Management of the fetus in transverse lie
- Robert A Strauss, MD
Robert A Strauss, MD
- Professor of Obstetrics and Gynecology
- University of North Carolina at Chapel Hill
The fetus is in a transverse lie when its longitudinal axis is perpendicular to the long axis of the uterus. A transverse lie can occur in either of two configurations:
●The curvature of the fetal spine is oriented upward (also called "back-up" or dorsosuperior), in which case the fetal small parts present at the cervix.
●The curvature of the fetal spine is oriented downward (also called "back-down" or dorsoinferior), such that the fetal shoulder presents at the cervix (figure 1).
Most fetuses in transverse lie early in pregnancy convert to a cephalic (or breech) presentation by term. The later in pregnancy the transverse lie is diagnosed, the more likely it is to persist. This was illustrated in a series of 235 patients with transverse fetal lie incidentally discovered by sonography at more than 20 weeks gestation . When the diagnosis was first made between 20 to 25 weeks of gestation, 2.6 percent persisted as transverse lie at term. By comparison, when the diagnosis was first made at 36 to 40 weeks, 11.8 percent persisted to the time of delivery.
- Gemer O, Segal S. Incidence and contribution of predisposing factors to transverse lie presentation. Int J Gynaecol Obstet 1994; 44:219.
- Cruikshank DP, White CA. Obstetric malpresentations: twenty years' experience. Am J Obstet Gynecol 1973; 116:1097.
- Scheer K, Nubar J. Variation of fetal presentation with gestational age. Am J Obstet Gynecol 1976; 125:269.
- Nassar N, Roberts CL, Cameron CA, Olive EC. Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study. BMJ 2006; 333:578.
- Phelan JP, Boucher M, Mueller E, et al. The nonlaboring transverse lie. A management dilemma. J Reprod Med 1986; 31:184.
- Sekulić SR. Possible explanation of cephalic and noncephalic presentation during pregnancy: a theoretical approach. Med Hypotheses 2000; 55:429.
- Lau WC, Fung HY, Lau TK, To KF. A benign polypoid adenomyoma: an unusual cause of persistent fetal transverse lie. Eur J Obstet Gynecol Reprod Biol 1997; 74:23.
- Seffah JD. Maternal and perinatal mortality and morbidity associated with transverse lie. Int J Gynaecol Obstet 1999; 65:11.
- Hankins GD, Hammond TL, Snyder RR, Gilstrap LC 3rd. Transverse lie. Am J Perinatol 1990; 7:66.
- Gemer O, Kopmar A, Sassoon E, Segal S. Neglected transverse lie with uterine rupture. Arch Gynecol Obstet 1993; 252:159.
- Spörlin L. Conduct of normal births through external examination alone (German). Arch Gynaekol 1894; 45:337.
- Chauhan AR, Singhal TT, Raut VS. Is internal podalic version a lost art? Optimum mode of delivery in transverse lie. J Postgrad Med 2001; 47:15.
- Okonofua FE. Management of neglected shoulder presentation. BJOG 2009; 116:1695.
- Mahajan NN, Gaikwad NL, Solomon MV, et al. Internal podalic version for neglected shoulder presentation with fetal demise. BJOG 2009; 116:1801.
- Phelan JP, Stine LE, Edwards NB, et al. The role of external version in the intrapartum management of the transverse lie presentation. Am J Obstet Gynecol 1985; 151:724.
- Edwards RL, Nicholson HO. The management of the unstable lie in late pregnancy. J Obstet Gynaecol Br Commonw 1969; 76:713.
- Wilmink FA, Hukkelhoven CW, Lunshof S, et al. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol 2010; 202:250.e1.
- Rabinovici J, Barkai G, Reichman B, et al. Internal podalic version with unruptured membranes for the second twin in transverse lie. Obstet Gynecol 1988; 71:428.
- Chervenak FA, Johnson RE, Berkowitz RL, Hobbins JC. Intrapartum external version of the second twin. Obstet Gynecol 1983; 62:160.
- Depp R. Cesarean delivery. In: Obstetrics. Normal and Problem Pregnancies, Gabbe SG, Niebyl JR, Simpson JL (Eds), Churchill Livingstone Elsevier, New York 2002. p.551.
- Shoham Z, Blickstein I, Zosmer A, et al. Transverse uterine incision for cesarean delivery of the transverse-lying fetus. Eur J Obstet Gynecol Reprod Biol 1989; 32:67.
- Segal S, Gemer O, Sassoon E. Transverse lower segment uterine incision in cesarean sections for transverse lie. A retrospective survey. Arch Gynecol Obstet 1994; 255:171.
- Pelosi MA, Apuzzio J, Fricchione D, Gowda VV. The "intra-abdominal version technique" for delivery of transverse lie by low-segment cesarean section. Am J Obstet Gynecol 1979; 135:1009.