UNSTABLE LIE

Dilki PunchihewaBatch – 03SAITM

Unstable lie occurs when the fetal lie repeatedly changes beyond 36 weeks of gestation.

Causes Maternal

• Multiparity • Uterine

abnormalities (fibroids)

• Placenta praevia • Pelvic contractures • Wrong dates

Fetal• Polyhydramnioas• Fetal abnormalities

(anencephaly, IUD) • Multiple

pregnancies

Assessment History• a) Make sure that the date is correct.• b) Find any risk factor associated with unstable lie.• c) Elicit any problem during pregnancy

Examination • Establish the fetal lie by palpation • Assess the laxity of the muscles • Does the fetal parts move easily? • Amniotic fluid volume?

Investigations • USS- look for fetal lie, pelvic pathologies, uterine pathologies, placental site.

Management • Admit patient to antenatal ward from 37 weeks.

Expectant• A) Daily observation for fetal lie• B) Discharge if longitudinal lie for 3 days• C) Review patient in a week time• D) Wait for spontaneous labour• Usually 80% of patients without underlying cause will go to the longitudinal lie with time.

Active management• A) Caeserean section at 39 weeks. If underlying cause found then c-section at 38 weeks • B) ECV • C) Stabilizing induction of labour

Why LSCS?

• Labour with with non-longitudinal lie will result in obstructed labour and potential uterine rupture

• Risk of cord prolapse and hand prolapse

Reference • Clinical Guideline South Australian Perinatal Practice Guidelines – unstable

lie of the fetus

• WOMEN AND NEWBORN HEALTH SERVICE King Edward Memorial Hospital

• Oxford handbook pg(88-89)