What is Transverse Lie?
In obstetrics,
transverse lie is a fetal position where the baby lies horizontally across the uterus, making the long axis of the fetus perpendicular to the long axis of the mother. This is an abnormal presentation that can complicate delivery.
Causes of Transverse Lie
Several factors can contribute to a fetus adopting a transverse lie, including: Multiparity - Women who have had multiple pregnancies may have more relaxed uterine muscles, allowing the fetus to move more freely.
Placenta previa - When the placenta covers the cervical opening, it can restrict the fetus’s ability to position head-down.
Polyhydramnios - Excessive amniotic fluid can give the fetus more space to move into a transverse position.
Uterine anomalies - Abnormalities in the shape of the uterus can prevent the fetus from adopting a normal vertex or breech position.
Diagnosis
The diagnosis of transverse lie is typically made through physical examination and confirmed by
ultrasound. During a physical exam, the healthcare provider may notice that the fundal height measurement does not match the gestational age, or the fetal head and buttocks are not felt in their expected positions.
Complications
A transverse lie can lead to several complications, especially if not identified before labor. These complications include: Cord prolapse - The umbilical cord may come out before the baby, which can cut off oxygen and blood flow to the fetus.
Obstructed labor - The baby cannot pass through the birth canal in this position, making vaginal delivery impossible.
Uterine rupture - If labor is attempted with a transverse lie, the uterus may tear, posing significant risks to both the mother and the baby.
Management
The management of transverse lie depends on the gestational age and whether the patient is in labor. Some of the management strategies include: External Cephalic Version (ECV) - This procedure involves manually turning the baby into a head-down position through the mother's abdomen. It is usually attempted around 37 weeks of gestation.
Cesarean section - If the transverse lie persists, a cesarean section is often planned to safely deliver the baby.
Expectant management - Close monitoring may be advised if the transverse lie is diagnosed before 37 weeks, as the baby may still turn naturally.
Prevention
While it is not always possible to prevent a transverse lie, early prenatal care can help identify risk factors and monitor fetal positioning. Regular
prenatal visits and diagnostic ultrasounds are crucial in managing and anticipating potential complications.
Prognosis
With appropriate management, the prognosis for both the mother and the baby is generally good. Early identification and intervention are key to minimizing risks and ensuring a safe delivery.
