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Management of Unstable Lie 2

This document discusses the management of unstable lie during pregnancy. It covers: 1) Prenatal assessment through clinical examination and ultrasound to determine fetal position and check for issues. 2) Prenatal management options including non-intervention with monitoring or intervention like external cephalic version, induction, or cesarean section. 3) Intrapartum management which depends on fetal presentation, with attempts made to convert to longitudinal lie if not already and emergency c-section for some non-longitudinal cases.

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5K views14 pages

Management of Unstable Lie 2

This document discusses the management of unstable lie during pregnancy. It covers: 1) Prenatal assessment through clinical examination and ultrasound to determine fetal position and check for issues. 2) Prenatal management options including non-intervention with monitoring or intervention like external cephalic version, induction, or cesarean section. 3) Intrapartum management which depends on fetal presentation, with attempts made to convert to longitudinal lie if not already and emergency c-section for some non-longitudinal cases.

Uploaded by

api-3705046
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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MANAGEMENT OF

UNSTABLE LIE
BY
DR T.K. NYENGIDIKI
PRENATAL ASSESSMENT

 CLINICAL


INVESTIGATIONAL

-Ultrasonological

-Radiological
-
PRENATAL ASSESSMENT-
CLINICAL
PRENATAL HISTORY
-Reliability of gestational assessment
-Relevant family History
PAST OBSTETRIC HISTORY
-significant polyhydramnios-cause
-abdominopelvic tumors
PELVIC EXAMINATION
-Pelvic shape,capacity, tumors etc
-Must have excluded presence of placenta
previa.
INVESTIGATIONS
Real time ultrasound scan
- fetal malformations,pelvic
tumors,placenta uterine malformations.

Radiological
-No place in the presence of above.
-X ray Gross fetal malformations/pelvic
size and shape.
MANAGEMENT
PRENATAL PERIOD

INTRAPARTUM PERIOD

POSTNATAL PERIOD
Prenatal management
NON – INTERVENTION

INTERVENTION

Non –intervention
 Spontanous version- 80% of cases

 Exclude possible causes of obstructed labour

 Advice on the risk associated with unstable lie

 Need for prompt admission in the event of mb rupture

/labour
 Physical exercises-knee-elbow position for 10mins on

a no of occasions 5-10% of longitudinal lie


 Individualization of treatment in this enviroment.
INTERVENTION
Hospitalization from 37weeks
-Daily observation of fetal lie ,presentation
-provides opportunity for correction of lie
-provides immediate clinical assistance in
the event of labour/mb rupture.
-facilitates urgent mgt in the event of a non
longitudinal lie, fetal distress, cord
presentation and prolapse.
INTERVENTION
EXPECTANT
-Admitted
-Daily examination of lie
-Cephalic/breech is maintained >48 hours
-Discharge home to report when in labour
.ACTIVE
-external cephalic version
-Stabilising induction
-Elective Cesarean section at 38/39 weeks.
ACTIVE MANAGEMENT
EXTERNAL CEPHALIC VERSION.
-Procedure done in a facility for emergency
C/section
-Longitudinal lie is maintained -discharge
patient
-Rhesus negative mothers- Anti D
immunoglobulin prophylaxis at/before.
-If unsuscessful patient to remain on admission.
-Success rate of version antenatally 40-65%
STABILIZING INDUCTION
Performed immediately after admission or within days or weeks

FIRST METHOD
In labour ward, ECV performed conversion to longitudinal lie and
maintained.
Titrated oxytocin infusion commenced to stimulate contractions.
Aim of achieving of contractions within 10 minutes
Low water amniotomy is performed while an assistance stabilises the head.
Monitor labour normally

SECOND METHOD
Perform an ECV
Stimulate uterine contractions with titrated oxytocin infusion
Perform Hind water rupture using a Drew-Smythe catheter
Reduces the risk of cord prolapse

Other methods of stimulation of uterine contraction include Prostalglandins


but unpredictable.
ELECTIVE CESAREAN SECTION
Advocated in the presence of:
- contraindication to external cephalic
version
- Failure of external version
-Mechanical obstruction to vaginal delivery
INTRAPARTUM MANAGEMENT
When the membranes rupture or labour occurs
-Longitudinal lie
Examine for fetal presentation
exclude cord prolapse
conduct a normal labour

-Non-longitudinal lie
-Determine state of fetus
-Vaginal examination to exclude mechanical obstruction ,
assess cervical dilatation and exclude cord prolapse.
-Perform ECV in between contractions or under
intravenous tocolytic administration.
-Success -Allow labour
-Unsuccessful -Emergency cesarean section.
INTRAPARTUM CONT.
Cord presentation /prolapse

-Partially dilated cervix/ Non


longitudinal lie- C/section

-Fully dilated longitudinal lie - Assisted

vaginal delivery
POSTNATAL
No specific management advice if vaginal
delivery or lower segment C/section

Classical C/section - Advice of future


pregnancy outcome/delivery is given.

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