Transverse/oblique

Question 1

Transverse/oblique lie is also known as…

Answer 1

…compound shoulder presentation (abnormal lie)

Question 2

How is this diagnosed antenatally?

Answer 2

Ovoid uterus wider at the sides
Lower pole is empty
Head lies in one flank
Foetal heart heard in variable positions

Question 3

What are the causes?

Answer 3

Multiparity
Multiple pregnancy
Polyhydramnios
Placenta praevia
Arcuate/septate uterus
Contracted pelvis

Question 4

What may be felt on vaginal exam?

Answer 4

If membranes intact - no distinguishing features

Ruptured membranes/cervix dilated - rib, shoulder or prolapsed hand or cord may be felt

Question 5

What is there a particularly high risk of with this presentation?

Answer 5

Cord prolapse

Question 6

What is the incidence?

Answer 6

1 in 200 (more common in early pregnancy)

Question 7

nWhat are the complications?

Answer 7

If head/breech cannot enter pelvis - cannot deliver baby by labour. Arm/cord may prolapse and if neglected this obstruction will eventually cause uterine rupture

Question 8

Management options?

Answer 8

No action required pre 37w unless woman in labour
Admission for woman may be recommended in case membranes rupture and USS performed to identify likely underlying causes e.g. polyhydramnios, placenta praevia
ECV not used (foetus normally turns back)
Spontaneous version can be discharged if remain in position >48hr
If no pelvic obstruction - abnormal lie normally stabilised before 41w

Question 9

What is done if abnormal lie persists at 41w?

Answer 9

Can be delivered by Caesarean

In expert hands - ECV and then amniotomy (stabilising induction)

Question 10

When would a woman be admitted for abnormal lie?

Answer 10

> 37w (to prevent prolapse of cord if SRM) and elective section may be discussed

Question 11

When is caesarean indicated?

Answer 11

Malpresentation >37w

When ECV fails