Presentation + Examination
Abnormal lie & Unstable lie
Definition
 Abnormal Lie = Transverse or Oblique lie at >= 37
weeks (i.e. only abnormal at term)
o Lie fixed
 Unstable lie = Lie or presentation continuously
changes within 24-48hr period at >=37 weeks
Epidemiology
 0.2-0.5% of pregnancies at term
 Most fetuses  longitudinal lie and cephalic
presentation at term  due to gravitational pull
of head (heaviest)
o Lie Changes
Causes
 Unstable lie  conditions allowing more room to
turn  no obstruction
 Abnormal lie  Conditions allowing less room to
turn OR conditions preventing engagement (e.g.
Obstruction)
Complications
 Mother  Obstructed labour // Uterine rupture
 Fetus  Cord prolapse
Assessment – History
 Background  Gestational age // DM // Fibroids
// Congenital uterine malformations //
Multiparous
 Presenting Obstetric Hx
 Antenatal care  lie and presentation throughout
pregnancy (fixed v.s. changing)
 Obstetric conditions  Placenta previa
 Maternal conditions  DM
 Fetal conditions  Anomalies (US 20wks) // SFGA
// IUGR // Poly or oligohydramnios
PC
 Detected through antenatal screening // Fetal
movements // Abdominal pain
Examination
 General  Increased BMI (diagnostic difficulty)
 Inspection  “Transverse” distention
 Palpation 
o Symphysis-Fundal Height 
 SGA (small fetus) // LGA
(Polyhydramnios)
o Fetal parts 
 Exclude multiparity // Confirm lie and
presentation // Exclude
polyhydramnios
 Pelvis  only if labour or ruptured membranes
Investigations
 FBC  haemoglobin  May need CS
 Group and Save  may need CS
 Fetal U/S 
o Presentation and lie  Confirm lie+present
o Amniotic fluid volume  polyhydramnios
o Placental location  placenta previa
o Fetal number  Multiparity
o Fetal size  SFGA
o Fetal anatomy  Fetal anomalies
o Uterus  exclude fibroids
 CTG  Confirm fetal wellbeing
Mx  Admission
 If term (>=37wks)
o Because of cord prolapse risk if labors or
ruptured membranes  requires
emergency CS
 If preterm (<37wks)
o Not admit except if preterm labor or
PPROM
Mx  Delivery
Abnormal Lie  pelvic obstruction PRESENT
 Delivery at 39 weeks by CS
Unstable lie  Pelvic obstruction ABSENT
 Avoid External cephalic version with unstable lie
 likely to return to abnormal lie
In labour
 If in labour / membranes ruptured  deliver
ASAP by CS
Case Presentation
 Opening statement
o “X was admitted with an abnormal /
unstable lie”
o “Since admission the lie has stabilized/ not
stabilized”
o The lie is X and the presentation is Y
Key Points
 Only significant ≥37 weeks i.e. only abnormal at
term except if preterm labour or PPROM
 Usually in multiparous women
 Cord prolapse is the most significant complication
 Always admit ≥37 weeks
 Either await spontaneous version or deliver by
caesarean section depending on the presence of a
pelvic obstruction