From the Research
The most appropriate response to this patient is to reassure her that at 28 weeks gestation, it is normal for the fetus to be in a transverse lie, and there is still ample time for the baby to move into a cephalic (head-down) presentation before delivery. Approximately 22.2% of fetuses with abnormal presentation at 28-30 weeks will persist in an abnormal presentation at term, as noted in a study of 1010 consecutive cases 1. The patient should be informed that if the baby remains in a transverse lie at term (37 weeks or beyond), a cesarean delivery would be necessary, as vaginal delivery is not safe with a transverse lie due to the risk of cord prolapse, birth trauma, and uterine rupture. Given her history of a previous cesarean delivery, she should be counseled that she will need regular follow-up ultrasounds in the third trimester to monitor fetal position. If the fetus remains in transverse lie at 36-37 weeks, an external cephalic version might be considered, though this procedure carries additional risks in patients with a prior cesarean, as discussed in a study on the role of external version in the intrapartum management of the transverse lie presentation 2. The discrepancy between fundal height and gestational age is explained by the transverse lie, which affects how the uterus expands. The patient should be advised to report any signs of labor, rupture of membranes, or decreased fetal movement immediately, as these could be concerning with a transverse lie. It is also important to note that cesarean section in breech or transverse presentation involves more complicated procedures than cesarean section in cephalic presentation, and requires additional manipulations for guiding the presenting part of the fetus, as discussed in a recent study on clinical tips for cesarean section in case of breech, transverse presentation, and incarcerated uterus 3. Overall, the management of fetal malpresentation, including transverse lie, is crucial to reduce the need for cesarean delivery and ensure a safe delivery for both the mother and the baby, as highlighted in a review on the management of fetal malpresentation 4.