UNSTABLE LIE

Definition It is a condition in which the presentation of the fetus is constantly changed even beyond 36th week of pregnancy when it should have been established.

Causes Are the factors which prevent the presenting part to remain fixed in the lower pole of the uterus Grand multipara with lack of uterine tone and pendulous abdomen Hydramnios Contracted pelvis Placenta previa Pelvic tumor

Management Antenatal Check presentation and lie of the fetus External version if not contraindicated Hospitalisation Admit at 38th week Do investigations to exclude placenta previa, contracted pelvis or congenital malformation of the fetus

Formulation of line of treatment Elective LSCS In the presence of complicating factors Stabilising induction of labour In the absence of complicating factors The principle is to secure uterine activity and to perform amniotomy

Procedure for stabilizing induction of labour Check presentation and do external cephalic version Start oxytocin drip Do internal examination Do low rupture of membrane Continue usual management

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