A 28-year-old G2P1 at 34 weeks gestation presents with a transverse lie confirmed on ultrasound. Her first pregnancy ended in vaginal delivery at term. Regarding transverse lie and its management, all of the following are TRUE EXCEPT:

Explanation

## Transverse Lie: Clinical Management ### Correct Answer (The Exception) **Vaginal delivery is NOT safe for transverse lie at term** — this is the FALSE statement. ### Why Each TRUE Statement Is Correct **High-Yield:** Three statements accurately reflect the epidemiology and management of transverse lie: | Aspect | Details | |--------|----------| | **Incidence at term** | 0.3% (increases to 1–3% at 20–24 weeks; most resolve spontaneously) | | **Risk factors** | Placenta previa, multiparity, uterine abnormalities, polyhydramnios, fetal anomalies | | **Spontaneous version rate** | ~95% before 37 weeks; higher in multiparous women (loose uterus) | | **Mode of delivery at term** | Planned cesarean section (MANDATORY) | ### The Trap **Warning:** The distractor statement suggests vaginal delivery for transverse lie. This is NEVER appropriate at term because: - Vaginal delivery with transverse lie leads to: - Obstructed labor - Uterine rupture - Fetal death - Maternal hemorrhage and morbidity - Cesarean section is the ONLY safe option at term **Key Point:** Transverse lie is an absolute indication for cesarean delivery at term. There is NO role for vaginal delivery. ### Management Algorithm ```mermaid flowchart TD A[Transverse lie confirmed]:::outcome --> B{Gestational age?}:::decision B -->|< 37 weeks| C[Expectant management]:::action B -->|≥ 37 weeks| D[Planned cesarean section]:::action C --> E{Spontaneous version?}:::decision E -->|Yes| F[Cephalic presentation]:::outcome E -->|No| D D --> G[Cesarean delivery at 39 weeks]:::action G --> H[Avoid labor/rupture]:::outcome ``` ### Clinical Pearl **Timing of cesarean for transverse lie:** - Planned cesarean at **39 weeks** (before spontaneous labor onset) - Earlier if: - Rupture of membranes - Labor onset - Vaginal bleeding - Fetal distress **Mnemonic: TRANSVERSE LIE MANAGEMENT — "NEVER VAGINALLY"** - **N**o vaginal delivery at term - **E**xpectant management <37 weeks - **V**ersion (spontaneous) likely before 37 weeks - **E**arly cesarean if no version - **R**upture risk if labor occurs ### Why Multiparous Women Have Higher Spontaneous Version Rates Multiparous women have: - Laxer uterine muscles - More space for fetal movement - ~95% spontaneous version rate before 37 weeks (vs. ~75% in nulliparas) However, **even in multiparous women, transverse lie at term requires cesarean delivery**.