Brow presentation is the least common and most unfavorable position in the variety of cephalic presentations where brow is the presenting part. As the labor starts, the assessment should be made between the fetal presenting part and the maternal pelvis so that there are no complications during the vaginal delivery. Around 4% of fetuses are in the malpresentation at term. (1)
In this article, we will be discussing in detail about the brow presentation, its complications, how to diagnose, how to manage if needed, and what precautions to be taken in case of brow presentation.
What Is a Brow Presentation?
After the completion of 38 weeks which is full term, the majority of fetuses are presented in the vertex position where the fetal head is flexed so that the chin of the fetus is in contact with the thorax. (2)
In brow presentation, the fetal head remains in the midway between full flexion. The presenting part remains the orbital ridges and the anterior fontanelle. This sort of malpresentation is known as brow presentation. (3)
How Can You Get to Know If Your Baby Is in This Position?
The brow presentation is generally very hard to diagnose before the patient is in labor at term since it appears to be a vertex presentation. The brow presentation generally takes longer time to deliver and that is when the brow presentation is identified. Another way to identify brow presentation is the fetal heart rate is best heard over the left lower quadrant of maternal abdomen (4).
What Are the Causes of Brow Presentation?
Certain factors help in this malpresentation. Those factors include both maternal and fetal factors. They are as follows: (5)
Maternal factors
- High parity with pendulous abdomen
- Multiple pregnancies
- Polyhydramnios
- Premature rupture of membranes
- Any pelvic mass
- Placenta previa
Fetal factors
- Congenital malformations
- Macrosomia
- Prematurity
- Coils of cord around the neck
How Is the Diagnosis Made?
The diagnosis is made by the examination done by the doctor in the term by both abdominal and vaginal examination. So for this trained healthcare professional is needed so as for the delivery.(6)
Abdominal Examination :
- Longitudinal lie with breech at fundus
- The head is at the pelvis, feels big, and not engaged
- Cephalic prominence and back are on the same side
- The depression between the cephalic prominence and back is less prominent
Vaginal Examination :
- The anteroposterior diameter of head is in the right oblique diameter of pelvis
- Head is at the right posterior quadrant
- Brow is palpated easily
- Frontal sutures felt but sagittal sutures are not
- Supraorbital ridges are identified
- Main mode to confirm diagnosis of brow presentation is ultrasound which is to be done at term.
Complications of Brow Presentation Delivery
Complications are the main setback in the malpresentation since it is rare. Brow presentation comes with its list of complications. They are-(7)
- Obstructed labor and rupture of uterus
- Risk of operative delivery
- Fetal death
- Fetal birth asphyxia
- Caput and molding
Alternatives for Labor During Brow Presentation
Elective c section delivery should be the delivery of choice in brow presentation. If not there is a good chance of needing emergency c section due to prolonged and obstructed vaginal delivery which in turn will harm both the mother and the baby. There is a good possibility of fetal death if the decision is not made early as soon as the diagnosis is made of brow presentation.(8)
But if there is no facility for c section available or the patient is persistent over vaginal delivery then there are 2 methods which can be given a try. They are-(9)
- Ventouse birth: Here vacuum suction is used to deliver the baby
- Manual rotation: After the full dilatation of the cervix the doctor with the hand tries to rotate the head.
Precautions to Take Before and After Labour
As we have already discussed in detail about the complications which can cause harm to the mother and the baby in the vaginal delivery so it’s obvious some precautions are a must (10).
- Proper and experienced doctors should be chosen, so that if there is time for vaginal delivery both the mother and baby are safe.
- Regular proper antenatal checkups should be done
- If the doctor suggests c c-section, hesitation should not be there to take the step.
How Will Brow Presentation Affect Your Baby During Labor?
If vaginal delivery is done in brow presentation it can cause fetal birth asphyxia which can in turn cause respiratory distress syndrome. Again it can cause abnormally shaped heads of the baby from obstruction. The newborn baby’s heads are soft, due to the obstruction it can cause molding and the baby might need an orthopedic surgeon for the same reason. So it will be best for the sake of the baby to undergo c-section (11).
As mentioned above brow presentation is rare and it can happen to anyone at any parity. This can occur in the second pregnancy. So the mother needs to be stress-free, have to take proper diet, and should undergo regular antenatal checkups as advised by the doctor. (12)
In conclusion, an experienced healthcare professional is needed for the management of the brow presentation. Follow the advice and trust the doctor if they ask for a c-section delivery that will save the life of both the mother and the child.
FAQ’s
1. What Are Brow Presentation Complications?
The brow presentation can cause prolonged labor which in turn causes fetal distress and arrhythmias. The fetal distress can lead to an emergency c-section. The prolonged labor can also cause swelling over the head which is known as caput.
2. What Is The Most Common Cause Of Brow Presentation?
The causes of brow presentation are many and it includes both maternal and fetal factors. High parity, multiple pregnancy, premature rupture of membrane, placenta previa, pelvic mass, polyhydramnios, fetal congenital anomaly, macrosomic fetus etc.
3. What Are The Side Effects Of Face Presentation?
The side effects include obstructed and prolonged labor, need for emergency c-section, fetal birth asphyxia which causes fetal respiratory depression and even death.
4. Can Brow Presentation Cause Obstructed Labor?
The brow presentation causes obstructed and prolonged labor. This can be harmful for both mother and fetus. At term, proper vaginal examination should be done.
Reference
- Bashiri, A., Burstein, E., Bar-David, J., Levy, A., & Mazor, M. (2008). Face and brow presentation: Independent risk factors. The Journal of Maternal-Fetal & Neonatal Medicine, 21(6), 357–360. – https://www.tandfonline.com/doi/abs/10.1080/14767050802037647#
- Ronald M. Meltzer, Marlene R. Sachtleben, Emanuel A. Friedman, Brow presentation, American Journal of Obstetrics and Gynecology, Volume 100, Issue 2, 1968, Pages 255-263 – https://www.sciencedirect.com/science/article/abs/pii/S0002937815337297#
- Loren J. Jacobson, Carl E. Johnson, Brow and face presentations, American Journal of Obstetrics and Gynecology, Volume 84, Issue 12, 1962, Pages 1881-1886 – https://www.sciencedirect.com/science/article/abs/pii/0002937862904787#
- S. BHAL N. J. DAVIES T. CHUNG, P. (1998). A population study of face and brow presentation. Journal of Obstetrics and Gynaecology, 18(3), 231–235. – https://www.tandfonline.com/doi/abs/10.1080/01443619867371#
- P. N. Jennings , Postgraduate School of Obstetrics and Gynaecology, University of Auckland, New Zealand –
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-828X.1968.tb00716.x# - Shipra Singh, Sara Paterson–Brown, Malpresentations in labour, Current Obstetrics & Gynaecology, Volume 13, Issue 5, 2003,Pages 300-306 – https://www.sciencedirect.com/science/article/abs/pii/S0957584703000465#
- Shipra Singh, Sara Paterson-Brown, Department of Obstetrics and Gynaecology, St. Mary’s Hospital, Portsmouth, UK – https://www.sciencedirect.com/science/article/abs/pii/S0957584706000588#
- Anna K. Richmond, Janet R. Ashworth, Management of malposition and malpresentation in labour, Obstetrics, Gynaecology & Reproductive Medicine, Volume 33, Issue 11, 2023, Pages 325-333 – https://www.sciencedirect.com/science/article/abs/pii/S1751721423001288#
- The Midwife’s Labour and Birth Handbook, Fourth Edition – https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119235064.ch8#
- A. Hakmi. (2008) Brow presentation does not mean caesarean section. Journal of Obstetrics and Gynaecology 28:2, pages 255-256. – https://www.tandfonline.com/doi/abs/10.1080/01443610063444#
- Vikram S. Talaulikar, Sabaratnam Arulkumaran, Malpositions and malpresentations of the fetal head,
Obstetrics, Gynaecology & Reproductive Medicine, Volume 25, Issue 6, 2015, Pages 152-159 – https://www.sciencedirect.com/science/article/abs/pii/S1751721415000561# - Suparna Sinha, Vikram S. Talaulikar, Sabaratnam Arulkumaran, Malpositions and malpresentations of the fetal head, Obstetrics, Gynaecology & Reproductive Medicine, Volume 28, Issue 3, 2018, Pages 83-91 – https://www.sciencedirect.com/science/article/abs/pii/S1751721418300010#
