Transverse Fetal Lie
If a pregnancy involves “transverse fetal lie,” this means that the baby is positioned sideways in the womb rather than in the typical head-down presentation (vertex/cephalic). This can make vaginal birth very risky for both the mother and baby. If transverse lie occurs early in pregnancy, the baby may simply move into a more favorable lie prior to birth. Later in pregnancy, it may also be possible for medical professionals to rotate the baby into a head-down presentation. However, if this is unsuccessful, then it will be necessary to deliver via C-section.
It is very important that doctors and nurses carefully manage pregnancies involving transverse lie. Mismanagement can cause serious obstetrical complications and birth injuries (1).
Transverse lie may also be referred to as transverse presentation or transverse position.
Fetal lie, presentation, and position: what’s the difference?
These terms are often used interchangeably; however, there are some subtle differences:
- Fetal lie describes the relationship between the long axis of the baby relative to the long axis of the mother. There are three main types of fetal lie:
- Longitudinal lie (vertex and breech are both longitudinal lies)
- Transverse lie (the baby’s long axis is perpendicular relative to the mother’s; in other words, the baby is sideways)
- Oblique lie (the baby is essentially at an angle between longitudinal and transverse)
- Fetal presentation describes what part of the baby is directly above the mother’s pelvic opening. For example in a vertex presentation it is the head, and in breech presentation it is the buttocks. If the baby is in transverse lie, the back or shoulder may be the presenting part.
- Fetal position is a detailed description of where the presenting part of the fetus is in relation to the mother’s pelvic opening. For example, if the head is the presenting part, fetal position will provide information on whether the head is facing the mother’s front, back, right, or left (2).
Incidence of transverse lie
Early in pregnancy, transverse lie is fairly common, but most fetuses rotate spontaneously to a head-first or breech presentation. At the time of delivery, approximately one in 300 fetuses is in transverse lie (1).
Risk factors for transverse lie
The following pregnancy characteristics and complications increase the risk of a transverse fetal lie (1):
- Prematurity (this is the most common risk factor for transverse lie at the time of delivery; babies are often in a transverse lie early in pregnancy)
- Placenta previa
- Multiples pregnancy (e.g. twins)
- Pelvic, uterine, or fetal anomalies
Management of a fetus in transverse lie
If the fetus does not spontaneously rotate into a more favorable lie prior to term, intervention will be necessary. In some cases, it may be possible for a medical professional to manually rotate the fetus into a head-first presentation. This may involve external version (pushing on the mother’s abdomen to roll the fetus; typically medications are also involved) or internal version (reaching into the mother’s uterus to move the fetus) (1, 3). The medical team may also perform an amniotomy in order to induce labor after turning the baby. In some cases (for example if version is unsuccessful) a C-section may be necessary (1). Physicians should always be prepared for this possibility.
Complications associated with transverse lie
Complications associated with a transverse fetal lie, especially when mismanaged, may include the following:
- Umbilical cord prolapse
- Birth trauma
- Premature birth
- Uterine rupture
- Maternal injury or death (e.g. from hemorrhage)
- Birth asphyxia (oxygen deprivation around the time of birth, which can lead to forms of permanent brain damage such as hypoxic-ischemic encephalopathy and cerebral palsy)
Legal help for mismanaged transverse fetal lie and birth injuries
ABC Law Centers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as hypoxic-ischemic encephalopathy (HIE), infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.
If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources.
If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win.
- (n.d.). Retrieved February 19, 2019, from https://www.uptodate.com/contents/transverse-fetal-lie
- Abnormal Fetal Lie and Presentation. (n.d.). Retrieved February 19, 2019, from https://www.glowm.com/section_view/heading/AbnormalFetalLieandPresentation/item/135
- External Cephalic Version (Version) for Breech Position. (n.d.). Retrieved February 19, 2019, from https://www.uofmhealth.org/health-library/hw180146