BY Lorelle Wachter

Transverse Lie
Editor's note: We received so many responses to the
question about transverse lie [Issue 3:3] that we
decided to dedicate this issue to the subject.
Transverse Lie
In the case of a transverse lie:

If precautions are not taken, when labour begins the
fetal shoulder may be forced down toward the pelvis.

The membranes are likely to rupture early and the
cord to prolapse, while in addition the fetal arm may
also prolapse.

In the case of a transverse lie:

A midwife would recognize shoulder presentation by
abdominal examination, and by vaginal examination,
when the shoulder is recognized by feeling the fetal
ribs and the hand (to be distinguished from the foot
because she can 'shake hands with it').

In the case of a transverse lie:

Vaginal examination is best avoided unless placenta
praevia has been excluded.... The more advanced the
labour, the more difficult it is to correct the lie; after
the membranes have ruptured it may be impossible.
Transverse Lie
A midwife may find...after the birth of a first twin that
the second child is lying transversely.

Immediate action is necessary and she should correct
the lie by external version and rupture the second bag
of membranes, thus stabilizing the longitudinal
[head-down] lie and hastening the birth of the child.

- Mayes' Midwifery, Betty Sweet, ed,1997, Balliere Tindall


Transverse Lie
Persistent transverse lie is much less common than
breech presentation, occurring in only 1 out of 500
term pregnancies.

Anything that prevents engagement of the head or the
breech makes transverse presentation more likely.

It is also more common in multigravidas because of
the laxness of the uterine and abdominal muscles.
Transverse Lie
Factors that need to be ruled out include: placenta
previa, multiple anomaly, polyhydramnios, pelvic
contraction, and uterine abnormalities.

However, cases do occur where no such associated
factors are present.
The diagnosis of transverse lie during abdominal
examination includes these findings:
The abdomen appears asymmetrical wider than it is
tall
The fundal height may be small for dates
Palpation of the fundus and the pelvic areas of the
uterus reveal no fetal poles, which are instead found
on either side
The fetal heart is heard below the mother's navel
Neither the head nor the breech can be felt during an
internal exam