December 14, 2009

Unstable lie

Case: 42/M/F G9P8 with unstable lie

a) Causes of unstable lie

b) Management

c) Complication


Unstable lie

1. Fetal lie and presentation repeatedly change at beyond 36/52 of gestation.

2. by 36W, fetal movement is limited, fetal should present as cephalic)

3. Incident at 26/32 is 40%, at 30/52 is 20% & at term is 3%


Causes of unstable lie

1. Prevention of head descending

a) Cephalopelvic disproportion

b) Fibroid

c) Ovarian cyst

d) Placenta previa

e) Uterine surgery

f) Multiple gestation

g) Fetal abnormality (anencephaly)

h) Fetal neuromuscular disorder


2. Condition that permit free fetal movement

a) Polyhydramnios (AFI>8)

b) Uterine laxation


History

a) Make sure that the date is correct cause unstable lie is physiological <36/52.

b) Find any risk factor associated with unstable lie.

c) Elicit any problem during pregnancy


Management


1) Admit patient to antenatal wards

a) Daily observation for fetal lie

b) Provide active management to correct lie

c) Provide immediate clinical assistance upon membrane rupture

2) Exclude factors contributing to unstable lie

3) Expectant vs Emergent management


Expectant

A) Daily observation for fetal lie

B) Discharge if longitudinal lie for 3 days

C) Review patient in a week time

D) Wait for spontaneous labour


Active management

A) Caeserean section

B) ECV

C) Stabilizing induction of labour


Complication

1) Cord prolapsed leading to fetal hypoxia/ fetal death.

2) Compound presentation

3) Uterine rupture

1 comment:

  1. Mohammad al-ShatouriJanuary 17, 2012 at 5:01 AM

    Very nice summary for the subject, thank you.

    ReplyDelete

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