurity, which are implicated in more
than 60% of cases of persistent brow
presentation. Premature rupture of
membranes preceded brow presentation in
as many as 27% of cases.
• Brow presentation constitutes an absolute foeto-pelvic disproportion,
and vaginal delivery is impossible (except with preterm birth or
extremely low birth weight).
• This is an obstetric emergency, because labour is obstructed and
there is a risk of uterine rupture and foetal distress.
Diagnosis
– Head is high; as with a face
presentation, there is a cleft
between the head and back,
but it is less marked.
– On vaginal examination the
brow, orbits, anterior
fontanelle and, occasionally,
the eyes and bridge of the
nose are palpable. But it is
not possible to palpate:
• the chin (it is not a face
presentation),
• the posterior fontanelle (it is
not a vertex presentation).
Management
• In brow presentation, engagement is usually impossible and arrested
labour is common. Spontaneous conversion to either vertex
presentation or face presentation can rarely occur, particularly when
the fetus is small or when there is fetal death with maceration. It is
unusual for spontaneous conversion to occur with an average-sized
live fetus once the membranes have ruptured.
• Ceserean section required in most cases". Brow presentation rarely can
deliver vaginally unless:
Spontaneously converts to vertex or face Presentation
Fetus is very small or pelvis is very large.
If the fetus is alive
• deliver by caesarean section.
If the fetus is dead and/
• The cervix is not fully dilated
• deliver by caesarean section
• If the cervix is fully dilated, deliver by craniotomy
• If the operator is not proficient in craniotomy deliver by caesarean
section.
• Do not attempt to convert brow presentation to vertex.
• Avoid Oxytocin
• do not deliver brow presentation by vacuum extraction, outlet forceps
or symphysiotomy.
The diagnosis of brow
presentation is, therefore, not
made until after the
membranes have ruptured and
the head has begun to engage
in a fixed presentation. Some
brow presentations will
spontaneously convert to a
vertex or, more rarely, a face
presentation.

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