ORIGINAL

TRANSVERSE LIE;
PROF-1233 PREDISPOSING FACTORS,
MATERNAL AND PERINATAL OUTCOME
DR. ROBINA ALI DR. AISHA ABRAR
Associate Professor Gynae & Obst. Senior Registrar
Punjab Medical College, Punjab Medical College,
Faisalabad. Faisalabad.

ABSTRACT… Transverse lie is dangerous not only to fetus but may endanger the life of mother if timely intervention is not done. Good
antenatal care is of tremendous importance for proper management of transverse lie. Objectives: 1). To determine the predisposing factors to
transverse lie. 2). To find out maternal and perinatal outcome in transverse lie. Facts were analyzed to find out the avoidable factors which make
the maternal and perinatal outcome worse. Setting: Gynae and obstetric unit-II DHQ Hospital Faisalabad. Study Design: It was a descriptive
study. Duration: Six months from 15th September, 2006 to 15th March, 2007. Materials and methods: Sixty cases of transverse lie were
included in this study. These sixty patients were analyzed in great details, regarding predisposing factors, clinical features, intrapartum and
postpartum management including the maternal and perinatal outcome. Results: Predisposing factors were found in 42% of the primpara but in
only 34% of the multipara. The mode of delivery was surgical and lower segment caesarean section was undertaken in 80% of cases. Maternal
outcome in order of frequency were difficult surgery in 23.3%, obstructed Labour in 15%, delayed recovery from anaesthesia in 3.3% and
uterine rupture in 1.6%. Fetal outcome in order of frequency were intrauterine death in 18.3%, hand prolapse in 20% and cord prolapse in 8.9%.
Conclusions: Known predisposing factors to transverse lie withstand a closer and more accurate assessment of their incidence. The maternal
and perinatal outcome can be improved by early diagnosis during antenatal care and hospital delivery, without any delay.

Key words: Transverse lie, Multiparity, Maternal mortality.

INTRODUCTION intervention and caesarean section has preference over

Transverse lie occurs when the long axis of the fetus is destructive procedures.
perpendicular to that of mother. The incidence in 0.3% at
term1. The predisposing factors to transverse lie are MATERIALS & METHODS
multiparity, placenta previa, contracted pelvis and uterine Sixty patients admitted in emergency and through
myoma2,3. outdoor with transverse lie were evaluated by history and
examination.
The diagnosis of transverse lie is suspected when fundal
height is less than expected, fetal head lies in iliac fossa These sixty patients were analyzed in great details,
and fetal heart rate auscultated near umbilicus. regarding predisposing factors, clinical features,
intrapartum and postpartum management, including the
Patients in transverse lie should not be allowed to labour maternal and fetal outcome.
because of risks of uterine rupture or cord prolapse4.
Maternal deaths are due to hemorrhage, infection and RESULTS
difficult surgery. In fetus there is risk of cord prolapse, During Six months of study, there were 2126 deliveries in
intrauterine death and traumatic delivery5. obstetrics and gynecology unit of D.H.Q Hospital,
Faisalabad.
It is usual to carry out a transverse lower segment
incision, although a vertical lower uterine incision may be
valuable when these is uncertanity with regard to the
6
position of fetal back . For optimal results, there is need
of early diagnosis, skilled assessment and planed
delivery by optimal route and by the experienced
obstetrician. Operative delivery by caesarean section is
7
mandatory for the majority of cases .
Successful management depends upon the timely
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TRANSVERSE LIE 2

A greater incidence was seen in the multipara.

Sixty patients presenting with transverse lie were

included in this study. 12 patients were excluded due to
prematurity and medical disorders.

There were fifty five (91.6%) un-booked and only five

(8.3%) were booked cases Regarding predisposing
factors, multiparity was found to be most common factor
as 48 cases (80%) were multipara. However other
predisposing factors occurred more frequently in
primiparas.

Regarding their management all patients had operative

delivery – lower segment caesarean section was
undertaken in majority i.e. 48 (80.1) of cases. Regarding
maternal outcome, there was no maternal death, while
morbidity was observed in 24 patients. Out of 24 patients,
7(15%) had obstructed labour- obstructed labour had a
significant relationship with IUD (0.028), two (3.31%)
patients had delayed recovery from anesthesia.

In 23.3% (n:14) patients, the maternal morbidity was in

the from of difficult surgery. neglected transverse lie, there are serious
consequences for both the mother and the fetus. This
Perinatal outcome was not very promising as 11 (18.3%) clearly shows the importance of good antenatal care for
cases were received with intrauterine death. Out of these proper management of transverse lie which would
11 cases, five had obstructed labour. There were 49 live provide the opportunity for early diagnosis and hence
births fetal loss after caesarean was five. All of them had prevention of neglected cases of transverse lie.
poor APGAR score at birth, three (5.11%) patients had
both hand and cord prolapse, in these cases intrauterine In our study majority was emergency admission
death was 100% surgical trauma or fracture did not occur reflecting poor antenatal care.
in any of the fetus.
The relative contribution of predisposing factors to
DISCUSSION transverse lie differs in various published series8,9.
Transverse lie as such is not associated with poor Multiparty is the predominant predisposing factor. In our
maternal and fetal outcome but once it becomes
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TRANSVERSE LIE 3

study, multiparity was a predisposing factor in 80% of one case of rupture uterus for which emergency
cases, and in fact a high incidence of transverse lie in a hysterectomy was performed. Thus transverse lie if not
given population may reflect a tendency to multiparty. diagnosed and managed properly can lead to uterine
rupture with life threatening maternal and fetal
15
Laxity of the abdominal wall with poor myometerial tone compromise .
10
may be the possible explanation .
Regarding perinatal outcome, perinatal mortality was
The incidence of placenta previa in our series was 13.3% found to be 26% in our study. 18 were still birth and five
comparable to that in other series 16% in 2001 in babies expired after CS during their stay in hospital.
Faisalabad8. Placenta Previa discourage engagement of
a fetal pole so predispose to transverse lie. However only three perinatal deaths were recorded
which occurred during the period of hospital stay of
In our studies, there were 13.3% cases of contracted patients. This may underestimate the true perinatal
pelvis, which was higher to that reported by Gemmer9. mortality. In neglected transverse lie, prolapse of an arm
Perhaps the higher incidence in our studies was due to or umblical cord is likely to occur with resultant fetal
16
environmental factors which caused pelvic anomalies in hypoxia and death .
our population. The dignosis to delivery interval is an important
determinant of perinatal outcome in cord prolapse17.
Although External Cephalic Version (ECV) reduces the
rate of caesarean section for transverse lie to 50%, in our CONCLUSIONS
studies, none of the patient underwent ECV due to late The main corner stone of proper management of
presentation. transverse lie lie in provision of good antenatal care. The
maternal and fetal outcome can be improved by early
In our studies, majority of the patients were not under diagnosis during the antenatal period when associated
medical supervision and no ultrasound was carried out risk factors such as placenta previa could be diagnosed.
during the third trimester. So only 8.3% patients had Delivery should be carried out without delay in a hospital
elective caesarean section and 90.6% had emergency well equipped for caesarean section, because once it
caesarean section. Khattak also reported that 66.7% of becomes neglected transverse lie, than the picture for
cases of transverse lie had emergency caesarian maternal and fetal outcome is poor.
12
section . Copyright© 20 May, 2011.

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Article received on: 06/05/2011 Accepted for Publication: 15/05/2011 Received after proof reading: 16/05/2011

Correspondence Address: Article Citation:

Dr. Robina Ali
Associate Professor Gynae & Obst. Ali R, Abrar A. Transverse lie; predisposing factors,
Punjab Medical College, maternal and perinatal outcome. Professional Med J
Faisalabad.
[email protected] Apr-Jun 2011;18(2): 208-211.

“In all things

it is better to hope
than to despair”
( Johann Wolfgang von Goethe)

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