short presentation with important facts about unstable lie and management

1. UNSTABLE LIE
Dilki Punchihewa
Batch – 03
SAITM

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

3. Causes
Maternal
• Multiparity
• Uterine
abnormalities
(fibroids)
• Placenta praevia
• Pelvic contractures
• Wrong dates
Fetal
• Polyhydramnioas
• Fetal abnormalities
(anencephaly, IUD)
• Multiple
pregnancies

4. 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.

5. 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

6. Why LSCS?
• Labour with with non-longitudinal lie will
result in obstructed labour and potential
uterine rupture
• Risk of cord prolapse and hand prolapse

7. 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)