Unstable Presentation- lie

Subject: Midwifery II (Theory)

Overview

The lying is classified as unstable when, after 36 weeks of gestation, instead of remaining longitudinal, it fluctuates from one examination to the next between longitudinal and oblique or transverse. Pelvic tumor, contracted pelvis, and lax uterine muscles are the most common reasons for unsteady presentation/lie in multigravidae. Polyhydramnios and placenta previa is the fetal reasons for unstable presentation/lie. In the 38th week of pregnancy, the mother should be admitted for antenatal care. There is a danger of premature membrane rupture and cord prolapse, and investigations such as the constricted pelvis, placenta previa, and elective cesarean section should be performed. If the pregnancy is long-term, induction of labor should be accomplished with syntocinon infusion. A controlled membrane rupture is conducted so that the head enters the pelvis.

After 36 weeks of gestation, the lying is characterized as unstable when it varies from one examination to the next between longitudinal and oblique or transverse.

Causes

Maternal Causes

Pelvic tumor
Contracted pelvis
Lax uterine muscles in multigravidae

Fetal Causes

Polyhydramnios
Placenta previa

Management

Antenatal Management

The presentation and lie are should be verified at each prenatal checkup.
In the 38th week, the mother should be admitted. There is a danger of premature membrane rupture and cord prolapse.
Contracted pelvis, placenta previa, and elective cesarean section should all be investigated.

During Labor

If the pregnancy is long-term, labor should be induced using a syntocinon infusion.
A controlled membrane rupture is accomplished, allowing the head to enter the pelvis.
The bladder, bowel, position, and progress of labor should be assessed on a regular basis if the labor is considered a trial.

References

www.huffingtonpost.co.uk/2013/11/29/u-what-is-an-unstable-lie_n_7398796.html
Tuitui, Roshani, and S. N. Dr. Suwal. Manual of Midwifery II (Intrapartum Care). Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014.
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/management-of-unstable-lie-query-bank/
http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/2/b2.10.4.pdf
https://www.slideshare.net/hanifmin/abnormal-lie-presentation-10016355

Things to remember

After 36 weeks of gestation, the lying is characterized as unstable when it varies from one examination to the next between longitudinal and oblique or transverse.
Pelvic tumor, contracted pelvis, and lax uterine muscles are all causes of unstable presentation/lie in multigravidae.
Polyhydramnios and placenta previa is fetal causes of unstable presentation/lie.
Antenatal care should begin with the mother's admittance in the 38th week. There is a danger of early membrane rupture and cord prolapse, and investigations such as the constricted pelvis, placenta previa, and elective cesarean delivery should be performed.
If the pregnancy is long-term, labor should be induced using a syntocinon infusion.
A controlled membrane rupture is accomplished, allowing the head to enter the pelvis.

Questions and Answers

Define Unstable presentation/ lie.

When the lie shifts between longitudinal and oblique or transverse from one examination to the next after 36 weeks of pregnancy, it is considered unstable.

List the causes of unstable presentation.