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Transverse lie

Prepared by:
Dr. Gehanath Baral
MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of
Nepal
Visiting Professor: CTGU
29th March,2007

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Position: Position of head on left or right
1. Left / Right  Dorsoanterior

2. Left / Right  Dorsoposterior

3. Left / Right  Dorsosuperior

4. Left / Right  Dorsoinferior

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Compound presentation

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Cause
Physiological factors Adaptive factors
1. Prematurity 1. Contracted pelvis

2. Multiparity 2. Placenta previa

3. (2nd) Twins 3. Pelvic tumors

4. Polyhydramnios 4. Uterine malformation

5. IUFD
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Diagnosis:
O/E: • Fundal ht. Less
1. P/A • Obstetric grips:
1. Fundal  No fetal
2. P/V pole
2. Lateral:
3. USG – Head  hard, smooth,
globular
– Breech  soft,
irregular, broad
3. Pelvic  Empty

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Diagnosis: P/V exam
• Not in labor Nothing palpable
• In labor
1. Elongated bag of membrane
2. Presentation:
– Shoulder:
• Axilla, Clavicle, Acromion, Scapula;
• Ribs, Intercostal spaces
– Cord
– Arm/Hand
– Compound
3. PositionThumb of the prolapsed hand when
supinated points towards HEAD.

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Complication
1. Cord prolapse

2. Perinatal death=25-50%

3. Uterine rupture

4. Hemorrhagic shock

5. Septicemia

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Management
1. External Cephalic Version
2. Risk of version: Transverse lie

1. Placental abruption
2. Rupture of uterus
3. Cord entanglement
ECV
4. Fetal distress/death

3. Internal Podalic Version


(IPV) 2nd Twin in
transverse lie Vx delivery

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Management: ExternalCephalicVersion

Failed ECV

Live fetus Dead fetus

+ IPV Decapitation
other complication

CS

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Mode of delivery
Favourable events
1. Spontaneous
rectification(Vx) or
• No mechanism of version(Br.)
labor  CS 2. Spontaneous
evolution
3. Spontaneous
expulsion

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Favourable Mode 1

Transverse lie

Spontaneous Spontaneous
rectification version

Rotates to Vx rotates to Br.

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Favourable Mode 2

Spontaneous evolution

Delivery of Br. & trunk (1st)

Delivery of Head (last)

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Favourable Mode 3

Spontaneous expulsion

Delivery of Chest & abd. (1st)

Delivery of feet & head (last)

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