**7. Transverse lie**

Transverse lie is fetal presentation in which the fetal longitudinal axis lies perpendicular to maternal spine. It affects <1% of pregnancies at term and it is an indication for cesarean section [11–13]. Fetal extraction is the commonest difficulty encountered during the procedure. All women with transverse lie must be admitted at 37 weeks +0 days.

	- Rapture the membrane while the vertex is held in position and start induction
	- Schedule the mother for elective CD at 39–39 weeks +6 days

Dorso-superior (back up) transverse lie

	- Good free access to the lower uterine segment
	- Try to convert it to longuitidinal
	- Rule out placenta previa
	- Keep the lower uterine segment free of fluids with suction
	- Incise the lower uterine segment
	- Feel for the presenting part
	- Make a low transverse hysterotomy using an accentuated curvilinear incision to reduce the risk of extension into the broad ligament

Dorso-inferior (back down) transverse lie

	- perform an intra-abdominal version to convert the transverse lie to a cephalic or breech presentation before making the hysterotomy, thus facilitating delivery through the low segment accentuated curvilinear transverse uterine incision
	- For the version, one hand is placed on the fetal head and the other hand is placed on the buttocks
	- The fetal pole that will become the presenting part is very gently manipulated toward the pelvic inlet while the other pole is guided in the opposite direction
	- Although either cephalic or podalic version can be performed, we have found that breech extraction is technically easier
	- After the version has been completed, an assistant holds the fetus in the longitudinal position so it will not revert to its original position, the hysterotomy is made, and the fetus is delivered

The assistant performs intraabdominal version prior to hysterotomy and holds the fetus in its new longitudinal position. The surgeon will then perform the lowersegment uterine incision at the dotted line.

After external version from transverse lie to breech, the fetus is extracted in the breech presentation by the operator, while the assistant continuously holds the fetus in longitudinal position.

