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What Is a Transverse Baby?

Although rare, a baby can be in a transverse lie position in the third trimester. Here's what that means and how it impacts delivery.

What Does Transverse Lie Mean?

What are the causes of a transverse lie position, what are the possible risks and complications, how can the transverse lie position affect pregnancy, what about delivery, can you turn a transverse baby.

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During pregnancy, the fetus moves around into different fetal positions , but most end up in the optimal head down, face down (cephalic occiput anterior) position in the last few weeks. When the fetus doesn’t move into the cephalic position for birth, it’s called fetal malpresentation.

One of the rarest positions is the transverse lie, where the fetus lies horizontally, often with one shoulder down or pressing against the birth canal. If you have a transverse baby at term, the provider will intervene because a vaginal delivery is not possible.

Here’s all you need to know about transverse lie causes and how it may affect pregnancy and delivery.   

The transverse lie position is when the fetus lies across the pregnant person’s abdomen horizontally. Because the shoulder is often in the pelvic inlet, it is also sometimes called shoulder presentation. But the fetus can also have its back facing the birth canal or with feet and hands facing it.

The chances of the baby being in the sideways position at term are only around 1 in 300. But before term, at 32 weeks gestation, it’s as high as 1 in 50.

“Transverse lie is normal in the first trimester, common in the second, unusual in the third, and it’s not a position where vaginal birth is possible,” says Gail Tully, CPM, creator of Spinning Babies, a website which offers ways to ease a baby’s rotation through the pelvis based on its position. 

Often, a clear cause or risk factor for a transverse lie position is unknown. “But two of the most common risk factors for transverse lie at term include having extra amniotic fluid —often associated with diabetes but can be found on its own—and multiple gestation , such as twins or triplets,” says Layan Alrahmani, MD , maternal and fetal medicine specialist and assistant professor in obstetrics and gynecology at Loyola University Medical Center. 

Other possible risk factors for transverse lie include: 

• Multiparity (previous births may lead to lax abdominal muscles)
• Premature labor
• Low amniotic fluid
• Placenta previa (placenta is covering the pregnant person’s cervix)
• Pelvic, uterine, or fetal abnormalities (the latter is more common in primiparity, or first time births)

“Sometimes the baby is in the position for a reason,” says Karolyn Zambrotta, CNM , an obstetrics and gynecology specialist. “And after the doctor does the C-section you’ll find the problem, like a short or tight umbilical cord.” 

Transverse lie at term can be risky for both the pregnant person and baby. 

“The transverse lie is frequently found early in the pregnancy. But if the baby does not change position, then a vaginal delivery cannot occur and we have to plan differently,” says Carolina Bibbo, MD , maternal-fetal medicine specialist at Brigham and Women’s Hospital. “If the water were to break when the baby is in a transverse lie position, the cord could prolapse which is an obstetrical emergency.”  

Other possible complications include:

• Obstructed labor
• Uterine rupture
• Birth trauma
• Postpartum hemorrhage
• Birth defects 

Some pregnant people feel abdominal and back pain during pregnancy when the fetus is in the sideways position. This is related to the uterus being stretched in different ways and can cause tightening in the ribs and cramping lungs. If your health care provider approves, you can try deep breathing and gentle yoga exercises at home to help relieve pain and encourage the fetus to turn. 

If the health care provider still suspects the fetus is lying horizontal at 36 weeks, an ultrasound will be performed to confirm. Because a baby in the transverse lie position cannot be delivered vaginally, your providers will develop an alternate birth plan which can include a procedure called external cephalic version (ECV) to try and turn the fetus for vaginal delivery, or a C-section.

In the case of multiples, triplets are almost always delivered via C-section. But for twins, if the first is head down, the second may drop into the cephalic position for normal delivery having more room after the first one comes out. “You could also try ECV or internal podalic version (IPV) on the second twin if needed,” says Dr. Alrahmani. “It’s really case by case and depends on the provider’s experience and preference too.” 

After 34 weeks, it is very unlikely for a fetus in transverse lie to spontaneously change to the optimal head down position. But, in some cases, it is possible to turn a transverse baby.

Natural methods

If the fetus is not head down by 32 weeks, and there are no health concerns, midwives like Zambrotta might first recommend trying some natural techniques. As Dr. Bibbo notes, the data is limited for different approaches but yoga positions can help in some cases. 

Low-risk methods to encourage transverse babies to turn include sound or light (putting music or a bright light near the bottom of the uterus), temperature (placing something cold like frozen peas behind the head and something warm like a rice-filled sock at the bottom of the stomach), and Traditional Chinese Medicine (TCM) like moxibustion , which involves heating acupuncture points with a stick of mugwort.

Small studies have shown that the Webster technique, a gentle chiropractic approach that aligns the pelvis, can help correct fetal malpresentation. And the forward leaning inversion, also developed by a chiropractor, is the most effective position for transverse lie babies, according to Tully, who trains labor and delivery nurses on body balance techniques. 

Always speak with your health care professional before trying any methods to turn the fetus.

Intervention

If natural methods have not helped by 36 weeks, your provider will likely want to try an ECV in which they use their hands to put pressure on your belly to try and turn the fetus head down. This procedure should be done in a hospital setting to monitor the fetal heart rate, and for the rare case where an emergency C-section is needed. Possible complications include placental abruption, fetal heart rate abnormalities (FHR), premature rupture of the membranes , preterm labor, fetal distress, and vaginal bleeding. 

ECV may not be safe if you have placenta previa, a low amount of amniotic fluid, a significant uterine abnormality, vaginal bleeding, high blood pressure, multiples (before delivery of the first twin), or fetal distress.

“In general, the success rate for external cephalic version is 60% of babies,” explains Dr. Bibbo. “But there’s a greater chance for ECV to turn a fetus in transverse lie than in a breech position.”

A baby in the transverse lie position cannot fit through the pregnant person’s pelvis. If gentle exercises, chiropractic techniques, or other natural methods don’t help your baby turn by 36 weeks, you may be a candidate for ECV to move the baby into the optimal head down position for birth. But if ECV doesn’t work, then the health care provider will schedule a C-section.

Whatever ends up being needed to ensure the safety of both parent and fetus, it's always important to ask any questions you may have. That includes information on postpartum recovery should you need a C-section.

Chapter 26: Transverse Lie . Oxorn-Foote Human Labor & Birth, 7e . 2023.

Effectiveness and Safety of Acupuncture and Moxibustion in Pregnant Women with Noncephalic Presentation: An Overview of Systematic Reviews . Evidence-Based Complementary and Alternative Medicine . 2019.

The Webster Technique: a chiropractic technique with obstetric implications . J Manipulative Physiol Ther . 2002.

External Cephalic Version . StatPearls. 2022.

External Cephalic Version . Obstetrics: Normal and Problem Pregnancies (Seventh Edition) , 2017.

External Cephalic Version: A Dying Art Worth Reviving . J Obstet Gynaecol India . 2018.

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Breech, posterior, transverse lie: What position is my baby in?

Fetal presentation, or how your baby is situated in your womb at birth, is determined by the body part that's positioned to come out first, and it can affect the way you deliver. At the time of delivery, 97 percent of babies are head-down (cephalic presentation). But there are several other possibilities, including feet or bottom first (breech) as well as sideways (transverse lie) and diagonal (oblique lie).

Fetal presentation and position

During the last trimester of your pregnancy, your provider will check your baby's presentation by feeling your belly to locate the head, bottom, and back. If it's unclear, your provider may do an ultrasound or an internal exam to feel what part of the baby is in your pelvis.

Fetal position refers to whether the baby is facing your spine (anterior position) or facing your belly (posterior position). Fetal position can change often: Your baby may be face up at the beginning of labor and face down at delivery.

Here are the many possibilities for fetal presentation and position in the womb.

Medical illustrations by Jonathan Dimes

Head down, facing down (anterior position)

A baby who is head down and facing your spine is in the anterior position. This is the most common fetal presentation and the easiest position for a vaginal delivery.

This position is also known as "occiput anterior" because the back of your baby's skull (occipital bone) is in the front (anterior) of your pelvis.

Head down, facing up (posterior position)

In the posterior position , your baby is head down and facing your belly. You may also hear it called "sunny-side up" because babies who stay in this position are born facing up. But many babies who are facing up during labor rotate to the easier face down (anterior) position before birth.

Posterior position is formally known as "occiput posterior" because the back of your baby's skull (occipital bone) is in the back (posterior) of your pelvis.

Frank breech

In the frank breech presentation, both the baby's legs are extended so that the feet are up near the face. This is the most common type of breech presentation. Breech babies are difficult to deliver vaginally, so most arrive by c-section .

Some providers will attempt to turn your baby manually to the head down position by applying pressure to your belly. This is called an external cephalic version , and it has a 58 percent success rate for turning breech babies. For more information, see our article on breech birth .

Complete breech

A complete breech is when your baby is bottom down with hips and knees bent in a tuck or cross-legged position. If your baby is in a complete breech, you may feel kicking in your lower abdomen.

Incomplete breech

In an incomplete breech, one of the baby's knees is bent so that the foot is tucked next to the bottom with the other leg extended, positioning that foot closer to the face.

Single footling breech

In the single footling breech presentation, one of the baby's feet is pointed toward your cervix.

Double footling breech

In the double footling breech presentation, both of the baby's feet are pointed toward your cervix.

Transverse lie

In a transverse lie, the baby is lying horizontally in your uterus and may be facing up toward your head or down toward your feet. Babies settle this way less than 1 percent of the time, but it happens more commonly if you're carrying multiples or deliver before your due date.

If your baby stays in a transverse lie until the end of your pregnancy, it can be dangerous for delivery. Your provider will likely schedule a c-section or attempt an external cephalic version , which is highly successful for turning babies in this position.

Oblique lie

In rare cases, your baby may lie diagonally in your uterus, with his rump facing the side of your body at an angle.

Like the transverse lie, this position is more common earlier in pregnancy, and it's likely your provider will intervene if your baby is still in the oblique lie at the end of your third trimester.

Was this article helpful?

What to know if your baby is breech

9 of the most jaw-dropping breech birth photos

Cord prolapse during pregnancy

Augmentation of labor: Why it's used to speed up childbirth

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

Ahmad A et al. 2014. Association of fetal position at onset of labor and mode of delivery: A prospective cohort study. Ultrasound in obstetrics & gynecology 43(2):176-182. https://www.ncbi.nlm.nih.gov/pubmed/23929533 Opens a new window [Accessed September 2021]

Gray CJ and Shanahan MM. 2019. Breech presentation. StatPearls.  https://www.ncbi.nlm.nih.gov/books/NBK448063/ Opens a new window [Accessed September 2021]

Hankins GD. 1990. Transverse lie. American Journal of Perinatology 7(1):66-70.  https://www.ncbi.nlm.nih.gov/pubmed/2131781 Opens a new window [Accessed September 2021]

Medline Plus. 2020. Your baby in the birth canal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002060.htm Opens a new window [Accessed September 2021]

Where to go next

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• Pregnancy week by week
• Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

• Down, with the back facing the birth canal.
• Sideways, with one shoulder pointing toward the birth canal.
• Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

• An attempt to deliver the baby in the breech position is not successful.
• You do not want to try to have the baby delivered vaginally in the breech position.
• An attempt to move the baby into a head-down position is not successful.
• You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

• Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
• Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
• Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
• Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
• Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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What Is a Transverse Baby Position?

Why It Happens, How to Turn Your Baby, and Tips for a Safe Delivery

Causes and Risk Factors

Turning the fetus, complications, frequently asked questions.

A transverse baby position, also called transverse fetal lie, is when the fetus is sideways—at a 90-degree angle to your spine—instead of head up or head down. This development means that a vaginal delivery poses major risks to both you and the fetus.

Sometimes, a transverse fetus will turn itself into the head-down position before you go into labor. Other times, a healthcare provider may be able to turn the position.

If a transverse fetus can't be turned to the right position before birth, you're likely to have a cesarean section (C-section).

This article looks at causes and risk factors for a transverse baby position. It also covers how it's diagnosed and treated, the possible complications, and how you can plan ahead for delivery.

Marko Geber / Getty Images

How Common Is Transverse Baby Position?

An estimated 2% to 13% of babies are in an unfavorable position at delivery —meaning they're not in the head-down position .

Certain physiological issues can lead to a transverse fetal lie. These include:

• A bicornuate uterus : The uterus has a deep V in the top that separates the uterus into two sides; it may only be able to hold a near-term fetus sideways.
• Oligohydramnios or polyhydramnios : Abnormally low or high amniotic fluid volume (respectively).

Several risk factors can make it more likely for the fetus to be in a transverse lie, such as:

• The placenta being in an unusual position, such as blocking the opening to the cervix ( placenta previa ), which doesn't allow the fetus to reach the head-down position
• Going into labor early, before the fetus has had a chance to get into the right position
• Being pregnant with twins or other multiples, as the uterus is crowded and may not allow for much movement
• An abnormal pelvic structure that limits fetal movement
• Having a cyst or fibroid tumor blocking the cervix

Transverse fetal positioning is also more common after your first pregnancy.

It’s not uncommon for a fetus to be in a transverse position during the earlier stages of pregnancy. In most cases, though, they shift on their own well before labor begins. The transverse fetal position doesn't cause any signs or symptoms.

Healthcare professionals diagnose a transverse lie through an examination called Leopold’s Maneuvers. That involves feeling your abdomen to determine the fetal position. It's usually confirmed by an ultrasound.

You may also discover a transverse fetal lie during a routine ultrasound.

Timing of Transverse Position Diagnosis

The ultrasound done at your 36-week checkup lets your healthcare provider see the fetal position as you get closer to labor and delivery. If it's still a transverse lie at that time, your medical team will look at options for the safest labor and delivery.

Approximately 97% of deliveries involve a fetus positioned with the head down, in the best position to slide out. That makes a vaginal delivery easier and safer.

A transverse position only happens in about 1% of deliveries. In that position, the shoulder, arm, or trunk of the fetus may present first. This isn't a good scenario for either of you because a vaginal delivery is nearly impossible.

In these cases, you have two options:

• Turning the fetal position
• Having a C-section

If the fetus is in a transverse lie late in pregnancy, you or your healthcare provider may be able to change the position. Turning into the proper head-down position may help you avoid a C-section.

Medical Options

A healthcare provider can use one of the following techniques to attempt re-positioning a fetus:

• External cephalic version (ECV) : This procedure typically is performed at or after 36 weeks of pregnancy; involves using pressure on your abdomen where the fetal head and buttocks are.
• Webster technique : This is a chiropractic method in which a healthcare professional moves your hips to allow your uterus to relax and make more room for the fetus to move itself. (Note: No evidence supports this method.)

A 2020 study reported a 100% success rate for trained practitioners who used turning to change a transverse fetal lie. Real-world success rates are closer to 60%.

At-Home Options

You may be able to encourage a move out of the transverse position at home. You can try:

• Getting on your hands and knees and gently rocking back and forth
• Lying on your back with your knees bent and feet flat on the floor, then pushing your hips up in the air (bridge pose)
• Talking or playing music to stimulate the fetus to become more active
• Applying some cold to your abdomen where the fetal head is, which may make them want to move away from it

These methods may or may not work for you. While there's anecdotal evidence that they sometimes work, they haven't been researched.

Talk to your healthcare provider before attempting any of these techniques to ensure you're not doing anything unsafe.

Can Babies Go Back to Transverse After Being Turned?

Even if the fetus does change position or is successfully moved, it is possible that it could return to a transverse position prior to delivery.

Whether your child is born via C-section or is successfully moved so you can have a vaginal delivery, potential complications remain.

Cesarean Sections

C-sections are extremely common and are generally safe for both you and the fetus. Still, some inherent risks are associated with the procedure, as there are with any surgery.

The transverse position can force the surgeon to make a different type of incision, as the fetal lie may be right where they'd usually cut. Possible C-section complications for you can include:

• Increased bleeding
• Bladder or bowel injury
• Reactions to medicines
• Blood clots
• Death (very rare)

In rare cases, a C-section can result in potential complications for the baby , including:

• Breathing problems, if fluid needs to be cleared from their lungs

Most C-sections are safe and result in a healthy baby and parent. In some situations, a surgical delivery is the safest option available.

Vaginal Delivery

If the fetus is successfully moved out of the transverse lie position, you'll likely be able to deliver it vaginally. However, a few complications are possible even after the fetus has been moved:

• Labor typically takes longer.
• Your baby’s face may be swollen and appear bruised for a few days.
• The umbilical cord may be compressed, potentially causing distress and leading to a C-section.

Studies suggest that ECV is safe, effective, and may help lower the C-section rate.

Planning Ahead

As with any birth, if you experience a transverse fetal position, you should work with your healthcare provider to develop a delivery plan. If the transverse position has been maintained throughout the pregnancy, the medical team will evaluate the position at about 36 weeks and make plans accordingly.

Remember that even if the fetal head is down late in pregnancy, things can change quickly during labor and delivery. That means it's worthwhile to discuss options for different types of delivery in case they become necessary.

A transverse baby position, or transverse fetal lie, is the term for a fetus that's lying sideways in the uterus. Vaginal delivery usually isn't possible in these cases.

If the fetus is in this position near the time of delivery, the options are to turn it to make vaginal delivery possible or to have a C-section. A trained healthcare provider can use turning techniques. You may also be able to get the fetus to turn at home with some simple techniques.

Both C-section and vaginal delivery pose a risk of certain complications. However, these problems are rare and the vast majority of deliveries end with a healthy baby and parent.

A Word From Verywell

Pregnancy comes with many unknowns, and the surprises can continue up through labor and delivery.

Talking to your healthcare provider early on about possible scenarios can give you time to think about possible outcomes. This helps to avoid a situation where you’re considering risks and benefits during labor when quick decisions need to be made.

Ideally, a baby should be in the cephalic position (head down) at 32 weeks. If not, a doctor will examine the fetal position at around the 36-week mark and determine what should happen next to ensure a smooth delivery. Whether this involves a cesarian section will depend on the specific case.

Less than 1% of babies are born in the transverse position. In many cases, a doctor might recommend a cesarian delivery to ensure a more safe delivery. The risk of giving birth in the transverse lie position is greater before a due date or if twins or triplets are also born.

A planned cesarian section, or C-section, is typically performed in the 39th week of gestation. This is done so the fetus is given enough time to grow and develop so that it is healthy.

In some cases, a doctor may perform an external cephalic version (ECV) to change a transverse fetal lie. This involves the doctor using their hands to apply firm pressure to the abdomen so the fetus is moved into the cephalic (head-down) position.

Most attempts of ECV are successful, but there is a chance the fetus can move back to its previous position; in these cases, a doctor can attempt ECV again.

The American College of Obstetricians and Gynecologists. If your baby is breech .

Tempest N, Lane S, Hapangama D.  Babies in occiput posterior position are significantly more likely to require an emergency cesarean birth compared with babies in occiput transverse position in the second stage of labor: a prospective observational study .  Acta Obstet Gynecol Scand . 2020;99(4):537-545. doi:10.1111/aogs.13765

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Congenital uterine anomalies .

Figueroa L, McClure EM, Swanson J, et al.  Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries .  Reprod Health.  2020;17 (article 19). doi:10.1186/s12978-020-0854-y

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Placenta previa .

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Your baby in the birth canal .

Van der Kaay DC, Horsch S, Duvekot JJ.  Severe neonatal complication of transverse lie after preterm premature rupture of membranes .  BMJ Case Rep . 2013;bcr2012008399. doi:10.1136/bcr-2012-008399

Oyinloye OI, Okoyomo AA.  Longitudinal evaluation of foetal transverse lie using ultrasonography .  Afr J Reprod Health ; 14(1):129-133.

Nishikawa M, Sakakibara H. Effect of nursing intervention program using abdominal palpation of Leopold’s maneuvers on maternal-fetal attachment .  Reprod Health  2013;10 (article 12). doi.org/10.1186/1742-4755-10-12

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Delivery presentations .

Dalvi SA. Difficult deliveries in Cesarean section .  J Obstet Gynaecol India . 2018;68(5):344-348. doi:10.1007/s13224-017-1052-x

Zhi Z, Xi L. Clinical analysis of 40 cases of external cephalic version without anesthesia .  J Int Med Res . 2021;49(1):300060520986699. doi:10.1177/0300060520986699

National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Questions to ask your doctor about labor and delivery .

Nemours KidsHealth. Cesarean sections .

By Elizabeth Yuko, PhD Yuko has a doctorate in bioethics and medical ethics and is a freelance journalist based in New York.

7.6 Transverse lie and shoulder presentation

A transverse lie constitutes an absolute foeto-pelvic disproportion, and vaginal delivery is impossible.

This is an obstetric emergency, because labour is obstructed and there is a risk of uterine rupture and foetal distress.

7.6.1 Diagnosis

• The uterus is very wide: the transverse axis is virtually equivalent to the longitudinal axis; fundal height is less than 30 cm near term.
• On examination: head in one side, breech in the other (Figures 7.1a and 7.1b). Vaginal examination reveals a nearly empty true pelvis or a shoulder with—sometimes—an arm prolapsing from the vagina (Figure 7.1c).

Figures 7.1 - Transverse lie and shoulder presentation

7.6.2 Possible causes

• Grand multiparity (5 deliveries or more)
• Uterine malformation

Twin pregnancy

• Prematurity
• Placenta praevia
• Foeto-pelvic disproportion

7.6.3 Management

This diagnosis should be made before labour begins, at the last prenatal visit before the birth.

At the end of pregnancy

Singleton pregnancy.

• External version 4 to 6 weeks before delivery, in a CEmONC facility ( Section 7.7 ).
• If this fails, delivery should be carried out by caesarean section, either planned or at the beginning of labour (Chapter 6, Section 6.4.1 ).
• External version is contra-indicated.
• If the first twin is in a transverse lie (unusual): schedule a caesarean section.
• If the second twin is in a transverse lie: there is no indication for caesarean section, but plan delivery in a CEmONC facility so that it can be performed if necessary. Deliver the first twin and then, assess the foetal position and give a few minutes for the second twin to adopt a longitudinal lie. If the second twin stays in a transverse lie, and depending on the experience of the operator, perform external version ( Section 7.7 ) and/or internal version ( Section 7.8 ) on the second twin.

During labour, in a CEmONC facility

Foetus alive and membranes intact.

• Gentle external version, between two contractions, as early as possible, then proceed as with normal delivery.
• If this fails: caesarean section.

Foetus alive and membranes ruptured

• Multipara with relaxed uterus and mobile foetus, and an experienced operator: internal version and total breech extraction.
• Primipara, or tight uterus, or immobile foetus, or engaged arm, or scarred uterus or insufficiently-experienced operator: caesarean section.
• Incomplete dilation: caesarean section.

Caesarean section can be difficult due to uterine retraction. Vertical hysterotomy is preferable. To perform extraction, grasp a foot in the fundus (equivalent to a total breech extraction, but by caesarean section).

Foetus dead

Embryotomy for transverse lie (Chapter 9, Section 9.7.7 ).

During labour, in remote settings where surgery is not available

Try to refer the patient to a CEmONC facility. If not feasible:

• Attempt external version as early as possible.
• If this fails, wait for complete dilation.
• Perform an external version ( Section 7.7 ) combined with an internal version ( Section 7.8 ), possibly placing the woman in various positions (Trendelenburg or knee-chest).
• Put the woman into the knee-chest position.
• Between contractions, push the foetus back and try to engage his head.
• Vacuum extraction (Chapter 5, Section 5.6.1 ) and symphysiotomy (Chapter 5, Section 5.7 ) at the slightest difficulty.
• Incomplete dilation: Trendelenburg position and watchful waiting until complete dilation.

Try to refer the patient, even if referral takes some time. If not feasible, embryotomy for transverse lie (Chapter 9, Section 9.7.7 ).

What is a Transverse Baby?

• Download PDF Copy

In the final weeks of pregnancy, babies often settle down in a head down position. However, in rare cases, the baby can be seen lying sideways or in a transverse position, known as malpresentation.

Although this is common in early pregnancy when the babies are more mobile, most babies turn into the head down position by the last trimester. When this does not happen, the malpresentation called transverse lie results.

According to studies, this presentation is rare and is found in only 1 in 400 cases.

Risk Factors for Transverse Lie

Women with the following conditions are at a high risk for transverse presentation:

• High ratio of amniotic fluid to fetus
• Uterine abnormality
• Placenta previa
• Fibroids in the uterus
• Factors preventing fetal head engagement in the mother’s pelvis
• Narrow or contracted pelvis
• More than 2 babies in the womb

Diagnosis of Transverse Presentation

Abdominal examination— In transverse position, the presenting part of the fetus is typically the shoulder. During abdominal examination, the head or the buttocks cannot be felt at the bottom of the uterus and the head is usually felt in the side.

Vaginal examination— A shoulder may be felt during a vaginal examination. An arm of the fetus may even slip forward and the hand or elbow may be felt during pelvic examination.

Confirmation - An ultrasound scan of the uterus confirms the transverse lie position.

Complications of Transverse Lie

Transverse presentation can cause serious complications during delivery. Some of the consequences are listed below:

• Obstructed labor
• Umbilical cord or hand prolapse
• Postpartum hemorrhage
• Birth trauma
• Rupture of the uterus

Delivering a Transverse Baby

It is almost impossible to deliver a transverse baby vaginally. So if a baby is still lying sideways at term or when labor begins, a C-section (caesarean) may be the safest option for delivering the baby.

If a transverse position is confirmed near term, the woman may be advised to be admitted to the hospital, as there is a minor risk of the umbilical cord slipping out of the uterus once water breaks.

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This should be treated as a medical emergency and attended to immediately, as the cord may come out of the uterus before the baby and then the baby will need to be delivered quickly.

In some cases of transverse lie and shoulder presentation, the baby can be turned manually into the head down position using a process called external cephalic version.

In this process, a skilled medical professional applies pressure on the maternal belly and guides the head of the fetus into the correct position, all the while monitoring the fetal presentation on an ultrasound monitor. Although this procedure is largely painless, it can cause some discomfort to the mother.

This process should be tried only if there is no risk of membrane rupture. Although the fetus can be readily rotated to a head first presentation, it may easily turn back to the transverse position.

If external cephalic version is successful, the chance of a normal, vaginal birth is very high. If external cephalic version is not recommended due to some reason or if the procedure is unsuccessful, delivery needs to be performed via caesarean section.

If a woman goes into labor while the baby is in a transverse position, it can impact the shoulder of the fetus adversely. This is because, in such cases, the fetus in a folded position is under pressure to move down the birth canal.

An immediate C-section should be carried out in such cases, even if the fetus is not alive, as this can cause rupture of the uterus.

• https://www.nhs.uk/
• http://apps.who.int/iris/bitstream/10665/43972/1/9241545879_eng.pdf

Further Reading

• All Childbirth Content
• Visitor Policies for Cesarean Sections
• Breeched Birth: Caesarean Section or Vaginal Delivery?
• Natural Childbirth
• Anal Sphincter Injury During Childbirth

Last Updated: Dec 29, 2022

Susha Cheriyedath

Susha is a scientific communication professional holding a Master's degree in Biochemistry, with expertise in Microbiology, Physiology, Biotechnology, and Nutrition. After a two-year tenure as a lecturer from 2000 to 2002, where she mentored undergraduates studying Biochemistry, she transitioned into editorial roles within scientific publishing. She has accumulated nearly two decades of experience in medical communication, assuming diverse roles in research, writing, editing, and editorial management.

Please use one of the following formats to cite this article in your essay, paper or report:

Cheriyedath, Susha. (2022, December 29). What is a Transverse Baby?. News-Medical. Retrieved on August 28, 2024 from https://www.news-medical.net/health/What-is-a-Transverse-Baby.aspx.

Cheriyedath, Susha. "What is a Transverse Baby?". News-Medical . 28 August 2024. <https://www.news-medical.net/health/What-is-a-Transverse-Baby.aspx>.

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What happens when my baby is in transverse lie?

What is a transverse baby?

Is a transverse baby healthy, will my baby stay in the transverse position, how will i know if my baby is in transverse lie in late pregnancy, what causes a baby to stay transverse, what will happen if my baby stays in the transverse position near my due date, what will happen if i have a cord prolapse, baby in transverse lie position.

• you have too much amniotic fluid in your womb (polyhydramnios)
• you’ve had multiple pregnancies
• you have any problems with the womb
• you have placenta praevia
• you have fibroids or ovarian cysts

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Low-lying placenta and placenta praevia

Breech birth

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Malpresentations and malpositions

Peer reviewed by Dr Laurence Knott Last updated by Dr Colin Tidy, MRCGP Last updated 22 Jun 2021

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In this article :

Malpresentation, malposition.

Usually the fetal head engages in the occipito-anterior position (more often left occipito-anterior (LOA) rather than right) and then undergoes a short rotation to be directly occipito-anterior in the mid-cavity. Malpositions are abnormal positions of the vertex of the fetal head relative to the maternal pelvis. Malpresentations are all presentations of the fetus other than vertex.

Obstetrics - the pelvis and head

Continue reading below

Predisposing factors to malpresentation include:

Prematurity.

Multiple pregnancy.

Abnormalities of the uterus - eg, fibroids.

Partial septate uterus.

Abnormal fetus.

Placenta praevia.

Primiparity.

Breech presentation

See the separate Breech Presentations article for more detailed discussion.

Breech presentation is the most common malpresentation, with the majority discovered before labour. Breech presentation is much more common in premature labour.

Approximately one third are diagnosed during labour when the fetus can be directly palpated through the cervix.

After 37 weeks, external cephalic version can be attempted whereby an attempt is made to turn the baby manually by manipulating the pregnant mother's abdomen. This reduces the risk of non-cephalic delivery 1 .

Maternal postural techniques have also been tried but there is insufficient evidence to support these 2 .

Many women who have a breech presentation can deliver vaginally. Factors which make this less likely to be successful include 3 :

Hyperextended neck on ultrasound.

High estimated fetal weight (more than 3.8 kg).

Low estimated weight (less than tenth centile).

Footling presentation.

Evidence of antenatal fetal compromise.

Transverse lie 4

When the fetus is positioned with the head on one side of the pelvis and the buttocks in the other (transverse lie), vaginal delivery is impossible.

This requires caesarean section unless it converts or is converted late in pregnancy. The surgeon may be able to rotate the fetus through the wall of the uterus once the abdominal wall has been opened. Otherwise, a transverse uterine incision is needed to gain access to a fetal pole.

Internal podalic version is no longer attempted.

Transverse lie is associated with a risk of cord prolapse of up to 20%.

Occipito-posterior position

This is the most common malposition where the head initially engages normally but then the occiput rotates posteriorly rather than anteriorly. 5.2% of deliveries are persistent occipito-posterior 5 .

The occipito-posterior position results from a poorly flexed vertex. The anterior fontanelle (four radiating sutures) is felt anteriorly. The posterior fontanelle (three radiating sutures) may also be palpable posteriorly.

It may occur because of a flat sacrum, poorly flexed head or weak uterine contractions which may not push the head down into the pelvis with sufficient strength to produce correct rotation.

As occipito-posterior-position pregnancies often result in a long labour, close maternal and fetal monitoring are required. An epidural is often recommended and it is essential that adequate fluids be given to the mother.

The mother may get the urge to push before full dilatation but this must be discouraged. If the head comes into a face-to-pubis position then vaginal delivery is possible as long as there is a reasonable pelvic size. Otherwise, forceps or caesarean section may be required.

Occipito-transverse position

The head initially engages correctly but fails to rotate and remains in a transverse position.

Alternatives for delivery include manual rotation of fetal head using Kielland's forceps, or delivery using vacuum extraction. This is inappropriate if there is any fetal acidosis because of the risk of cerebral haemorrhage.

Therefore, there must be provision for a failure of forceps delivery to be changed immediately to a caesarean. The trial of forceps is therefore often performed in theatre. Some centres prefer to manage by caesarean section without trial of forceps.

Face presentations

Face presents for delivery if there is complete extension of the fetal head.

Face presentation occurs in 1 in 1,000 deliveries 5 .

With adequate pelvic size, and rotation of the head to the mento-anterior position, vaginal delivery should be achieved after a long labour.

Backwards rotation of the head to a mento-posterior position requires a caesarean section.

Brow positions

The fetal head stays between full extension and full flexion so that the biggest diameter (the mento-vertex) presents.

Brow presentation occurs in 0.14% of deliveries 5 .

Brow presentation is usually only diagnosed once labour is well established.

The anterior fontanelle and super orbital ridges are palpable on vaginal examination.

Unless the head flexes, a vaginal delivery is not possible, and a caesarean section is required.

Further reading and references

• Hofmeyr GJ, Kulier R, West HM ; External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2015 Apr 1;(4):CD000083. doi: 10.1002/14651858.CD000083.pub3.
• Hofmeyr GJ, Kulier R ; Cephalic version by postural management for breech presentation. Cochrane Database Syst Rev. 2012 Oct 17;10:CD000051. doi: 10.1002/14651858.CD000051.pub2.
• Management of Breech Presentation ; Royal College of Obstetricians and Gynaecologists (Mar 2017)
• Szaboova R, Sankaran S, Harding K, et al ; PLD.23 Management of transverse and unstable lie at term. Arch Dis Child Fetal Neonatal Ed. 2014 Jun;99 Suppl 1:A112-3. doi: 10.1136/archdischild-2014-306576.324.
• Gardberg M, Leonova Y, Laakkonen E ; Malpresentations - impact on mode of delivery. Acta Obstet Gynecol Scand. 2011 May;90(5):540-2. doi: 10.1111/j.1600-0412.2011.01105.x.

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Next review due: 21 Jun 2026

22 jun 2021 | latest version.

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Fetal Malpresentation and Malposition

Fetal presentation describes which part of the fetus will enter through the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy first, while position is the orientation Orientation Awareness of oneself in relation to time, place and person. Psychiatric Assessment of the fetus compared to the maternal bony pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy . Presentations include vertex (the fetal occiput will present through the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy first), face, brow, shoulder, and breech. If a fetal limb is presenting next to the presenting part (e.g., the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy is next to the head), this is known as a compound presentation. Malpresentation refers to any presentation other than vertex, with the most common being breech presentations. Vaginal delivery of a breech infant increases the risk for head entrapment and hypoxia Hypoxia Sub-optimal oxygen levels in the ambient air of living organisms. Ischemic Cell Damage , so, especially in the United States, mothers are generally offered a procedure to help manually rotate the baby to a head-down position instead (known as an external cephalic version) or a planned cesarean delivery Cesarean Delivery Cesarean delivery (CD) is the operative delivery of ≥ 1 infants through a surgical incision in the maternal abdomen and uterus. Cesarean deliveries may be indicated for a number of either maternal or fetal reasons, most commonly including fetal intolerance to labor, arrest of labor, a history of prior uterine surgery, fetal malpresentation, and placental abnormalities. Cesarean Delivery .

Last updated: Feb 14, 2023

Fetal Lie and Presentation

Presenting diameter, management of cephalic and compound presentations, risks and management of breech and transverse presentations.

Share this concept:

• The “presenting part” refers to the part of the baby that will come through the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy first. 
• The position refers to how that body part (and thus the baby) is oriented within the maternal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy . 
• The uterine fundus Fundus The superior portion of the body of the stomach above the level of the cardiac notch. Stomach: Anatomy is typically roomier, so babies tend to orient themselves head down so that their body and limbs occupy the larger portion of the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy .

Clinical relevance

• The maternal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy has a diameter of about 10 cm, through which the fetus must pass.
• The presentation and position of the fetus will determine how wide the fetus is (known as the “presenting fetal diameter”) as it attempts to pass through the maternal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy .
• Certain presentation/positions are more difficult (or even impossible) to pass through the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy because of their large presenting diameter.
• Knowledge of the presentation and position are required to safely manage labor and delivery.

Risk factors for fetal malpresentation

• Multiparity (which can result in lax abdominal walls)
• Multiple gestations (e.g., twins)
• Prematurity Prematurity Neonatal Respiratory Distress Syndrome
• Uterine abnormalities (e.g., leiomyomas, uterine septa)
• Narrow pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy shapes
• Fetal anomalies (e.g., hydrocephalus Hydrocephalus Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial. Subarachnoid Hemorrhage )
• Placental anomalies (e.g.,   placenta previa Placenta Previa Abnormal placentation in which the placenta implants in the lower segment of the uterus (the zone of dilation) and may cover part or all of the opening of the cervix. It is often associated with serious antepartum bleeding and premature labor. Placental Abnormalities , in which the placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity covers the internal cervical os)
• Polyhydramnios Polyhydramnios Polyhydramnios is a pathological excess of amniotic fluid. Common causes of polyhydramnios include fetal anomalies, gestational diabetes, multiple gestations, and congenital infections. Patients are often asymptomatic but may present with dyspnea, extremity swelling, or abdominal distention. Polyhydramnios (too much fluid)
• Oligohydramnios Oligohydramnios Oligohydramnios refers to amniotic fluid volume less than expected for the current gestational age. Oligohydramnios is diagnosed by ultrasound and defined as an amniotic fluid index (AFI) of ‰¤ 5 cm or a single deep pocket (SDP) of Oligohydramnios (not enough fluid)
• Malpresentation in a previous pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care

Epidemiology

Prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency rates for different malpresentations at term:

• Vertex presentation, occiput posterior position: 1 in 19 deliveries
• Breech presentation: 1 in 33 deliveries
• Face presentation: 1 in 600–800 deliveries
• Transverse lie: 1 in 833 deliveries
• Compound presentation: 1 in 1500 deliveries 

Related videos

Fetal lie is how the long axis of the fetus is oriented in relation to the mother. Possible lies include:

• Longitudinal: fetus and mother have the same vertical axis (their spines are parallel).
• Transverse: fetal vertical axis is at a 90-degree angle to mother’s vertical axis (their spines are perpendicular).
• Oblique: fetal vertical axis is at a 45-degree angle to mother’s vertical axis (unstable, and will resolve to longitudinal or transverse during labor).

Presentation

Presentation describes which body part of the fetus will pass through the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy first. Presentations include:

• Cephalic: head down
• Breech: bottom/feet down
• Transverse presentation: shoulder 
• Compound presentation: an extremity presents alongside the primary presenting part

Cephalic presentations

Cephalic presentations can be categorized as:

• Vertex presentation: chin Chin The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. Melasma flexed, with the occipital Occipital Part of the back and base of the cranium that encloses the foramen magnum. Skull: Anatomy fontanel as the presenting part
• Face presentation
• Brow presentation: forehead Forehead The part of the face above the eyes. Melasma is the presenting part

Vertex presentation

Face presentation (mentum anterior position)

Brow presentation (mentum posterior position)

Breech presentations

Breech presentations can be categorized as:

• Frank breech: bottom down, legs extended (50%–70%) 
• Complete breech: bottom down, hips and knees both flexed
• Incomplete breech: 1 or both hips not completely flexed
• Footling breech: feet down

Breech presentations: Frank (bottom down, legs extended), complete (bottom down, hips and knees both flexed), and footling (feet down) breech presentations

Transverse and compound presentations

• Uncommon, but when they occur, the presenting fetal part is the shoulder.
• If the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy begins dilating, the arm Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy may prolapse through the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy .
• In compound presentations, the most common situation is a hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy or arm Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy presenting with the head.

Shoulder presentation (transverse lie)

Neglected shoulder presentation resulting in arm prolapse during labor

Vertex presentation with a compound hand

Fetal malpresentation

• Any presentation other than vertex
• Clinically, this means breech, face, brow, and shoulder presentations.

Position describes the relation of the fetal presenting part to the maternal bony pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy .

Vertex positions

Positions for vertex presentations describe the position of the fetal occiput .

• Identified on cervical exam as the area in the midline between the anterior and posterior fontanelles Fontanelles Physical Examination of the Newborn
• Anterior, posterior, or transverse in relation to the maternal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy
• Being on the maternal right or left
• Right or left occiput anterior
• Right or left occiput posterior
• Right or left occiput transverse
• Direct occiput anterior or posterior
• The most common positions (and easiest for vaginal delivery) are occiput anterior.

Overview of different vertex positions LOA: left occiput anterior LOP: left occiput posterior LOT: left occiput transverse OA occiput anterior OP: occiput posterior ROA: right occiput anterior ROP: right occiput posterior ROT: right occiput transverse

Face and brow positions

Positions for face and brow presentations describe the position of the chin Chin The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. Melasma .

• The chin Chin The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. Melasma is referred to as the mentum.
• Right or left mentum anterior
• Right or left mentum posterior
• Right or left mentum transverse
• Direct mentum anterior or posterior

Face presentation (mentum posterior position)

Breech and shoulder positions

• Positions for breech presentations describe the position of the sacrum Sacrum Five fused vertebrae forming a triangle-shaped structure at the back of the pelvis. It articulates superiorly with the lumbar vertebrae, inferiorly with the coccyx, and anteriorly with the ilium of the pelvis. The sacrum strengthens and stabilizes the pelvis. Vertebral Column: Anatomy . Similar to other presentations, they include anterior, posterior, and transverse and right, left, and direct.
• Dorso-superior (back up)
• Dorso-inferior (back down)

Dorso-inferior shoulder presentation

Dorso-superior shoulder presentation

Attitude and asynclitism

• Attitude: amount of flexion Flexion Examination of the Upper Limbs or extension Extension Examination of the Upper Limbs of the fetal head
• Lateral deflection of the sagittal Sagittal Computed Tomography (CT) suture to 1 side or the other
• Mild degrees of asynclitism are normal.
• More severe asynclitism increases the presenting fetal diameter and makes it more difficult for the fetal head to pass through the maternal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy .

Fetal malposition

• Commonly refers to any position other than right occiput anterior, left occiput anterior, or direct occiput anterior
• All nonvertex presentations are also malpositioned.
• The terms fetal malpresentation and fetal malposition are often used interchangeably.
• The presenting diameter refers to the width of the presenting part.
• The maternal pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy is about 10 cm at its narrowest point; the infant must orient itself so that it can fit through.
• Most commonly, the infant will move into a cephalic, vertex presentation, in 1 of the occiput anterior positions → presents the narrowest diameter
• Vertex presentation: suboccipitobregmatic diameter, approximately 9.5 cm
• Vertex presentation with deflexed head: occipitofrontal diameter, approximately 11.5 cm
• Brow presentation: occipitomental diameter, approximately 13 cm
• Face presentation: submentobregmatic diameter, approximately 9.5 cm

Diameters of the fetal head

Comparison of presentation, attitude, and presenting diameter

How to establish lie, presentation, and position

Delivery is managed differently depending on the presentation and position of the infant. This information can be established in several different ways:

Leopold’s maneuvers

Ultrasonography.

• Cervical examination
• Techniques using abdominal palpation Abdominal Palpation Abdominal Examination to determine the presentation of the fetus
• The fetal head will be hard and round.
• The lower body will be bulkier, nodular, and mobile.
• The back will be hard and smooth.
• The other side (anterior surface of the fetus) will be filled with irregular, mobile fetal parts.
• Experienced providers can also estimate the fetal weight using these maneuvers.
• Bedside abdominal ultrasonography can easily identify the fetal head and its orientation Orientation Awareness of oneself in relation to time, place and person. Psychiatric Assessment .
• Quick bedside ultrasonography Bedside Ultrasonography ACES and RUSH: Resuscitation Ultrasound Protocols on admission to labor and delivery to assess fetal presentation is considered standard of care Standard of care The minimum acceptable patient care, based on statutes, court decisions, policies, or professional guidelines. Malpractice .
• The fetal head will typically encompass the entire window and appear like a large white circle (the fetal skull Skull The skull (cranium) is the skeletal structure of the head supporting the face and forming a protective cavity for the brain. The skull consists of 22 bones divided into the viscerocranium (facial skeleton) and the neurocranium. Skull: Anatomy ).
• Identification Identification Defense Mechanisms of the eyes can help determine position.
• It is quick and easy to perform and presents minimal risk to mother and infant.
• Allowing mothers to labor with infants in a noncephalic presentation significantly increases the risks to both of them.

Suprapubic bedside ultrasound showing the large white circle of the fetal skull, confirming a cephalic presentation F: fetal falx

Vaginal and cervical examination

• As the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy dilates, the fetal fontanelles Fontanelles Physical Examination of the Newborn can be directly palpated.
• Identifying the location of the fetal fontanelles Fontanelles Physical Examination of the Newborn allows the practitioner to establish the position.
• Insert 1–2 fingers through the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy posteriorly.
• Sweep fingers along the fetal head moving anteriorly.
• This maneuver allows for identification Identification Defense Mechanisms of the sagittal Sagittal Computed Tomography (CT) suture.
• The fontanelles Fontanelles Physical Examination of the Newborn are then identified by moving along the sagittal Sagittal Computed Tomography (CT) suture.

Vertex presentations

• Expectant management
• All have high chances of successful vaginal delivery.

Compound presentations

• Observation when labor is progressing normally (many compound presentations will resolve spontaneously intrapartum).
• Can attempt to gently pinch the compound extremity trying to provoke the fetus into withdrawing the part (no good quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement evidence, but unlikely to be harmful)
• Can attempt to manually replace the compound extremity
• If labor is prolonged and the compound part remains, cesarean delivery Cesarean Delivery Cesarean delivery (CD) is the operative delivery of ≥ 1 infants through a surgical incision in the maternal abdomen and uterus. Cesarean deliveries may be indicated for a number of either maternal or fetal reasons, most commonly including fetal intolerance to labor, arrest of labor, a history of prior uterine surgery, fetal malpresentation, and placental abnormalities. Cesarean Delivery (CD) should be performed.
• Prolonged labor
• Umbilical cord Umbilical cord The flexible rope-like structure that connects a developing fetus to the placenta in mammals. The cord contains blood vessels which carry oxygen and nutrients from the mother to the fetus and waste products away from the fetus. Placenta, Umbilical Cord, and Amniotic Cavity prolapse
• Increased maternal morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status from lacerations
• Ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage of the compound part

Brow presentations

• The majority spontaneously convert to a vertex presentation.
• Cesarean delivery Cesarean Delivery Cesarean delivery (CD) is the operative delivery of ≥ 1 infants through a surgical incision in the maternal abdomen and uterus. Cesarean deliveries may be indicated for a number of either maternal or fetal reasons, most commonly including fetal intolerance to labor, arrest of labor, a history of prior uterine surgery, fetal malpresentation, and placental abnormalities. Cesarean Delivery may be required if labor is prolonged.

Face presentations

• Management depends on the position.
• Can be delivered vaginally by an experienced provider
• Cesarean delivery Cesarean Delivery Cesarean delivery (CD) is the operative delivery of ≥ 1 infants through a surgical incision in the maternal abdomen and uterus. Cesarean deliveries may be indicated for a number of either maternal or fetal reasons, most commonly including fetal intolerance to labor, arrest of labor, a history of prior uterine surgery, fetal malpresentation, and placental abnormalities. Cesarean Delivery may be required.
• Head is fully extended and unable to pass through the birth canal Birth canal Pelvis: Anatomy .
• Normally, the fetal head flexes as it passes under the pubic bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types ; however, this is impossible in an MP position.
• Cesarean delivery Cesarean Delivery Cesarean delivery (CD) is the operative delivery of ≥ 1 infants through a surgical incision in the maternal abdomen and uterus. Cesarean deliveries may be indicated for a number of either maternal or fetal reasons, most commonly including fetal intolerance to labor, arrest of labor, a history of prior uterine surgery, fetal malpresentation, and placental abnormalities. Cesarean Delivery is always required (unless the infant spontaneously rotates to a mentum anterior (MA) position).

There are 3 primary options for managing breech presentations: performing CD, attempting an external cephalic version to manually rotate the baby into a vertex presentation for attempted vaginal delivery, or a planned vaginal breech delivery (which is generally not done in the United States).

Natural history of breech presentations

Most infants will spontaneously rotate to a vertex presentation as the pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care progresses. At different gestational ages, the prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency of breech presentations is:

• < 28 weeks: 20%–25%
• 32 weeks: 10%–15%
• Term (> 37 weeks): 3% 
• Spontaneous version is possible even at > 40 weeks.
• Flexed fetal legs
• Polyhydramnios Polyhydramnios Polyhydramnios is a pathological excess of amniotic fluid. Common causes of polyhydramnios include fetal anomalies, gestational diabetes, multiple gestations, and congenital infections. Patients are often asymptomatic but may present with dyspnea, extremity swelling, or abdominal distention. Polyhydramnios
• Longer umbilical cord Umbilical cord The flexible rope-like structure that connects a developing fetus to the placenta in mammals. The cord contains blood vessels which carry oxygen and nutrients from the mother to the fetus and waste products away from the fetus. Placenta, Umbilical Cord, and Amniotic Cavity
• Lack of fetal/uterine anomalies
• Multiparity

Fetal risks associated with breech presentations

The following risks are associated with breech presentations in utero, regardless of mode of delivery:

• ↑ Association with congenital Congenital Chorioretinitis malformations
• Torticollis Torticollis A symptom, not a disease, of a twisted neck. In most instances, the head is tipped toward one side and the chin rotated toward the other. The involuntary muscle contractions in the neck region of patients with torticollis can be due to congenital defects, trauma, inflammation, tumors, and neurological or other factors. Cranial Nerve Palsies
• Developmental hip dysplasia 

Fetal risks associated with vaginal breech delivery

The primary risk of a vaginal breech delivery is fetal head entrapment:

• The fetal body delivers, but the head remains trapped in the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy .
• Causes compression Compression Blunt Chest Trauma of the umbilical cord Umbilical cord The flexible rope-like structure that connects a developing fetus to the placenta in mammals. The cord contains blood vessels which carry oxygen and nutrients from the mother to the fetus and waste products away from the fetus. Placenta, Umbilical Cord, and Amniotic Cavity running past the head (between the delivered umbilicus and the undelivered placenta Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (chorionic villi) derived from trophoblasts and a maternal portion (decidua) derived from the uterine endometrium. The placenta produces an array of steroid, protein and peptide hormones (placental hormones). Placenta, Umbilical Cord, and Amniotic Cavity ) 
• Leads to hypoxia Hypoxia Sub-optimal oxygen levels in the ambient air of living organisms. Ischemic Cell Damage until head is delivered → ↑ risk of fetal death
• The cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy may not be fully dilated enough to accommodate the head.
• The fetal head may not fit through the bony pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy .
• The mother’s expulsive efforts are unable to quickly deliver the head.
• Umbilical cord Umbilical cord The flexible rope-like structure that connects a developing fetus to the placenta in mammals. The cord contains blood vessels which carry oxygen and nutrients from the mother to the fetus and waste products away from the fetus. Placenta, Umbilical Cord, and Amniotic Cavity prolapse during labor → requires emergent CD
• Birth injuries to the fetus (e.g., brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region injury)

Vaginal breech delivery

Vaginal breech deliveries for singleton gestations may be considered for certain low-risk women if vaginal delivery is strongly desired by the mother. In contrast, vaginal breech deliveries are done frequently for breech 2nd twins; the procedure is known as a breech extraction.

• Mothers must be fully counseled on risks.
• Mothers and infants should be monitored throughout labor with continuous electronic fetal heart rate Heart rate The number of times the heart ventricles contract per unit of time, usually per minute. Cardiac Physiology (FHR) and tocometry monitors.
• Mothers should understand that a CD will be recommended if there are signs of fetal distress or prolonged labor.
• Avoid artificial rupture of membranes to ↓ risk of cord prolapse.
• Frank or complete breech presentation with no hyperextension of the fetal head on ultrasonography
• No contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation to a vaginal birth
• No prior CDs
• Prior successful vaginal deliveries (i.e., multiparity)
• Gestational age Gestational age The age of the conceptus, beginning from the time of fertilization. In clinical obstetrics, the gestational age is often estimated as the time from the last day of the last menstruation which is about 2 weeks before ovulation and fertilization. Pregnancy: Diagnosis, Physiology, and Care ≥ 36 weeks
• Spontaneous labor
• Normal bony pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy shown on X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests
• Estimated fetal weight Estimated Fetal Weight Obstetric Imaging between approximately 2500 and 3500 grams (exact range varies based on clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship )
• Immediately after delivery of the 1st twin in the cephalic presentation, the physician reaches up into the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy , manually grabs the infant’s legs, and gently guides them down through the birth canal Birth canal Pelvis: Anatomy while the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy is still fully dilated.
• ↓ Risk of head entrapment compared to singleton vaginal breech deliveries

External cephalic version

An external cephalic version (ECV) is a procedure in which the physician attempts to manually rotate the fetus from a breech to a cephalic presentation by pushing on the maternal abdomen.

• Approximately 50%–60% (higher in multiparous Multiparous A woman with prior deliveries Normal and Abnormal Labor than in nulliparous women) 
• 97% of infants remained cephalic at birth.
• 86% delivered vaginally.
• Women who are candidates for ECV should be counseled on their options to attempt an ECV, or they may simply elect to schedule a CD.
• Infant is full term in case emergent CD is required because of complications from the procedure (e.g., placental abruption Placental Abruption Premature separation of the normally implanted placenta from the uterus. Signs of varying degree of severity include uterine bleeding, uterine muscle hypertonia, and fetal distress or fetal death. Antepartum Hemorrhage ).
• Better ratio of infant size to fluid level than later in pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care
• Allows infant more time for spontaneous version than if the procedure was done earlier
• After a successful version, the mother can await spontaneous labor or be induced immediately, depending on the situation.
• There is still a chance that the infant may spontaneously rotate between the failed ECV and the planned CD date; therefore, presentation should always be checked immediately prior to CD.
• Another contraindication for a vaginal delivery (e.g., placenta previa Placenta Previa Abnormal placentation in which the placenta implants in the lower segment of the uterus (the zone of dilation) and may cover part or all of the opening of the cervix. It is often associated with serious antepartum bleeding and premature labor. Placental Abnormalities )
• Severe oligohydramnios Oligohydramnios Oligohydramnios refers to amniotic fluid volume less than expected for the current gestational age. Oligohydramnios is diagnosed by ultrasound and defined as an amniotic fluid index (AFI) of ‰¤ 5 cm or a single deep pocket (SDP) of Oligohydramnios
• Nonreassuring fetal monitoring Fetal monitoring The primary goals of antepartum testing and monitoring are to assess fetal well-being, identify treatable situations that may cause complications, and evaluate for chromosomal abnormalities. These tests are divided into screening tests (which include cell-free DNA testing, serum analyte testing, and nuchal translucency measurements), and diagnostic tests, which provide a definitive diagnosis of aneuploidy and include chorionic villus sampling (CVS) and amniocentesis. Antepartum Testing and Monitoring prior to the procedure
• A hyperextended fetal head
• Significant fetal or uterine anomalies
• Leads to fetal and maternal hemorrhage
• An immediate CD is required.
• If the version was successful, labor should be induced immediately.
• If the version was unsuccessful, the mother should undergo immediate CD.
• Cord prolapse: can occur with PROM PROM Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, refers to the rupture of the amniotic sac before the onset of labor. Prelabor rupture of membranes may occur in term or preterm pregnancies. Prelabor Rupture of Membranes and requires immediate/emergent CD.
• Common during the procedure, but typically resolves shortly after pressure on the abdomen is released.
• If distress persists, the mother should undergo an immediate CD.

Cesarean delivery Cesarean Delivery Cesarean delivery (CD) is the operative delivery of ≥ 1 infants through a surgical incision in the maternal abdomen and uterus. Cesarean deliveries may be indicated for a number of either maternal or fetal reasons, most commonly including fetal intolerance to labor, arrest of labor, a history of prior uterine surgery, fetal malpresentation, and placental abnormalities. Cesarean Delivery

• Scheduled at 39 weeks’ gestational age Gestational age The age of the conceptus, beginning from the time of fertilization. In clinical obstetrics, the gestational age is often estimated as the time from the last day of the last menstruation which is about 2 weeks before ovulation and fertilization. Pregnancy: Diagnosis, Physiology, and Care (WGA) if the infant is known to be in the breech presentation.
• Alternative option to attempting ECV
• Postpartum hemorrhage Postpartum hemorrhage Postpartum hemorrhage is one of the most common and deadly obstetric complications. Since 2017, postpartum hemorrhage has been defined as blood loss greater than 1,000 mL for both cesarean and vaginal deliveries, or excessive blood loss with signs of hemodynamic instability. Postpartum Hemorrhage
• Postpartum endomyometritis
• Maternal injury
• Longer recovery time postpartum
• Complications in future pregnancies (e.g., placenta previa Placenta Previa Abnormal placentation in which the placenta implants in the lower segment of the uterus (the zone of dilation) and may cover part or all of the opening of the cervix. It is often associated with serious antepartum bleeding and premature labor. Placental Abnormalities , placenta accreta Placenta Accreta Abnormal placentation in which all or parts of the placenta are attached directly to the myometrium due to a complete or partial absence of decidua. It is associated with postpartum hemorrhage because of the failure of placental separation. Placental Abnormalities , uterine rupture Uterine Rupture A complete separation or tear in the wall of the uterus with or without expulsion of the fetus. It may be due to injuries, multiple pregnancies, large fetus, previous scarring, or obstruction. Antepartum Hemorrhage )
• Maternal request (mother declines ECV attempt)
• ECV contraindicated
• ECV unsuccessful
• Fetal distress during labor

Management of transverse presentations

• As with breech presentations, mothers may be offered an attempt at ECV or a CD.
• Unlike breech presentations, vaginal transverse delivery is always contraindicated.
• Hofmeyr, G.J. (2021). Overview of breech presentation. In Barss, V.A. (Ed.), UpToDate. Retrieved July 14, 2021, from https://www.uptodate.com/contents/overview-of-breech-presentation  
• Hofmeyr, G.J. (2021). Delivery of the singleton fetus in breech presentation. In Barss, V.A. (Ed.), UpToDate. Retrieved July 14, 2021, from https://www.uptodate.com/contents/delivery-of-the-singleton-fetus-in-breech-presentation  
• Hofmeyr, G.J. (2021). External cephalic version. In Barss, V.A. (Ed.), UpToDate. Retrieved July 14, 2021, from https://www.uptodate.com/contents/external-cephalic-version  
• Julien, S., and Galerneau, F. (2021). Face and brow presentations in labor. In Barss, V.A., (Ed.), UpToDate. Retrieved July 14, 2021, from https://www.uptodate.com/contents/face-and-brow-presentations-in-labor  
• Strauss, R.A., Herrera, C.A. (2021). Transverse fetal lie. In Barss, V.A., (Ed.), UpToDate. Retrieved July 14, 2021, from https://www.uptodate.com/contents/transverse-fetal-lie  
• Barth, W.H. (2021). Compound fetal presentation. In Barss, V.A., (Ed.), UpToDate. Retrieved July 14, 2021, from https://www.uptodate.com/contents/compound-fetal-presentation  
• Cunningham, F. G., Leveno, K. J., et al. (2010). Williams Obstetrics, 23rd ed., pp. 374‒382. 

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trans·verse

• acute transverse myelitis
• anterior column
• anthropoid pelvis
• ascending branch of superficial cervical artery
• assimilation pelvis
• axial image
• brachypellic pelvis
• caput transversum musculi adductoris hallucis
• caput transversum musculi adductoris pollicis
• cardinal rotation
• cerebral index
• cesarean section
• clamshell incision
• colon cut-off sign
• compound presentation
• costotransverse
• transtracheal oxygen catheterization
• transtracheal oxygen therapy
• transtympanic
• transudation
• transureteroureterostomy
• transurethral
• Transurethral Bladder Resection
• transurethral laser-induced prostatectomy
• transurethral microwave therapy
• transurethral needle ablation
• transurethral resection
• transurethral resection of bladder tumor
• transurethral resection of prostate
• Transurethral resection of the prostate
• transurethral resection syndrome
• transvaginal
• transvaginal scanning
• transvaginal ultrasound
• transvector
• transvenous pacing
• transversalis
• transversalis fascia
• transverse abdominal incision
• transverse acetabular ligament
• transverse amputation
• transverse anthelicine groove
• transverse arch of foot
• transverse arytenoid (muscle)
• transverse branch of lateral femoral circumflex artery
• transverse carpal ligament
• transverse cerebral fissure
• transverse cervical artery
• transverse cervical nerve
• transverse cervical veins
• transverse colon
• transverse costal facet
• transverse crest of internal acoustic meatus
• transverse diameter
• transverse disc
• transverse ductules of epoophoron
• transverse facial artery
• transverse facial fracture
• transverse facial vein
• transverse fissure
• transverse fissure of cerebellum
• transverse fissure of cerebrum
• transverse fissure of the right lung
• transversal
• Transversal Electric Field Integral Equation
• Transversal Filtering Section
• Transversal intersection
• Transversal line
• Transversal Magnetic Field Integral Equation
• Transversalis
• Transversalis artery colli
• Transversalis colli artery
• Transversalis fascia
• Transversalis muscle
• Transversality
• Transversality condition
• transversally
• transversals
• transversarial part of vertebral artery
• Transverse abdominal
• Transverse Abdominal Island Flap
• Transverse abdominal muscle
• Transverse abdominis
• Transverse Abdominis Muscle Release
• Transverse Abdominus
• Transverse acetabular ligament
• Transverse Acoustic
• Transverse Acoustic-wave Voltage
• Transverse Alternating-Field Electrophoresis
• Transverse Anastomosis
• Transverse Aortic Arch
• transverse apparent diffusion coefficient
• transverse arch
• transverse artery of face
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