Explaining the concept and implications behind this common obstetric problem

1. Abnormal lie & presentation -
concepts
A basic understanding of the issues
Associate Professor Dr Hanifullah Khan
May 2020

2. Definitions
What is it?
2

3. Normal lie
• lie of the fetus - the relationship between the long axis of the fetus with
respect to the long axis of the mother
• Normal lie - longitudinal lie
• longitudinal lie can either be cephalic or breech presentation
• Any other lie apart from this is abnormal

4. Presentation
• This is the part of the fetus that is overlying the maternal pelvic inlet
It is the part that will engage the birth canal
• The most common presentation is cephalic
• However, presentations can be any part of the fetus
e.g. breech, cord, hand, face etc
• Only cephalic presentation is normal

5. 5
Lies and presentations
Abnormal

6. Abnormal lies
• Any lie apart from longitudinal
• Oblique and transverse lies are usually similar and need not be strictly
differentiated
• In both these lies, there is usually no presenting part

7. Abnormal presentations
• Any fetal presentation that is not cephalic
• Face, brow, cord, hand, breech
• Face and brow presentations
• Usually per abdomen, felt as cephalic
• diagnosed via vaginal exam (V/E)

8. • Can be felt per abdomen
• Soft fetal pole lower part of
uterus
Breech presentations
• Can be frank, complete or footling breech
• Footling breech presents as foot presentation

9. 9
1. Implications
2. Labour
Why is the lie
important?

10. Implications
May signify underlying problem with pregnancy
Causes of abnormal lie
or presentation has to
be investigated
Is the fetus too big?
Is the inlet obstructed?
Is there an abnormality?
Too much or too little?

11. Differential diagnoses
May signify underlying
problem with
pregnancy
Causes of abnormal lie
or presentation has to
be investigated
Is the fetus too big?
Is the inlet obstructed?
Is there an abnormality?
Too much or too little?
Macrosomia
Polyhydramnios
Preterm
Fetal
Maternal
Placenta
Cervical
tumour
Problem
Diabetes
mellitus
Diabetes
mellitus
Fetal anomaly
Uterine
anomaly
Praevia
Fibroid
Diagnosis

12. Implications
Underlying abnormalities
Any fetal anomaly may
cause abnormal lie
Cause unknown

13. Diagnoses
Some common problems

14. Macrosomia is most common

15. Preparation for labour
• The lie at term prepares the presenting part for engagement during labour
• A combination of longitudinal lie and cephalic presentation is ideal
Greatest chance of successful vaginal delivery
• Any other lie apart from longitudinal cannot lead to vaginal delivery
• However, cephalic presentation is not the only presentation that can lead to
vaginal delivery
• Face and breech presentation can also have successful vaginal delivery
The chances are much less than cephalic

16. Lie and presentation in labour
• During labour, any lie that is not longitudinal has to be dealt with by Caesarean
section (LSCS)
• If diagnosed antenatally, prior to labour, the patient may have to be prepared for
elective LSCS
• Same applies for breech presentation
• Only breech presentation with low station and advanced cervical dilation may
be allowed to attempt vaginal delivery
• Breech in early labour has to be delivered by LSCS

17. Face and cord presentation
• Both of these can only be diagnosed through vaginal examination
• Cord presentation is an obstetric emergency
• Face presentation
• ⅓ may achieve normal delivery
• ⅔ will cause obstructed labour

18. 18
Determine diagnosis
Clinical

19. Diagnostic process
Patient presents with problem
Clinical assessment
Diagnosis Manage
History
U/S
P/E

20. Clinical process

21. 21
Summary
Conclusion

22. Abnormal lies and fetal
presentations are high risk
situations that need a proper
diagnosis of the underlying
cause to avoid delivery
complications and morbidity
and mortality

23. “Abnormal lie is not
what you tell your
wife”
Thank you