Transverse fetal lie
- Robert A Strauss, MD
Robert A Strauss, MD
- Professor of Obstetrics and Gynecology
- University of North Carolina at Chapel Hill
Transverse lie refers to a fetal presentation in which the fetal longitudinal axis lies perpendicular to the long axis of the uterus. It can occur in either of two configurations:
●The curvature of the fetal spine is oriented upward (also called "back-up" or dorsosuperior), and the fetal small parts and umbilical cord present at the cervix.
●The curvature of the fetal spine is oriented downward (also called "back-down" or dorsoinferior), and the fetal shoulder presents at the cervix (figure 1).
(Note: Lie refers to the long axis of the fetus relative to the longitudinal axis of the uterus; it can be longitudinal, transverse, or oblique. Presentation refers to the fetal part that directly overlies the pelvic inlet; it is usually vertex [head] or breech [buttocks], but can be a shoulder, compound [eg, head and hand], or funic [umbilical cord]. Position is the relationship of a nominated site of the presenting part to a denominating location on the maternal pelvis, eg, right occiput anterior.)
- 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.
- Oyinloye OI, Okoyomo AA. Longitudinal evaluation of foetal transverse lie using ultrasonography. Afr J Reprod Health 2010; 14:129.
- 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.
- 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.
- 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.
- Leopold G, Spörlin L. Conduct of normal births through external examination alone (German). Arch Gynaekol 1894; 45:337.
- 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.
- 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.
- Rosman AN, Guijt A, Vlemmix F, et al. Contraindications for external cephalic version in breech position at term: a systematic review. Acta Obstet Gynecol Scand 2013; 92:137.
- 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.
- 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.
- DIGONNET L, LE GOFF J. [Observation of spontaneous delivery in conduplicato corpore with living infant]. Bull Fed Soc Gynecol Obstet Lang Fr 1950; 2:563.
- 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.
- Cunningham FG. Williams obstetrics, 24, Cunningham FG, Leveno KJ, Bloom SL, et al (Eds), McGraw-Hill Education/Medical, New York 2014. p.469.
- Cunningham FG. Williams obstetrics, 24, Cunningham FG, Leveno KJ, Bloom SL, et al (Eds), McGraw-Hill Education/Medical, New York 2014. p.598.
- NATURAL HISTORY
- PATHOGENESIS AND RISK FACTORS
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- MANAGEMENT OF DELIVERY
- Transverse lie, intact membranes, live fetus
- - Before onset of labor
- - Early labor
- - Active labor
- Transverse lie with ruptured membranes
- Transverse lie of second twin after delivery of first twin
- Transverse lie with fetal demise or previable fetus
- Transverse lie with coexistent placenta previa or umbilical cord prolapse
- PROCEDURE FOR CESAREAN DELIVERY
- Dorsosuperior (back up) transverse lie
- Dorsoinferior (back down) transverse lie
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS