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What Is Brow Presentation? What Are Its Complications?

5 min read

Pregnancy is one of the most exciting phase in a woman’s life. She goes through those nine months with great enthusiasm and expectation overcoming all the discomforts with the hope of holding a healthy precious little baby in her hands. Although pregnancy can be a memorable experience but there are lot of concerns and complications that a pregnant woman can face over the course of pregnancy or during the childbirth process. One such complication that can come at the last minute of any delivery is the presentation of the baby. Normally, babies bow down their chin well tucked into the chest during their journey through the birth canal. This position is called flexed position or vertex presentation. This is the ideal position that makes delivery easier as the baby’s head will be in its smallest possible diameter in this presentation. This helps the baby to easily pass through the birth canal. However, not all presentations are as perfect as the head first presentation and brow presentation is one such complicated presentation of the baby. Read on to know more about it.
brow presentation

  • What Is Brow Presentation?
  • What Leads To Brow Presentation?
  • Diagnosis Of Brow Presentation
  • How To Avoid C-Section If Baby Is In Brow Presentation?
  • What Complications Can Arise Due To Brow Presentation?

What Is Brow Presentation?

Unlike the flexed position, in a brow presentation, the baby’s head will not be well flexed into its chest. Therefore, her head and neck will be extended back a little, as if it is looking up. If the baby remains in a brow presentation, it is doubtful that there will be enough space for the baby to descend through the pelvis. This increases the chances of a C-section. Brow presentation is least common of all fetal presentations. In fact, it happens one in every 1400 deliveries. Over half of the babies who are in brow presentation in the early labor will flex their head down during the pushing stage of the labor and the labor may progress as expected.
Out of the other 50%, some babies tend to tip their head further back to the face first position while they descends further into the birth canal. Compared to the brow presentation, face first position has a higher chance to undergo a vaginal birth, provided, the chin of the baby is near the pubic bone. But if the baby’s chin is near the tailbone, C-section is the only option to avoid any complications in the delivery.
In spite of the fact that brow presentation very rarely happens, it can happen to anybody. If the baby stays in a brow presentation, it is highly unlikely that there will be enough room for it to pass through the pelvis. If the labor is not progressing, or that the baby is becoming distressed, then the doctor will recommend a caesarean delivery.

What Leads To Brow Presentation?

There are several conditions, which increase the chances of brow presentation. The brow presentation usually takes place because of :

  • Polyhydramnios: Excess amniotic fluid can make it difficult for the baby’s head to take a flexed position
  • Size and shape of the pelvis: Abnormally shaped and sized pelvis can make it difficult for the baby to pick up a vertex presentation. Android pelvis, which has a triangular or heart-shaped inlet with a narrower front part, is usually behind most of the brow presentations. Similarly, contracted pelvis, a pelvis that is abnormally small, can cause brow presentation
  • Fetal abnormality: Fetal abnormalities such as hydrocephalus, anencephaly and neck masses accounts for the majority of brow presentations
  • Premature birth/low birth weight baby: If the baby is born prematurely or if the baby is having low birth weight, the chances of brow presentation increases
  • Big baby: If the baby is larger than normal size, the baby tends to extend its head instead of curling inward
  • Multiple pregnancies: Multiple pregnancies also increase the risk of brow presentation
  • Multiple nuchal cords: If the umbilical cord wraps around the baby’s neck, obviously, it cannot tuck its chin into the chest. In such cases, the baby tends to be brow or face presentations
  • Laxity of the uterus: If the uterine wall loses its firmness, the baby may not able to hold its chin tucked to the chest firmly and the baby tends to be in brow presentation
  • Cephalopelvic disproportion (CPD): If the mother’s pelvis and the baby’s head are not proportionate to each other, brow presentation can happen

Diagnosis Of Brow Presentation

It is very difficult to detect brow presentation until labor is well established. A highly experienced obstetrician and close observation can help to know the position better. Ultrasound test or digital exam is considered mandatory for monitoring closely. On vaginal examination, only the distinctive facial features can be felt. If the head rotates less, vaginal delivery becomes impossible and cesarean delivery is the only way out.
brow presentation deliver

How To Avoid C-Section If Baby Is In Brow Presentation?

When the baby is in brow presentation, the labor will not progress as it should and prolonged labor can result in fetal distress, calling for an immediate C-section. However, if the baby picks up brow presentation and your cervix is fully dilated, there are two procedures through which the doctors try to avoid the need of C-section.

    • Manual rotation: Doctor inserts his hand through the cervix and tries to flex the baby’s head
    • Utilization of ventouse: Doctor uses the ventouse to flex the baby’s head by pulling during contraction with maternal pushing. However, for using ventouse for flexing the baby’s head,
      • The baby’s head should be engaged in the pelvis and should be in a front anterior position
      • The pelvis should have sufficient room to permit the ventouse cup to be inserted posteriorly and to reach the occiput
    • The success rate of these two methods depends on
      • Ability and experience of the obstetrician
      • How favorable is the position of the baby’s head inside the pelvis
      • Available space inside the pelvis

If both these methods fail, then the doctor will go ahead with the decision to perform a caesarean.

What Complications Can Arise Due To Brow Presentation?

There are several complications associated with a brow presentation if vaginal delivery is attempted without proper measures.

  • Increased chances of spinal cord injury are associated with brow presentation
  • Fetal distress
  • Abnormal shape of the baby’s head after delivery
  • Prolonged labor
  • Increased chances of using forceps which in turn increases the chances of facial trauma
  • Obstructed labor

If it is your first delivery, it is very unlikely that your baby will be in a brow presentation. Also if you had a brow presentation in one delivery, it doesn’t mean that it will definitely happen in your next delivery. Once you are closer to your delivery date, make sure you do not miss any of your doctor appointments.It is advisable to follow your doctor’s instructions from the very beginning of your pregnancy. Make sure you take all precautionary measures to avoid any kind of uneasiness. Have a balanced diet and sufficient rest. Keep yourself positive as you get ready for a healthy delivery.
Have a safe and happy pregnancy!

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