A 28-year-old primigravida at 32 weeks of gestation is found to have transverse lie on routine ultrasound. All of the following are true regarding transverse lie EXCEPT:

Explanation

## Transverse Lie: Key Concepts ### Key Point: **The statement that ECV is contraindicated in ALL cases of transverse lie is FALSE.** ECV is actually recommended in transverse lie at term (≥37 weeks) in the absence of contraindications, and is often successful. The statement overgeneralizes and misrepresents the role of ECV. ### High-Yield Facts on Transverse Lie | Feature | Details | |---------|----------| | **Incidence** | 0.3% at term; 10% at 20–24 weeks; decreases with advancing gestation | | **Risk factors** | Multiparity, placenta previa, uterine anomalies (bicornuate, septate), fibroids, polyhydramnios, fetal anomalies | | **Spontaneous version** | ~50–60% of transverse lies convert to cephalic by 37 weeks; ~10% remain transverse | | **ECV at term** | Recommended if no contraindications; success rate 50–70% | | **Contraindications to ECV** | Placenta previa, previous cesarean (relative), rupture of membranes, vaginal bleeding, fetal compromise, multiple gestation (relative) — NOT transverse lie itself | | **Management if persistent** | Planned cesarean section at 39 weeks | ### Mnemonic for Risk Factors of Transverse Lie: **PUMP-FAD** - **P**lacenta previa - **U**terine anomalies - **M**ultiparity - **P**olyhydramnios - **F**ibroids - **A**nomalies (fetal) - **D**iminished space (multiple gestation) ### Clinical Pearl: **Transverse lie at 32 weeks is NOT an emergency.** Most will spontaneously convert. ECV should be offered at 37 weeks if the lie remains transverse and there are no contraindications. Planned cesarean is reserved for persistent transverse lie at term or when ECV fails/is contraindicated. ### Why Each Statement Is Correct (Except the Answer) 1. **Incidence by gestational age** — Well-documented; transverse lie is common in early pregnancy but rare at term. 2. **Maternal risk factors** — Multiparity, placenta previa, and uterine anomalies are established risk factors. 3. **Spontaneous version** — The majority of transverse lies convert to cephalic before 37 weeks; only ~10% persist. [cite:ACOG Practice Bulletin 13; Williams Obstetrics 26e Ch 28]