The nonlaboring transverse lie. A management dilemma

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Transverse lie, a non-vertex fetal presentation, complicates 0.3% of term pregnancies.
• Management options for transverse lie near term include expectant management or external cephalic version.

Purpose of the Study:

• To evaluate the outcomes of pregnancies with sonographically diagnosed transverse lie at or after 37 weeks' gestation managed expectantly.
• To assess the cesarean section rate and associated morbidities in this patient group.

Main Methods:

• Retrospective review of 29 patients with transverse lie at ≥37 weeks' gestation.
• Patients were managed expectantly due to high spontaneous conversion rates.
• Subsequent delivery outcomes and indications for cesarean section were analyzed.

Main Results:

• 83% of patients spontaneously converted to a longitudinal lie (vertex or breech).
• 5 patients (17%) presented with a persistent transverse lie.
• The overall cesarean section rate was 45%, with indications including breech presentation (62%) and transverse lie (38%).
• Major complications included cord prolapse, uterine rupture, and neonatal death.

Conclusions:

• Expectant management of transverse lie after 37 weeks is associated with a high cesarean section rate and significant morbidity.
• External cephalic version around 39 weeks should be considered for persistent transverse lie.
• Elective cesarean section may be warranted if version is unsuccessful.