"Conduplicato corpore" indicates spontaneous_____
Ans. d (Expulsion) (Ref. Williams Obstetrics 22nd/Ch. 20)If the fetus is small--usually less than 800 g--and the pelvis is large, spontaneous delivery is possible despite persistence of the abnormal lie. The fetus is compressed with the head forced against the abdomen. A portion of the thoracic wall below the shoulder thus becomes the most dependent part, appearing at the vulva. The head and thorax then pass through the pelvic cavity at the same time, and the fetus, which is doubled upon itself, sometimes referred to as conduplicato corpore, is expelled.TRANSVERSE LIE# The long axis of the fetus is approximately perpendicular to that of the mother. When the long axis forms an acute angle, an oblique lie results. The latter is usually only transitory, because either a longitudinal or transverse lie commonly results when labor supervenes. For this reason, the oblique lie is called an unstable lie.# In transverse lies, the shoulder is usually over the pelvic inlet, with the head lying in one iliac fossa and the breech in the other. In such a shoulder presentation, the side of the mother on which the acromion rests determines the designation of the lie as right or left acromial. Moreover, because in either position the back may be directed anteriorly or posteriorly, superiorly or inferiorly, it is customary to distinguish varieties as dorsoanterior and dorsoposterior.Diagnosis# The diagnosis usually is made easily, often by inspection alone.# On vaginal examination, in the early stages of labor, the side of the thorax, if it can be reached, may be recognized by the "gridiron" feel of the ribs. When dilatation is further advanced, the scapula and the clavicle are distinguished on opposite sides of the thorax. The position of axilla indicates the side of the mother toward which shoulder is directed.Etiology# Abdominal wall relaxation from high parity.# Preterm fetus.# Placenta previa.# Abnormal uterine anatomy.# Excessive amnionic fluid.# Contracted pelvis.Mechanism of Labor# Spontaneous delivery of a fully developed newborn is impossible with a persistent transverse lie. After rupture of the membranes, if labor continues, the fetal shoulder is forced into the pelvis, and the corresponding arm frequently prolapses. After some descent, the shoulder is arrested by the margins of the pelvic inlet, with the head in one iliac fossa and the breech in the other. As labor continues, the shoulder is impacted firmly in the upper part of the pelvis. The uterus then contracts vigorously in an unsuccessful attempt to overcome the obstacle. With time, a retraction ring rises increasingly higher and becomes more marked. The situation is referred to as a neglected transverse lie. If not promptly managed, the uterus eventually ruptures, placing the mother and fetus at grave risk. Even with the best of care, morbidity is T because of the frequent association with placenta previa, the T likelihood of cord prolapse, and the necessity for major operative efforts.Management# In general, the onset of active labor in a woman with a transverse lie is an indication for cesarean delivery. Once labor is well established, attempts at conversion to a longitudinal lie by abdominal manipulation will likely not be successful. Before labor or early in labor, with the membranes intact, attempts at external version are worthy of a trial in the absence of other complications that indicate cesarean delivery. If during early labor, the fetal head can be maneuvered by abdominal manipulation into the pelvis, it should be held there during the next contractions in an attempt to fix the head in the pelvis. If these measures fail, cesarean delivery is performed.# Because neither the feet nor the head of the fetus occupies the lower uterine segment, a low transverse incision into the uterus may lead to difficulty in extraction of a fetus entrapped in the body of the uterus above the level of incision. Therefore, a vertical incision is likely to be indicated.
Version
Rectification
Evolution
Expulsion
Miscellaneous (Gynae)