The vast majority of fetuses at term are in cephalic presentation. Approx 5% of these fetuses are in a cephalic malpresentation, such as occiput posterior or transverse, face or brow.

Face presentation refers to a fetal presentation in which the fetal face from forehead to chin is the leading fetal body part descending into the birth canal. The fetal neck is highly extended (sharply deflexed), such that the occiput may touch the back.

In mentum anterior face presentation, the fetal chin needs to pass under the symphysis pubis. For this to occur, the extended fetal neck may need to extend even more. After the chin clears the symphysis, further descent and expulsion of the fetus can occur. Over 75 percent of mentum anterior fetuses deliver vaginally.

In the mentum posterior face presentation, the fetal neck is already maximally extended and cannot extend further to allow the occiput to pass under the symphysis. Therefore, the mentum posterior face presentation will not deliver vaginally unless spontaneous rotation to mentum anterior occurs, often late in the second stage of labor, or the fetus is very small, or the pelvis is very large.

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I am a double board certified ObGyn and Maternal-Fetal Medicine specialist focusing on the care of people with maternal and/or fetal complications of pregnancy. I discuss hot topics related to fertility, pregnancy and the postpartum period, and do a little myth-busting and fact-checking to keep things real! Not only am I a doc, but I was also a patient who had infertility, a high-risk twin pregnancy and preterm delivery, and NICU stay at age 43 as a first-time mom--so I GET IT! Leave requests for new topics in comments!

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