## Most Common Maternal Factor in Transverse Lie **Key Point:** Multiparity with consequent laxity of uterine muscles is the single most common maternal factor predisposing to transverse lie. Multiparous women have weaker, more distensible uteri that allow the fetus to assume an abnormal lie. ### Risk Factors for Transverse Lie | Factor | Category | Frequency | Mechanism | | --- | --- | --- | --- | | **Multiparity** | **Maternal** | **Most common** | **Lax uterine muscles allow abnormal positioning** | | Placenta previa | Placental | Common | Mechanical obstruction to normal lie | | Uterine anomalies | Uterine | Common | Distorted uterine cavity | | Fetal anomalies | Fetal | Less common | Neurological or skeletal abnormality | | Maternal obesity | Maternal | Uncommon | Not a primary cause | | Advanced maternal age | Maternal | Uncommon | Not independently associated | | Maternal diabetes | Maternal | Uncommon | Associated with macrosomia, not transverse lie | **High-Yield:** The classic teaching is that transverse lie is **more common in multiparous women** than in nulliparous women. This is because repeated pregnancies lead to progressive loss of uterine muscle tone and elasticity. **Mnemonic:** **TULIP** — causes of Transverse lie: - **T**win pregnancy - **U**terine anomalies - **L**ax uterus (multiparity) - **I**ntrauterine mass (fibroid, placenta previa) - **P**revious cesarean section (scar tissue) ### Clinical Significance - Transverse lie at term requires cesarean delivery (vaginal delivery is impossible) - If diagnosed before 34 weeks, external cephalic version may be attempted - Multiparous women should be counseled about increased risk in subsequent pregnancies **Clinical Pearl:** A multiparous woman with a history of transverse lie in a previous pregnancy has a recurrence risk of approximately 10–15% in the next pregnancy.
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