Unstable lie, transverse lie and shoulder presentation

Question 1

Definition + features

Unstable lie transverse lie and shoulder presentation

Answer 1

An unstable lie is one that is constantly changing.

It is commonly associated with multiparity, where the
maternal abdominal wall is lax, low placental implantation or uterine anomalies such as a bicornuate
uterus, uterine fibroids, polyhydramnios, and placenta praevia. (US is needed).

§ If an unstable lie resulting in a transverse lie persists until the onset of labour, it may result in prolapse
of the cord or a shoulder presentation,a prolapsed arm, PROM, and uterine rupture.

Question 2

Management

Answer 2

No action until 37 weeks unless labour starts spontaneously, check causes using US; low placental localization, tumors, or fetal abnormalities.

• Stabilizing induction, performed by correcting the lie to a cephalic presentation, and rupturing the
  membranes as the head approaches the pelvic brim assisted by gentle suprapubic pressure,
  followed by oxytocin infusion.
• ECV and admit the mother to the hospital after 39 weeks in case of complication (membranes
  rupture, cord prolapse); caesarian section will be admitted.