Abnormal Lie Neocities V2 Sem10

uhh ....... Sorry. It is wrong. Madam G's lie is changing constantly. If the lie is changing between oblique, longitudinal, and transverse, the best term for this is <b>unstable lie</b>. <img src="/Abnormal Lie/imgFetalLie.jpg" /> Try again ;-) (track: 'Baby Giggle 1', 'play') (track: 'Baby Giggle 1','volume', 0.1)

You are good. That's right Madam G's lie is changing constantly. If the lie is changing between oblique, longitudinal, and transverse, the best term for this is <b>unstable lie</b>. <img src="/Abnormal Lie/imgFetalLie.jpg" /> Now..... you are entering the next step of this marvellous game. [[click here| causes]] (track: 'Bingo', 'play') (track: 'Bingo','volume', 0.1)

What are the possible causes of this abnormal lie? Take a deep breath and choose the correct answer from below: [[1. Fibroid, fetal anormalies, maternal iron deficiency anaemia]] [[2. Polyhydramnios, fetal anormalies, uterine anormalies, pregnancy induced hypertension]] [[3. Adenomyosis, fetal anormalies, uterine anormalies, polyhydramnios]] [[4. Fibroid, fetal anormalies, uterine anormalies, polyhydramnios]]

Oh dear ;-( You are almost right. But..... maternal iron deficiency anaemia is not directly linked to abnormal lie. Try again. (track: 'Oh no', 'play') (track: 'Oh no','volume', 0.05)

Oh dear ;-( You are almost right. But..... pregnancy induced hypertension is not directly linked to abnormal lie. Try again. (track: 'Oh no', 'play') (track: 'Oh no','volume', 0.05)

Oh dear ;-( You are almost right. But..... you failed to notice " adenomyosis" which is not linked to abnormal lie. Try again. (track: 'Oh no', 'play') (track: 'Oh no','volume', 0.05)

Excellent! Yes, you are right. Here is a list of causes of malpresentation: <b>1. Maternal</b> • Multiparity. • Pelvic tumours. • Congenital uterine anomalies. • Contracted pelvis. <b>2. Fetal</b> • Prematurity. • Multiple pregnancy. • Intrauterine death. • Macrosomia. • Fetal abnormality including: hydrocephalus, anencephaly, cystic hygroma. <b>3. Placental</b> • Placenta praevia. • Polyhydramnios./ oligohydramnios • Amniotic bands Okay, are you ready for next question? Good. [[Click here|examination]] (track: 'clapping', 'play') (track: 'clapping','volume', 0.05)

Select the most relevant investigation to find the cause of her problem. [[1. Biophysical profile]] [[2. Cardiotocograph CTG]] [[3. Ultrasound]] [[4. Pelvic examination]]

You are partially correct. But look at the question again. It asked for the most relevant investigation to find the cause of her problem. Biophysical profile is done if you need to determine fetal wellbeing, not to find the cause of her unstable lie. <img src="/Abnormal Lie/imgbiophysprofile.png"/> No worries. Try again. (track: 'Smirk 1', 'play') (track: 'Smirk 1','volume', 0.05)

You are partially correct. But look at the question again. It asked for the most relevant investigation to find the cause of her problem. CTG is done if you need to determine fetal wellbeing, not to find the cause of her unstable lie. <img src="/Abnormal Lie/imgctg.jpg"/> No worries. Try again. (track: 'Smirk 1', 'play') (track: 'Smirk 1','volume', 0.05)

Hey.... That's true. You need to do an ultrasound to find the cause of her unstable lie. In addition, ultrasound can give information on: 1. Fetal parameters 2. Placenta 3. Amniotic fluid <img src="/Abnormal Lie/imgUSS.jpg" /> You may move on to the next question. Sit tight and [[click here|complications]] (track: 'lightapplause', 'play') (track: 'lightapplause','volume', 0.05)

Uhhhh Look at the question again. It asked for the most relevant investigation to find the cause of her problem. Pelvic examination is not an investigation, it is part of the physical examination. Furthermore, it will not help you find the cause of her unstable lie. <img src="/Abnormal Lie/imgpelvicexam.jpg" /> No worries. Try again. (track: 'Smirk 1', 'play') (track: 'Smirk 1','volume', 0.05)

What would you expect to find on Madam G's abdominal examination at 37 weeks POG? [[1. Empty in pelvis, fetal head in epigastrium, fetal back at maternal symphysis pubis]] [[2. Empty in pelvis, fetal head in left hypochondrium, fetal back at maternal xiphisternum]] [[3. Fetal head in maternal pelvis, fetal buttock in left hypochondrium, fetal back on maternal right side]]

So sorry, that is not the correct abdominal examination findings that you would expect for the transverse lie that Madam G presented with at 37 weeks POG. The maternal abdomen is unusually wide and the fundus is lower than expected for the gestation. Neither fetal pole is palpable entering the pelvis. The fetal head is identifiable on one side. On vaginal examination, the pelvis is empty. A limb or cord may prolapse through the cervix. <img src="/Abnormal Lie/imgtransverselie.jpg" /> Try again (track: 'Game over', 'play') (track: 'Game over','volume', 0.05)

That's smart. Yes, you are right about the correct abdominal examination findings for transverse lie that Madam G presented with at 37 weeks POG. The maternal abdomen is unusually wide and the fundus is lower than expected for the gestation. Neither fetal pole is palpable entering the pelvis. The fetal head is identifiable on one side. On vaginal examination, the pelvis is empty. A limb or cord may prolapse through the cervix. <img src="/Abnormal Lie/imgtransverselie.jpg" /> Relax. Now the next door is open for you. [[Click here|inv]] (track: 'happykids', 'play') (track: 'happykids','volume', 0.05)

Madam G is advised for admission at 37 weeks due to unstable lie. However, she isn't keen to be admitted to hospital because she has two toddlers to take care of at home. Choose the right complications that you are going to counsel Madam G for at this juncture, as your reasons for admission. [[1. Hand prolapse, uterine rupture, preterm labour]] [[2. IUGR, cord prolapse, abruptio placenta]] [[3. Cord prolapse, hand prolapse, scar rupture]]

Oh dear. Although hand prolapse and uterine rupture can occur, Madam G is already at 37 weeks so preterm labour is not our concern anymore. <img src="/Abnormal Lie/imghandprolapse.jpg" /> Try again (track: 'Punch 2', 'play') (track: 'Punch 2','volume', 0.05)

Oh dear. IUGR is not the common complications for abnormal lie/ presentation in pregnancy. So is abruptio placenta. But you are partially right, cord prolapse can occur if Madam G goes into labour. <img src="/Abnormal Lie/imgcomplications.png" /> Try again. (track: 'Punch 2', 'play') (track: 'Punch 2','volume', 0.05)

Bingo. You are right. Madam G is now having unstable lie and at this moment, the fetus is in transverse lie. In addition, she is now 37 weeks and multipara. She can go into labour at any time. If she goes into labour while in transverse lie, there are risks of cord prolapse, hand prolapse, uterine rupture, scar rupture, and even fetal death. <img src="/Abnormal Lie/imgcomplications.png" /> You have nearly reached the end of the game, after succesfully navigating through the most difficult parts. It is now time to make the most important decision for your patient and her unborn child. Remember, <b>two</b> lives. [[Click here|management]] (track: 'success', 'play') (track: 'success','volume', 0.1)

Madam G finally agrees to be admitted to hospital. You place her on a fetal lie chart. It shows the following record: &nbsp&nbsp&nbsp&nbsp Day 1 admission AM: Transverse lie &nbsp&nbsp&nbsp&nbsp Day 2 admission PM: Longitudinal lie, breech &nbsp&nbsp&nbsp&nbsp Day 3 admission AM: Transverse lie &nbsp&nbsp&nbsp&nbsp Day 4 admission PM: Transverse lie &nbsp&nbsp&nbsp&nbsp Day 5 admission AM: Transverse lie &nbsp&nbsp&nbsp&nbsp Day 6 admission PM: Transverse lie What is the BEST time and mode of delivery you need to plan for Madam G? [[1. Lower segment Caesarean section LSCS at 40 weeks]] [[2. Lower segment Caesarean section LSCS at 39 weeks]] [[3. Induction of labour IOL at 39 weeks]] [[4. Induction of labour IOL at 40 weeks]] [[5. External cephalic version ECV at 39 weeks]] [[6. External cephalic version ECV at 40 weeks]]

Are you sure? LSCS is the right mode of delivery. But if you wait until 40 weeks, Madam G is likely go into labour beforehand and there is a chance that she might encounter unwanted complications of transverse lie in labour. <img src="/Abnormal Lie/imgdelivery.jpg" /> Try again (track: 'witch', 'play') (track: 'witch','volume', 0.03)

<h3>Bravo!</h3> You have delivered Madam G sucessfully by choosing the safest mode of delivery and best timing. Since she is still transverse lie, vaginal delivery is contraindicated, therefore LSCS is the best option. Regarding timing of delivery, you made the correct decision. Kaunitz, A. M. (2009) states that elective cesarean delivery between 37 and 39 weeks’ gestation carries a greater risk of respiratory complications and other adverse outcomes for neonates than delivery at 39 weeks. Now it's time to celebrate. Madam G and baby G are very grateful to their wonderful doctor, "You". Hey don't forget Mr G too ;D <img src="/Abnormal Lie/imgbaby.jpg" /> Recommended reading: 1. <a href="/Abnormal Lie/Abnormal lie Oxford Handbook of Obstretics & Gyneacology 3rd Ed [PDF].pdf" target="_blank">Abnormal lie, Oxford Handbook of Obstretics & Gyneacology 3ed</a> 2. <a href="/Abnormal Lie/Abnormal lie Obstetric by Ten Teachers 18th Ed.pdf" target="_blank">Abnormal lie, Ten Teachers, Obstetrics</a> 3. <a href="/Abnormal Lie/ECV externalcephalicversion greentop.pdf" target="_blank">External Cephalic Version RCOG Guidelines (2010)</a> 4. <a href="/Abnormal Lie/Management of breech presentation RCOG.pdf" target="_blank">Management of Breech Presentation RCOG Guidelines (2017)</a> Reference: Kaunitz, A. M. (2009). What is the optimal timing of elective cesarean delivery at term?. OBG Management, 21(4), 20. (link: "Restart Game")[(reload:)] <p>Back to <a href="https://medventure.neocities.org/Semester10/index.html">Home</a> (track: 'cheer', 'play') (track: 'cheer','volume', 0.05)

Oh nooo.... Remember the complications of transverse lie in labour? So IOL and vaginal delivery are contraindicated for Madam G unless the fetus turns back into longitudinal lie. <img src="/Abnormal Lie/imgIOLdelivery.jpg" /> Try again. (track: 'witch', 'play') (track: 'witch','volume', 0.03)

You can attempt ECV if your patient has no contraindication for ECV and also no contraindication for vaginal delivery. But..... Madam G has a previous LSCS scar, you should not forget that important point. Therefore, she has a relative contraindication for ECV. <b>Absolute contraindications for ECV are:-</b> Where caesarean delivery is required, antepartum haemorrhage within the last 7 days, abnormal cardiotocography, major uterine anomaly, ruptured membranes, multiple pregnancy (except delivery of second twin). <b>Relative contraindications for ECV are:-</b> Small-for-gestational-age fetus with abnormal Doppler parameters, proteinuric pre-eclampsia, oligohydramnios, major fetal anomalies, scarred uterus, unstable lie <img src="/Abnormal Lie/imgextcephversion.jpg" /> Try again. (track: 'witch', 'play') (track: 'witch','volume', 0.03)

<h3>Welcome to the most fascinating session of our posting!</h3> Are you excited? ;-) So am I.... Let's start. [[Click here|start]] <img src="/Abnormal Lie/imgERrun.jpg" />

Madam G, 35 year-old G3P2 with a history of one previous caesarean section, was seen at 32 weeks period of gestation, and the fetus was noted to be in transverse lie. Upon review at 35 weeks period of gestation, the fetus was found to be in oblique lie. Now Madam G comes to your antenatal clinic at 37 weeks POG, and her fetus is found to be in transverse lie again. <img src="/Abnormal Lie/imgpregnantwoman.jpg" /> What is the best obstetric terminology/diagnosis to describe Madam G's pregnancy at this jucture? [[1. Oblique lie]] [[2. Transverse lie]] [[3. Unstable lie]] [[4. Longitudinal lie]] <sound

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