LIE

It is defined as relationship of longitudinal axis of fetus with that of uterus.

TYPES
Longitudinal LIE Cephalic / Breech presentations Transverse LIE Oblique LIE

Transverse / Oblique LIE

Longitudinal LIE is the normal and transverse and Oblique lies are the two fetal abnormal lies seen in clinical practice. In transverse and oblique lies the long axis of the fetus lies at right angle and obliquely to that of the uterus respectably, when the point of the shoulder is usually the presenting part.

INCIDENCE
In the absence of antenatal care shoulder presentations occur about once in 500 labours.

CAUSES
Multiparity: By far the most common cause of oblique lie is multipartiy associated with a lax uterus and abdominal wall. Pre Maturity Poly Hydromnios Multiple pregnancy Contracted pelvis Uterine malformations (Arcuate or subseptate uterus)

POSITIONS
Dorso anterior Dorso Posterior

DIAGNOSIS
Abdominal Examination: 1. Uretus asymmetrical, broader than usual and fundal height is lower than duration of gestation. 2. On palpation hard round head is felt in one iliac fossa with softer beach on opposite side. 3. In the center of abdomen the back will be felt in the dorso anterior position and small parts in dorso posterior position. 4. Mother usually experiences fetal movements in the upper pole and fetal heart sounds are best heard in the lower pole of the uterus.

Vaginal Examination: 1. At the beginning of labour the presenting part is too high. 2. Membranes usually rupture early. 3. An arm or a loop of cord may prolapse.

COURSE OF LABOUR
A fetus lying obliquely cannot be born vaginally unless it is macerated or very premature. There is no true mechanism of labour, and an untreated case will end in obstructed labour and fetal death.

MANAGEMENT
Early labour: if an oblique lie discovered early in lobour it may be corrected by external version if the membranes are intact. Once the lie has been corrected the membranes should be ruptured and the uterine contractions will usually maintain a longitudinal lie. If an oblique or transverse lie persists in lobour C-section is performed.

Late in labour when the shoulder has become impacted

In neglected cases, when the uterus is tonically retracted any form of version is extremely dangerous, owing to the very great risk of rupturing the thinned out lower uterine segment. If the fetus is dead C-section is the safest Cprocedure. In this case a low vertical incision in the uterus is given.

Management at term
The patient where abnormal lie is the sole factor can be managed in three ways. a- Conservative management 1. The patient is admitted in the hospital in the hope that the lie will correct itself spontaneously. 2. The patient is kept under observation until 41 weeks. 3. If the abnormal lie persists at 41 weeks the patient is evaluated for stabilizing induction.

b- Stabilizing Induction 1. The lie is corrected by ECV and maintained by gentle lateral pressure on the uterus. 2. The labour is induced with oxytocin infusion. Vaginal prostaglandins may be used. 3. The membranes are ruptured when the uterine contraction starts. 4. In patients with polyhydramnios a preliminary amniocentesis is often helpful in the maintenance of longitudinal lie.

c- Elective Caesarean Section 1. Elective caesarean section should be performed if the conservative management or stabilizing induction is not appropriate.