Obstetrics & Gynecology>>>>>Normal and Abnormal Labor and Delivery
Question 8#

A 23-year-old G1 at 38 weeks’ gestation presents in active labor at 6-cm dilated with ruptured membranes. On cervical examination the fetal nose, eyes, and lips can be palpated. The fetal heart tracing is 140 beats per minute with accelerations and no decelerations.

Which of the following is the most appropriate next step in management for this patient?

A. Perform immediate cesarean delivery
B. Allow spontaneous labor with vaginal delivery
C. Perform forceps rotation in the second stage of labor to convert mentum posterior to mentum anterior and to allow vaginal delivery
D. Allow the patient to labor spontaneously until complete cervical dilation is achieved and then perform an internal podalic version with breech extraction
E. Attempt manual conversion of the face to vertex in the second stage of labor

Correct Answer is B


With face presentation, the fetal head is hyperextended so the occiput is in contact with the fetal back, and the chin (mentum) is presenting. In the event of a face presentation, successful vaginal delivery will occur the majority of the time with an adequate pelvis. Spontaneous internal rotation during labor is required to bring the chin to the anterior position, which allows the neck to pass beneath the pubis. Therefore, the patient is allowed to labor spontaneously; a cesarean delivery is employed for labor abnormality or for fetal distress. Manual conversion to vertex, forceps rotation, and internal version are not used to deliver the face presentation because of undue trauma to both the mother and the fetus.