A woman at term is found to have a transverse lie with the shoulder presenting. Labour has started. Which single management is appropriate for a persistent transverse lie in labour?

Answer: A. Caesarean section

Transverse lie / shoulder presentation in labour

In a transverse (or oblique) lie, the fetus lies across the uterus and the shoulder may present; the denominator is the acromion.

Why it cannot deliver vaginally

• A persistent transverse lie cannot deliver vaginally at term.
• There is a risk of cord prolapse and, if neglected, obstructed labour and uterine rupture.

Management

• In labour with a persistent transverse lie, deliver by caesarean section.
• Antenatally (before labour), an unstable/transverse lie may be managed with ECV attempts and investigation of the cause (for example placenta praevia, polyhydramnios, uterine anomaly).

So a persistent transverse lie in labour is delivered by caesarean section.