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Transverse Lie Deformation


KEY POINTS

  • Transverse lie is the second most common nonvertex presentation during delivery, occurring in 1.2–3 per 100 deliveries.

  • Multiparity, prematurity, placenta previa, polyhydramnios, uterine anomalies, and uterine myomas are associated with transverse lie.

  • Laxity of abdominal musculature in multiparous women is considered the primary factor contributing to transverse lie in these women.

  • Transverse lie can lead to facial flattening, limited mandibular growth, retroflexed head, prominent occipital shelf, torticollis, scoliosis, and other associated deformations.

  • Management options for transverse lie at term include expectant management, external cephalic version, or elective cesarean section.

  • The facial compression resulting from transverse lie can create facial features that may resemble a malformation syndrome or craniosynostosis, leading to potential differential diagnoses.

GENESIS

Transverse lie is the second most common nonvertex presentation and occurs in 1.2–3 per 100 deliveries. It is associated with multiparity (90%), prematurity (13%), placenta previa (11%), polyhydramnios (8%), uterine anomalies (8%), and uterine myomas (3%), especially when myomas are located in the lower uterine segment. Predisposing factors such as uterine structural anomalies, prematurity, and placenta previa are found in 66% of primiparas, but only 33% of multiparas manifest these factors. Thus multiparity is the most common factor, and women delivering transverse-lying infants tend to be older than those delivering vertex-presenting infants; the other factors such as low-lying placenta, uterine anomalies, myomas, or prematurity occur more frequently in primigravidas. Laxity of abdominal musculature in multiparous women is considered the predominant factor accounting for the liability toward transverse lie in these women. The occurrence of polyhydramnios may relate to the inability of the fetus to swallow amniotic fluid because the mouth is pushed up against the side of the uterus.

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