Unstable lie 2

Case: Unstable lie

Question:

a) Physical examination (abdomen)

b) Level of exposure

c) Clinical evidence of head and buttock

d) Management for this patient

e) Option for this patient

f) What is unstable lie

Unstable lie

1. Fetal lie and presentation repeatedly change at beyond 36/52 of gestation.

2. by 36W, fetal movement is limited, fetal should present as cephalic)

3. Incident at 26/32 is 40%, at 30/52 is 20% & at term is 3%

Clinical evidence of head and buttock

Head: Hard, round and ballotable

Buttock: Soft, broad and not ballotable.

Management

1) Admit patient to antenatal wards

a) Daily observation for fetal lie

b) Provide active management to correct lie

c) Provide immediate clinical assistance upon membrane rupture

2) Exclude factors contributing to unstable lie

3) Expectant vs Emergent management

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

Option for this patient

A) Passive management by observation in hope that the lie will return to normal position during term.

B) Caeserean section

C) ECV [Relative contraindication]

Results vary from 30% up to 80% in different series. Race, parity, uterine tone, liquor volume, engagement of the breech and whether the head is palpable, and the use of tocolysis, all affect the success rate. [Greentop]

D) Stabilizing induction of labour

Notes: B-D is active management.