Obstetrics Book

Delivery

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Shoulder Presentation

Aka: Shoulder Presentation, Transverse Lie
  1. 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
  2. Epidemiology
    1. Incidence: 0.3% of singleton births
  3. Causes
    1. Prematurity
    2. Placenta Previa
    3. Abnormal Uterus
    4. Contracted Pelvis or relaxed abdominal wall
    5. Polyhydramnios
  4. Diagnosis
    1. Leopold's Maneuvers
      1. Transverse Lie should be easy to identify
    2. Digital cervical exam
      1. No presenting part
  5. 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
  6. Complications
    1. Uterine Rupture

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