Question

A 27-year-old pregnant G3P2L2 woman presents to you at 36+6 weeks. Ultrasound is done and shows the fetus is in a transverse lie. The liquor is adequate, the placenta is normal, and she has no risk factors. Both her previous deliveries were normal vaginal deliveries. How will you manage this patient?

• A. Cesarean section
• B. External cephalic version
• C. Expectant management
• D. Induction of labor

Answer 1

The Correct Option is B

In managing a pregnant woman at 36+6 weeks gestation with a fetus in transverse lie, various options are available. The key steps involve:

• External Cephalic Version (ECV): This is the correct management in this scenario. At nearly 37 weeks, attempting an ECV can help to turn the fetus from a transverse lie to a cephalic presentation, possibly avoiding the need for cesarean delivery. Given that her pregnancy otherwise appears uncomplicated, this is a viable option.
• Cesarean Section: While this is an option for transverse lie, it is not necessary at this stage as an ECV could first be attempted.
• Expectant Management: Waiting without any intervention is generally not advised for a transverse lie at term since it reduces the chance of spontaneous correction and increases the risk of labor complications.
• Induction of Labor: Inducing labor is not recommended here because the fetal position is not suitable for a safe vaginal delivery.

In conclusion, External Cephalic Version is the preferred initial management step. It is a safe and often successful method to address a transverse fetal lie when the patient has no other complications.