Face and brow presentation: independent risk factors.

OBJECTIVES

The objectives of this study were to determine clinical characteristics including pregnancy and delivery outcome, among patients with face/brow presentation, and to investigate independent risk factors for these malpresentations.

METHODS

This was a retrospective cohort study comparing all singleton pregnancies of patients with and without face/brow presentation. Deliveries occurred during the years 1988-2002 at the Soroka University Medical Center. Stratified analyses using a multiple logistic regression model were performed to control for confounders.

RESULTS

Two hundred and nineteen cases were included in the study out of 130,247 deliveries with vertex presentation, giving a prevalence for face/brow presentation of 0.17%. No significant difference was found with regard to maternal age and gravidity between the control and study groups, but the primiparity rate was lower in the study group (20.4% vs.14.6%, p = 0.034). There was a significantly higher rate of previous history of cesarean delivery (CD), polyhydramnios, non-progressive labor, and non-reassuring fetal heart rate in the study group, but the rate of hypertensive disorders was lower. The prevalence of congenital anomalies was higher in the study group than in the control group, 7.3% vs. 3.6%, respectively. Also the CD rate in the study group was 67.1% as compared to 8.6% in the control group (p < 0.001). In contrast, neonatal outcome was not different between groups, including Apgar scores and perinatal mortality (0.5% vs. 1.2%, p = NS). In a logistic regression analysis model for face/brow presentation, the independent risk factors were fetal malformations (OR = 2.0), polyhydramnios (OR = 2.77) and primiparity (OR = 0.65).

CONCLUSION

Face/brow presentation was associated with several adverse pregnancy outcomes, although there was a favorable neonatal outcome. Independent risk factors for face/brow presentation were fetal malformations and polyhydramnios, but primiparity had a protective effect.