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Definition
When The fetus lies with its long axis across the long axis of the uterus, the
shoulder is most likely to present,it is called transverse lie.
The longitudinal axis of the foetus does not coincide with that of the mother.
These are the most hazardous malpresentations due to mechanical difficulties that
occur during labour .
The oblique lie which is deviation of the head or the breech to one iliac fossa, is
less hazardous as correction to a longitudinal lie is more feasible.
Incidence
3-4% during the last quarter of pregnancy but 0.5% by the time labour commences. Or
shoulder presentation occurs in approximately1:300 pregnancies near term. It is common
in premature and macerated fetuses, 5 times more common in multiparae than
primigravidae. Transverse lie in twins pregnancy is found in 40% of cases.
Aetiology
Positions
Left scapulo-anterior.
Right scapulo-anterior.
Right scapulo-posterior.
Left scapulo-posterior.
Scapulo-anterior are more common than scapulo-posterior as the concavity of the front of
the foetus tends to fit with the convexity of the maternal spines.
Diagnosis
During pregnancy
Inspection:
o The abdomen is broader from side to side.
Palpation:
o Fundal level: lower than that corresponds to the period of amenorrhoea.
o Fundal grip: The fundus feels empty.
o Umbilical grip: The head is felt on one side while the breech one the other.
o First pelvic grip: Empty lower uterine segment.
Auscultation:
o FHS are best heard on one side of the umbilicus towards the foetal head.
Ultrasound or X-ray:
o Confirms the diagnosis and may identify the cause as multiple pregnancy
or placenta praevia.
During labour
Mechanism of Labour
Impaction: The shoulder is pushed into the pelvis and if the mother is not assisted,
it may get impacted in the pelvis.
Management
Antenatal
During labour
If transverse lie is detected in early labour while the membranes are still intact and there
is no contraindication, attempt Externalcephalic verson .
If Externalcephalic verson is successful, proceed with normal childbirth..
It is mainly indicated in 2nd twin of transverse lie and followed by breech extraction.
Prerequisites:
Management
Caesarean section is the safest procedure even if the baby is dead. A classical or
low vertical incision in the uterus facilitates extraction of the foetus as a breech in
such a condition.
Any other manipulations will lead eventually to rupture uterus so they are
contraindicated