TRANSVERSE LIE (NEGLECTED TRANSVERSE LIE)

39 year old G6P5 (5005), 39 weeks AOG, brought in by a midwife. She has been in labor for the past 10
hours. BP =130/80; Hr 100s; Temp 39 degrees.
PE: fetal cephalic pole palpable in the left iliac crest of the mother. NO FHTs. (+)transverse ridge, 2 cm
below the umbilicus
IE: cervix fully dilated, ruptured BOW, with the fetu’s hand prolapsed in the vagina

Diagnosis?
Initial Management?
Subsequent Management? Reasons for your plan.

Pregnancy Uterine, 39 weeks AOG, G6P5(5005), Intrauterine Fetal Demise secondary to Neglected
Transverse Lie
(IUFD, retraction ring –at risk for uterine rupture)

Admit patient. Start intravenous line for hydration.

Stabilize the patient. Oxygen supplementation.
Do laboratory test: CBC with differential count, coagulation tests
Start intravenous antibiotics
Schedule for Emergency Cesarean Section.

*Vaginal delivery is not possible because the shoulder is already arrested at the margins at the pelvic
inlet. There is already a retraction ring present (as evidenced by the transverse ridge 2 cm below the
mother’s umbilicus). If the uterus would continuously contract, the uterus may eventually rupture.
Depending on the position of the fetus, I may have to use a vertical uterine incision, since a low
transverse incision may lead to a difficult fetal extraction, since neither the feet nor the head of the
fetus occupies the lower uterine segment (especially if the presentation is dorsoanterior). Diffiult
extraction may lead to manipulation of the uterus, may cause further uterine lacerations and
hemorrhage.

*Conduplicato corpora – fetus doubled upon itself*