Prognosis for deliveries in face presentation: a case–control study

Purpose To estimate the maternal and fetal prognosis for attempted vaginal deliveries of fetuses in face compared with vertex presentations. To evaluate the factors associated with a cesarean during labor for fetuses in face presentation. Methods This case–control study collected all the cases of face presentation in a university hospital level-3 maternity ward between 22 and 42 weeks of gestation over a 16-year period. For each case, we selected three control cases with vertex presentations delivered the same day. Cesareans before labor were excluded. Results We compared 60 attempted vaginal deliveries of fetuses in face presentation with 174 of fetuses in vertex presentation. The cesarean rate during labor was more than three times higher for the face presentations (31.7 vs 9.2%, P < 0.0001). Arterial pH values and Apgar scores were similar in both sets of newborns. After logistic regression, the factors associated with a cesarean during labor were nulliparity and early diagnosis of the presentation (i.e., before 5 cm dilatation). The initial position (mentum-anterior vs. transverse or posterior) was not significantly associated with the mode of delivery. Conclusions In face presentations, attempted vaginal delivery triples the cesarean risk. Nonetheless, more than two-thirds of these women give birth vaginally without any impairment of neonatal condition.