19.7 More malpresentations

A transverse lie occurs most frequently in multiparas, and in mothers with polyhydramnios. When you diagnose it, don’t forget the possibility that it may have been caused by twins, a major degree of placenta praevia, or CPD. Rarer causes include a congenital uterine abnormality, a grossly abnormal pelvic brim, a fibroid, an ovarian tumour, and an extrauterine pregnancy. When labour is obstructed by a transverse lie, the lower segment is particularly vulnerable, so don’t stretch it any more by doing an internal version in advanced labour with a dead baby. Do a destructive operation (22.9).