Shoulder Presentation

Aka: Shoulder Presentation, Transverse Lie

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II. Definitions

  1. Transverse Lie
    1. Fetal Lie perpendicular to mother's long axis
  2. Shoulder Presentation
    1. Occurs when fetus is transverse with back down
    2. Shoulder sits over pelvic inlet

III. Epidemiology

  1. Incidence: 0.3% of singleton births

IV. Causes

  1. Prematurity
  2. Placenta Previa
  3. Abnormal Uterus
  4. Contracted Pelvis or relaxed abdominal wall
  5. Polyhydramnios

V. Diagnosis

  1. Leopold's Maneuvers
    1. Transverse Lie should be easy to identify
  2. Digital cervical exam
    1. No presenting part

VI. Management

  1. Ceserean section required in most cases
  2. Indications to consider External Cephalic Version
    1. Intact membranes and no labor
    2. Back-up Transverse Lie with Cervix fully dilated

VII. Complications

  1. Uterine Rupture

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