Shoulder presentation
Transverse position (English: transverse lie) is a rarely occurring obstetric malposition of the child in the womb. The main body axis of the child forms a right angle with the mother or the so-called " leader " of the birth canal, making a natural birth is excluded and thus is a " birth impossible situation " that requires a caesarean section.
From an inclined position (English: oblique lie) is used when the body principal axes of the child and the parent form an acute angle. By itself, this situation setting is " unstable " and is changed under the influence of uterine contractions in a longitudinal or transverse position. The diagnosis of skew is therefore initially only be seen as a warning, especially since it came in a study in 83 percent of cases of spontaneous twist in a longitudinal position (52 percent cephalic, breech 31 percent ).
In ICD -10 the " Maternal care for transverse and oblique position " with O32.2 is encoded. With included here are states as a reason for " observation, hospitalization or other obstetric care of the mother or for caesarean section before onset of labor ."
Frequency
The diagnosis of a transverse position is placed in 0.3-0.6 percent of births. However, the incidence increases with increasing number of previous births ( parity), so a transverse position in women who have given birth already more than four times, there is ten times more likely. Can be diagnosed a transverse position by the outer finding ( Leopold- handles ) or by ultrasound.
Also significantly increased the rate of cross layers in preterm births, so the incidence is given here with three percent. Other factors that favor a transverse position, besides multiparity and prematurity
- Multiple pregnancy ( small children)
- Placenta previa
- Polyhydramnios
- Fetal malformations
- Uterine malformations
- Tumors in the pelvis
- (rarely a ) narrow pelvis
Complications, therapy
For the transverse position typical complications are premature rupture of membranes, umbilical cord prolapse and uterine rupture due to over-stretching.
An external version of the child, in the 34th - 37th Week of pregnancy are sought. This is best achieved in an existing polyhydramnios and multiple women in labor. Contraindicated in this protracted cross- location with impaction of the Child ( wedging his shoulder, Armvorfall ). An inner turn is made only in twin births, when after the birth of 1.Zwillings, the 2.Zwilling is in the transverse position.
Since the risk for mother and child after onset of labor or bladder rupture is greatest, the indication for cesarean section is at an early stage.