Transverse Lie Position: Diagnosis & Treatment

A longitudinal lie is a position assumed by a normal baby before labour. A transverse baby position, on the other hand, is when the baby lies across the stomach with her head facing away from the birth canal. As this interferes with the delivery, different techniques are used to correct a transverse lie position. Keep reading for everything you need to know about the fetal transverse position. Understanding the implications and corrective measures for fetal positions is crucial for ensuring a smooth and safe delivery process.

What Is a Transverse Lie Position?

If you can’t feel your baby’s head near the pelvis when the abdominal region is palpitated, and feel it in one of the flanks, your baby is in a transverse lie position. A transverse lie is a position in which the baby lies sideways. This makes a vaginal pregnancy impossible. In most of the cases, a C-section is recommended. If a transverse position baby is diagnosed late during the pregnancy, the chances of the baby staying in that position until birth are high.

Causes of the Transverse Lie Position

There are many reasons why babies assume the transverse lie position. The most common transverse lie causes are:

• An abnormal amount of amniotic fluid in the womb
• Being pregnant with twins
• Flexible abdominal muscles, which make it easier for the baby to move around in the womb
• Malformations of the uterus or obstruction of the birth canal due to some reason
• Placenta previa, a condition where the placenta partially or completely covers the cervix, affecting the baby’s positioning.

Diagnosis of the Transverse Lie Position

The doctor can tell the position of the baby by placing her hands on the abdomen in a series of movements. This is known as Leopold’s Maneuvers. She may also request an ultrasound exam to confirm the position of your baby. Typically, the position of the baby is not a concern until the last trimester of pregnancy.

Types of Transverse Lie Position

There are three commonly identifiable transverse lie baby symptoms or presentations in mothers.

They are :-

• Left-Shoulder Presentation – This is when the baby’s left shoulder faces the birth canal. What makes this dangerous is the cord may prolapse and leave the birth canal before the baby leaves, thus, making pregnancy impossible in this position.
• Right-Shoulder Presentation – When the baby’s right shoulder faces the bottom of the uterus, then that’s a right-shoulder presentation. The baby’s head can face either side in this presentation, and the position needs to be changed, or else, mothers have to go through a caesarean.
• Back-Down Presentation – If your baby lies on her back with neither shoulder facing in the direction of the birth canal, then that’s a back-down presentation. This position makes it impossible for labour to move forward since there’s no way the baby can exit in this position.
• Oblique Lie – This occurs when the baby is positioned diagonally in the uterus, with the head on one side and the feet on the other. This oblique presentation can complicate labor and delivery, requiring careful management to ensure a positive outcome.

Complications Arising From a Transverse Lie Position

When your baby is in the transverse lie position, the complications or transverse lie baby risks that arise are:

• Poor oxygen and blood supply due to umbilical cord prolapse. This can result in the death of the baby.
• Since the baby can’t pass through the vagina in such a position, a C-section will be required.
• Prolonged labour can lead to infections.
• Prolonged attempts at vaginal delivery with a transverse lie may lead to uterine rupture, a serious complication requiring emergency medical intervention. This poses risks to both the mother and the baby.

What If You’re Pregnant With Twins?

In the case of twins, if the second twin is in a transverse position then there are chances of vaginal delivery, as the uterine contractions change the position suitable for vaginal delivery. However, it may not be true in every case. In such a scenario, a cesarean may be needed, especially if the baby is big.

What Are the Effective Methods for Repositioning a Baby From a Transverse Lie?

Wondering how to turn a transverse baby? Here are some professional options as well as options you can try at home.

1) Professional Option

If exercises and natural remedies fail, then it’s time to turn to some professional help. Here’s what you can do If there’s no success after 37 weeks of pregnancy.

1. External Cephalic Version (ECV)

A medical procedure performed by healthcare providers where external manipulation is used to turn the baby into a head-down position, reducing the risk associated with a transverse lie.

2. Amnioinfusion

This technique involves introducing a saline solution into the amniotic cavity to create more space and encourage the baby to move into the proper head-down position for delivery.

3. Cesarean Section (C-Section)

In cases where other interventions are unsuccessful or deemed unsafe, a cesarean section may be recommended to ensure a controlled and timely delivery, minimizing risks associated with a transverse lie.

2) Options That Can Be Tried at Home

While addressing a transverse lie baby position at home, it’s essential to approach potential solutions cautiously and consult with a healthcare professional for guidance. Here are some options that may be considered, but it’s crucial to ensure safety and efficacy:

• Pelvic Tilts and Exercises: Gentle exercises and pelvic tilts may help encourage the baby to move into a head-down position. Consult with a healthcare provider or a certified prenatal fitness instructor for appropriate exercises.
• Optimal Maternal Positioning: Maintaining certain positions, such as hands and knees, may help create more space for the baby to turn naturally. Regularly adopting these positions, especially during periods of fetal activity, can be attempted with guidance from healthcare professionals.
• Cold and Warm Compresses: Applying a cold pack to the top of the abdomen and a warm pack to the lower abdomen, while being cautious of temperature, could potentially encourage the baby to move. However, this should be done under supervision and guidance to avoid any adverse effects.

FAQs

1. Is the Transverse Position Considered Healthy for a Baby?

No, the transverse lie position is not considered healthy for a baby. Is transverse position dangerous for a baby? Yes, as it can lead to complications such as umbilical cord prolapse, fetal distress, and difficulties during delivery.

2. What Happens if Your Baby Cannot Be Turned?

If attempts to turn the baby into a head-down position are unsuccessful or deemed unsafe, a cesarean section (C-section) may be recommended to ensure a controlled and timely delivery, minimizing risks associated with a transverse lie.

3. What Is the Typical Duration for a Baby to Remain in the Transverse Lie Position?

There is no fixed duration for a baby to remain in the transverse lie position. However, it is crucial to address this position promptly to avoid complications. The position should ideally be corrected before labor begins, and medical interventions may be necessary to ensure safe delivery.

A transverse pregnancy is often fraught with risks to the mother as well as the baby. Having a baby lying in the transverse position can surely worry mothers. But in most cases, certain medical techniques prove useful in getting the baby to assume the head-down position.

References/Resources:

1. Yolli. H, Cim. N, Yıldızhan. R, Sahin. H; A Fatal and Extremely Rare Obstetric Complication: Neglected Shoulder Presentation at Term Pregnancy (Case Reports in Obstetrics and Gynecology); Hindawi; https://www.hindawi.com/journals/criog/2015/819874/#B7; August 2015

2. Polyhydramnios: Too Much Amniotic Fluid; Birth Injury Help Center; https://www.birthinjuryhelpcenter.org/amniotic-fluid-excess.html

3. Transverse lie and shoulder presentation; Medicins Sans Frontierers; https://medicalguidelines.msf.org/en/viewport/ONC/english/7-6-transverse-lie-and-shoulder-presentation-51417541.html

4. Ali. R, Abrar. A; Transverse lie; predisposing factors, maternal and perinatal outcome; The Professional Medical Journal; https://applications.emro.who.int/imemrf/Professional_Med_J_Q/Professional_Med_J_Q_2011_18_2_208_211.pdf

5. Malpresentation; Pregnancy, Birth & Baby; https://www.pregnancybirthbaby.org.au/malpresentation

6. Boushra. M, Stone. A, Rathbun. K; Umbilical Cord Prolapse; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK542241/

7. External Cephalic Version for Breech Position; Michigan Medicine University of Michigan; https://www.uofmhealth.org/health-library/hw180146

Also Read: 

Shoulder Presentation
Assisted Delivery (Forceps and Ventouse)
Fetal Cephalic Presentation during Pregnancy
Baby’s Positions in the Womb and How to Discover Them