Review Question - QID 109397

This patient presents with a fetus in transverse lie at 32 weeks gestation. The best next step in management is expectant management, with repeat ultrasound at 37 weeks, as most fetuses will correct to cephalic presentation by then.

Transverse lie, in which the fetus’s head is to either side of the mother (displaced laterally), can cause significant complications (shoulder presentation, labor dystocia, impaction of the fetus, etc.) at the time of delivery. Correction with external cephalic version may ultimately be necessary, but fetuses commonly move into the cephalic presentation on their own later in the third trimester. Observation and repeat ultrasound at 37 weeks is the most appropriate management for a transverse lie detected earlier in the pregnancy.

Incorrect Answers:
Answer 2: Weekly ultrasound is unnecessary, as no change in management would be required until 37 weeks. This option would be more appropriate for conditions such as intrauterine growth restriction, in which antenatal surveillance is indicated.

Answer 3: External cephalic version is the eventual treatment for fetuses that are not in cephalic presentation, but it should only be performed at 37 weeks gestation. Earlier cephalic versions may result in the fetus resuming the incorrect position.

Answer 4: Internal cephalic version involves insertion of a hand into the vagina to change the fetal position. It is rarely performed in modern medicine.

Answer 5: Caesarean section at 38 weeks is not indicated for transverse lie in this case, because it is likely that the fetus will self-correct to the cephalic presentation. If transverse lie persists, and external cephalic version is unsuccessful, this would be an appropriate course of action.

Bullet Summary:
For fetal transverse lie detected before 37 weeks, observation with repeat ultrasound at 37 weeks is the best management.