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.

中文翻译：

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足月面部表情：发病率、危险因素以及对孕产妇和新生儿结局的影响

目标

分析了足月时面部表情的发生率、诊断、处理和结果。

方法

2006 年 4 月至 2021 年 2 月期间进行了一项回顾性孕龄匹配病例对照研究，包括 27 名足月时出现面部表情的单身孕妇。对于每个病例，有 4 名具有相同孕龄、同月分娩且头顶位置和选择单身人士作为对照（对照组，n = 108）。使用条件逻辑回归来评估面部呈现的危险因素。对面部呈现组的孕产妇和新生儿结局进行随访。

结果

足月时面部表情的发生率为0.14‰。条件 Logistic 回归后，与面部外观相关的两个因素是高奇偶性（调整后优势比 [aOR] 2.76，95% CI 1.19–6.39）] 和羊水指数 > 18 cm（aOR 2.60，95% CI 1.08–6.27） 。 27例中，在临产前、临产潜伏期、临产活跃期、剖宫产期间确诊的比例分别为3.7%（1/27）、40.7%（11/27） ，分别占病例的 11.1% (3/27) 和 44.4% (12/27)。在1例宫颈扩张直径5厘米的病例中，我们创新性地使用阴道窥器快速诊断面容。面诊组剖宫产率和产后出血≥500 ml的发生率高于对照组（88.9% vs. 13.9%，P  < 0.001，14.8% vs. 2.8%，P  = 0.024），但两组新生儿的阿普加评分相似。 27例面容中，出现母婴不良结局3例，其中新生儿右臂丛神经损伤1例，子宫下段严重撕裂伤产后出血≥1000ml 2例。

结论

面部表情很少见。早期诊断很困难，因此很容易被忽视。高产次和羊水指数 > 18 厘米是面部先露的危险因素。早期诊断和适当的面部表情管理可以带来良好的孕产妇和新生儿结局。