Face, Breech, Brow Presentation A rare condition where the face is the presenting part Often head diameter

of the fetus presents to the pelvis is often too large for birth to proceed. [A fetal head presenting at a different angle than expected is termed Asynclitism. Face and brow presentations are examples of this.] A head that feels more prominent than usual, with no engagement apparent on Leopolds maneuver suggests a face position or when the head and back are both felt on the same side of the uterus. The back is difficult to outline in this presentation because it is concave. A face presentation is confirmed by vaginal examination when the nose, mouth, or chin can be felt as the presenting part or through ultrasound It is considered a warning signal that the mother may have been caused by: Contracted pelvis or placenta previa In the relaxed uterus of a multipara With prematurity, hydramnios, or fetal malformation If the chin is anterior and the pelvic diameters are within normal limits, then its possible for a delivery without difficulty (after a long first stage of labor since the face doesnt mold well as an engaging part) Babies born by face presentation have a great deal of facial edema and may be purple from ecchymotic bruising. All edema is temporary and will disappear in a few days ADPIE Assessment - Head that feels more prominent than usual, with no engagement apparent on Leopolds maneuver Back is difficult to outline Ultrasound confirms face presentation with chin posterior Mother frequently asks questions about her fetuss condition Diagnosis: Risk for maternal injury r/t malpresentation of the fetus Risk for fetal injury r/t difficulty in engaging and descending into the pelvis Fear, frequent questioning r/t lack of knowledge about her condition Planning -to educate the client of her condition and provide emotional support Implementation Give health teachings to the mother about her current condition Provide emotional support as necessary Allow client to understand the need for cesarean delivery

Monitor the mothers vitals and monitor fetal heart patterns Prepare the set-up for client to delivery via Cesarean Section Evaluation The mother understands her condition and its corresponding risks The mother gives birth to a healthy neonate after cesarean section Breech presentation A presentation where either the buttocks or the feet are the first body parts that will contact the cervix Occur in 3% of births They are difficult presentations to give birth to Fetus is at risk for anoxia from prolapsed cord Traumatic injury to the after coming head (possibility of intracranial hemorrhage or anoxia) Fracture of the spine or arm Dysfunctional labor Early Rupture of the membranes because of poor fit of presenting part Fetus is at risk for anoxia from prolapsed cord Traumatic injury to the after coming head (possibility of intracranial hemorrhage or anoxia) Fracture of the spine or arm Dysfunctional labor Early Rupture of the membranes because of poor fit of presenting part Causes of breech presentation: Gestational age of less than 40 weeks Abnormality in a fetus Hydramnios that allows for free fetal movement Congenital anomaly of the uterus Any space occupying mass in the pelvis, such as a fibroid tumor Pendulous abdomen Multiple gestations Birth of the head is the most hazardous part of normal vaginal delivery of a breech presenting fetus This is because the head passes with a loop of cord alongside it. The cord is compressed Pressure changes of the fetal head occurs instantaneously and is at risk for intracranial hemorrhage ADPIE Assessment Fetal heart sounds are heard high in the abdomen Leopolds maneuvers and a vaginal examination reveals the presentation Ultrasound confirms presentation Mother appears anxious about her child being in a breech presentation Diagnosis

Risk for Fetal injury r/t difficult vaginal delivery of the head Anxiety, anxiousness r/t concern about her child Planning - allow client to accept her condition - ensure that delivery proceeds with minimal complications Implementations Provide emotional support Give health teachings about her condition Educate her the risks of vaginal delivery Prepare the set-up for CS if chosen Assist in delivery of the breech presenting infant Monitor FHT in case of possible fetal distress Evaluation The mother is now calmer and more accepting of her condition The mother gives birth to a normal breech presenting neonate (If the fetus was either frank or footling, the neonate tends to keep its legs extended for the first 2-3 days. This is completely normal) Brow Presentation This is the rarest of the presentations. It occurs in multiparous women or women with relaxed abdominal muscles. Almost invariably results in obstructed labor, because head becomes jammed in the brim of the pelvis. Unless the presentation spontaneously corrects itself, Cesarean Section is necessary to birth the infant safely. Brow presentations also leave an infant with extreme ecchymotic bruising on the face. Parents often need reassurance that their child is well nonetheless. ADPIE Assessment Leopolds maneuver and vaginal inspection indicates possible brow presentation Ultrasound confirms brow presentation Mother frequently asks questions about her childs presentation Diagnosis Risk for fetal injury r/t possible inability to descend due to fetal head being jammed in the brim of the pelvis Anxiety, frequent questioning r/t concern towards her child and how birthing will be done Planning - To ensure the mother understands her condition with its risks and possible complications To reduce complications in the birth of the child Implementation Administer health teachings

Provide emotional support Prepare a CS set-up if vaginal delivery cannot proceed Monitor maternal and fetal vitals Assess if the fetus is able to descend or if it is jammed into the brim of the pelvis. Assist in CS as appropriate Evaluation Mother is more calm and accepting of her condition Mother gives birth to a normal neonate with ecchymotic bruising on the face which the nurse reassures is normal.