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Shoulder PresentationAka: Transverse Lie

Definition
1. Transverse lie is perpendicular to mother's long axis
2. Shoulder presentation
  1. Occurs when fetus is transverse with back down
  2. Shoulder sits over pelvic inlet
Epidemiology
1. Incidence: 0.3% of singleton births
Causes
1. Prematurity
2. Placenta Previa
3. Abnormal uterus
4. Contracted pelvis or relaxed abdominal wall
5. Polyhydramnios
Diagnosis
1. Leopold's Maneuvers
  1. Transverse lie should be easy to identify
2. Digital cervical exam
  1. No presenting part
Management
1. Ceserean section required in most cases
2. Indications to consider External Cephalic Version
  1. Intact membranes and no labor
  2. Back-up transverse lie with cervix fully dilated
Complications
1. Uterine Rupture

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.