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While a transverse lie prior to labor can be manually versed to a longitudinal lie, once the uterus starts contracting the uterus normally will not allow any version procedure. A shoulder presentation is an indication for a caesarean section. Generally, as it is diagnosed early, the baby is not damaged by the time of delivery.
According to Gabbe, "There is no place for internal podalic version and breech extraction in the management of transverse or oblique lie or unstable presentation in singleton pregnancies because of the unacceptably high rate of fetal and maternal complications." Podalic version has a long history spanning back to Hippocrates.
Relationship of presenting part to maternal pelvis based on presentation. The fetus enters the pelvis in the occipito-transverse plane (left or right), descent, and flexion and then rotates 90 degrees to the occipitoanterior (most commonly). Cephalic presentation. Vertex presentation with longitudinal lie: [1]
Shoulder presentation with transverse lie are classified into four types, based on the location of the scapula (shoulderblade); note: the presentation is significantly different from asynclitic positioning, and in most cases needs to be delivered by cesarean section. Left scapula-anterior (LSA) Right scapula-anterior (RSA) Left scapula ...
The maneuvers are important because they help determine the position and lie of the fetus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether a caesarean section is necessary.
Most commonly, a baby is delivered by making a transverse incision in the lower uterine segment, above the attachment of the urinary bladder to the uterus. This type of incision results in less blood loss and is easier to repair than other types of caesarean sections.
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In obstetrics, a cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part (the part that first enters the birth canal). [1]