From the Guidelines
A transverse lie labor at 2 cm effaced is a strong indication for cesarean section (CS) due to the high risk of complications and the impossibility of vaginal delivery in this presentation. In a transverse lie, the baby is positioned horizontally across the birth canal, making it impossible for the head or buttocks to enter the pelvis and progress through labor 1. According to the American Journal of Obstetrics and Gynecology, if cephalopelvic disproportion (CPD) cannot be ruled out, CS is a more prudent and safer choice to avoid risks of damage to the mother and fetus 1.
Key considerations in this scenario include:
- The impossibility of vaginal delivery with a transverse lie presentation
- The risks associated with attempting vaginal delivery, including umbilical cord prolapse, uterine rupture, birth trauma, and fetal distress
- The importance of thorough cephalopelvimetric assessment to exclude CPD before considering any intervention other than CS
- The standard of care in obstetric practice, which is to proceed with CS in cases of transverse lie presentation with cervical changes, as it ensures the safety of both mother and baby 1.
In the context of real-life clinical medicine, prioritizing the safety of both mother and baby is paramount, and the potential risks associated with attempting vaginal delivery in a transverse lie presentation far outweigh any potential benefits, making CS the recommended course of action 1.
From the Research
Transverse Lie Labor and Cesarean Section Indication
- The provided studies do not directly address whether a transverse lie labor with 2 cm effacement is an indication for cesarean section (CS) 2, 3, 4, 5, 6.
- However, the studies suggest that external cephalic version (ECV) can be a viable option to reduce the need for CS in cases of transverse lie or breech presentation 2, 3, 4, 5.
- One study found that ECV was successful in 65% of cases, with a reversion rate of 5%, and no maternal or fetal complications related to the procedure 5.
- Another study reported a 50% reduction in CS rate with the use of external version in laboring patients with transverse lie presentation 2.
- The decision to perform a CS in cases of transverse lie labor may depend on various factors, including the progression of labor, fetal well-being, and the presence of any complications 6.
- The "intra-abdominal version technique" has been described as a method to facilitate delivery of transverse lie by low-segment CS, avoiding the need for a classic CS 6.