Mrs. D , a 35 year old, G6p5+0 was seen in the antenatal clinic with a pregnancy of 34 weeks gestation, with minimal bleeding off and on and increased fetal movements. She was examined and diagnosed to have a low lying placenta with a fetus in the transverse position. After admission the baby position was confirmed clinically and by a scan. The lie changed frequently to a transverse or an oblique one.
A changing fetal lie could be due to a fibroid, excess of amniotic fluid, a fetal abnormality or a placenta previa. Often, the decision of how to deliver can be a challenge, and the route determined only close to labor. Where there is a fibroid or lower segment tumor or fibrosis, a previa obstructing the delivery route, the decision for a cesarean section is straight forward.
When the baby is normal and still in the transverse position or breech near term, the cesarean is best along with a tubal sterilization, if the patient is willing.
The oblique lie, near term, is delivered by a stabilizing induction with oxytocin, to allow for a vaginal delivery, with a back-up plan for a section in case of maternal or fetal distress!!
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