LIE in May 2010

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LIE LIE It is defined as It is defined as relationship of longitudinal relationship of longitudinal axis of fetus with that of axis of fetus with that of uterus. uterus.

Transcript of LIE in May 2010

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LIELIE

It is defined as relationship of It is defined as relationship of longitudinal axis of fetus with that longitudinal axis of fetus with that of uterus.of uterus.

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TYPESTYPES

• Longitudinal LIELongitudinal LIE

Cephalic / Breech presentationsCephalic / Breech presentations

• Transverse LIETransverse LIE

• Oblique LIEOblique LIE

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Transverse / Oblique LIETransverse / Oblique LIE

Longitudinal LIE is the normal and Longitudinal LIE is the normal and transverse and Oblique lies are the two transverse and Oblique lies are the two fetal abnormal lies seen in clinical fetal abnormal lies seen in clinical practice. In transverse and oblique lies practice. In transverse and oblique lies the long axis of the fetus lies at right the long axis of the fetus lies at right angle and obliquely to that of the angle and obliquely to that of the uterus respectably, when the point of uterus respectably, when the point of the shoulder is usually the presenting the shoulder is usually the presenting part.part.

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INCIDENCEINCIDENCE

In the absence of antenatal care In the absence of antenatal care shoulder presentations occur about shoulder presentations occur about once in 500 labours.once in 500 labours.

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CAUSESCAUSES

• Multiparity:Multiparity: By far the most common cause By far the most common cause of oblique lie is multipartiy associated with a of oblique lie is multipartiy associated with a lax uterus and abdominal wall.lax uterus and abdominal wall.

• Pre MaturityPre Maturity• Poly HydromniosPoly Hydromnios• Multiple pregnancy Multiple pregnancy • Contracted pelvisContracted pelvis• Uterine malformationsUterine malformations (Arcuate or (Arcuate or

subseptate uterus)subseptate uterus)

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POSITIONSPOSITIONS

• Dorso anteriorDorso anterior

• Dorso PosteriorDorso Posterior

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DIAGNOSISDIAGNOSIS• Abdominal Examination:Abdominal Examination: 1. Uretus asymmetrical, broader than usual 1. Uretus asymmetrical, broader than usual

and fundal height is lower than duration of and fundal height is lower than duration of gestation. gestation.

2. On palpation hard round head is felt in one 2. On palpation hard round head is felt in one iliac fossa with softer beach on opposite side.iliac fossa with softer beach on opposite side.

3. In the center of abdomen the back will be 3. In the center of abdomen the back will be felt in the dorso anterior position and small felt in the dorso anterior position and small parts in dorso posterior position.parts in dorso posterior position.

4. Mother usually experiences fetal 4. Mother usually experiences fetal movements in the upper pole and fetal heart movements in the upper pole and fetal heart sounds are best heard in the lower pole of sounds are best heard in the lower pole of the uterus.the uterus.

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• Vaginal Examination:Vaginal Examination:

1. At the beginning of labour the 1. At the beginning of labour the presenting part is too high.presenting part is too high.

2. Membranes usually rupture early.2. Membranes usually rupture early.

3. An arm or a loop of cord may 3. An arm or a loop of cord may prolapse.prolapse.

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COURSE OF LABOURCOURSE OF LABOUR

A fetus lying obliquely cannot be A fetus lying obliquely cannot be born vaginally unless it is macerated born vaginally unless it is macerated or very premature. There is no true or very premature. There is no true mechanism of labour, and an mechanism of labour, and an untreated case will end in obstructed untreated case will end in obstructed labour and fetal death.labour and fetal death.

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MANAGEMENTMANAGEMENT

• Early labour: if an oblique lie discovered Early labour: if an oblique lie discovered early in lobour it may be corrected by early in lobour it may be corrected by external version if the membranes are external version if the membranes are intact. Once the lie has been corrected the intact. Once the lie has been corrected the membranes should be ruptured and the membranes should be ruptured and the uterine contractions will usually maintain a uterine contractions will usually maintain a longitudinal lie.longitudinal lie.

• If an oblique or transverse lie persists in If an oblique or transverse lie persists in lobour C-section is performed.lobour C-section is performed.

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Late in labour when the Late in labour when the shoulder has become impactedshoulder has become impacted

• In neglected cases, when the uterus is In neglected cases, when the uterus is tonically retracted any form of version tonically retracted any form of version is extremely dangerous, owing to the is extremely dangerous, owing to the very great risk of rupturing the thinned very great risk of rupturing the thinned out lower uterine segment.out lower uterine segment.

• If the fetus is dead C-section is the If the fetus is dead C-section is the safest procedure. In this case a low safest procedure. In this case a low vertical incision in the uterus is given.vertical incision in the uterus is given.

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Management at termManagement at term

The patient where abnormal lie is the sole The patient where abnormal lie is the sole factor can be managed in three ways.factor can be managed in three ways.

a- Conservative managementa- Conservative management 1. The patient is admitted in the hospital in 1. The patient is admitted in the hospital in

the hope that the lie will correct itself the hope that the lie will correct itself spontaneously.spontaneously.

2. The patient is kept under observation 2. The patient is kept under observation until 41 weeks.until 41 weeks.

3. If the abnormal lie persists at 41 weeks 3. If the abnormal lie persists at 41 weeks the patient is evaluated for stabilizing the patient is evaluated for stabilizing induction. induction.

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b- Stabilizing Inductionb- Stabilizing Induction 1. The lie is corrected by ECV and maintained 1. The lie is corrected by ECV and maintained

by gentle lateral pressure on the uterus.by gentle lateral pressure on the uterus. 2. The labour is induced with oxytocin 2. The labour is induced with oxytocin

infusion. Vaginal prostaglandins may be infusion. Vaginal prostaglandins may be used.used.

3. The membranes are ruptured when the 3. The membranes are ruptured when the uterine contraction starts.uterine contraction starts.

4. In patients with polyhydramnios a 4. In patients with polyhydramnios a preliminary amniocentesis is often helpful in preliminary amniocentesis is often helpful in the maintenance of longitudinal lie.the maintenance of longitudinal lie.

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c- Elective Caesarean Sectionc- Elective Caesarean Section

1. Elective caesarean section should 1. Elective caesarean section should be performed if the conservative be performed if the conservative management or stabilizing induction management or stabilizing induction is not appropriate. is not appropriate.