Unstable lie

Case: 42/M/F G9P8 with unstable lie

a) Causes of unstable lie

b) Management

c) Complication

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%

Causes of unstable lie

1. Prevention of head descending

a) Cephalopelvic disproportion

b) Fibroid

c) Ovarian cyst

d) Placenta previa

e) Uterine surgery

f) Multiple gestation

g) Fetal abnormality (anencephaly)

h) Fetal neuromuscular disorder

2. Condition that permit free fetal movement

a) Polyhydramnios (AFI>8)

b) Uterine laxation

History

a) Make sure that the date is correct cause unstable lie is physiological <36/52.

b) Find any risk factor associated with unstable lie.

c) Elicit any problem during pregnancy

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

Active management

A) Caeserean section

B) ECV

C) Stabilizing induction of labour

Complication

1) Cord prolapsed leading to fetal hypoxia/ fetal death.

2) Compound presentation

3) Uterine rupture