Transverse dystocia

　　Transverse dystocia is one type of abnormal fetal position. The common causes in clinical practice include:
　　1. Abdominal wall overrelaxation in multiparous women, polyhydramnios.
　　2. Incomplete-term fetus, not yet converted to cephalic presentation.
　　3. Uterine malformation or tumor, pelvic narrowness, placenta previa, etc., hinder the longitudinal axis of the fetus from being parallel to the mother and the connection of the fetal head.
　　4. The round fetal head cannot be fixed, leading to difficulties in entering the pelvis.
　　5. Non-ovoid uterus, such as pelvic narrowness, pelvic tumors, polyhydramnios, abdominal wall relaxation, multiple pregnancy, uterine malformation, bicornuate uterus, preterm birth, placenta previa, or placenta on the posterior wall of the lower uterine segment, etc., due to the above reasons.

　　Transverse dystocia can easily lead to uterine atony and premature rupture of the amniotic membrane. After the membrane breaks, the amniotic fluid rapidly flows out, and the fetal upper limbs and umbilical cord are prone to be extruded, leading to fetal distress and even death. If a neglected (impacted) shoulder presentation occurs, the uterine contractions continue to strengthen, which is prone to threatened uterine rupture. If not treated in time, uterine rupture will occur, leading to massive hemorrhage and death.

　　Transverse dystocia can easily lead to uterine atony and premature rupture of the amniotic membrane. After the membrane breaks, the amniotic fluid rapidly flows out, and the fetal upper limbs and umbilical cord are prone to be extruded, leading to fetal distress and even death. As the labor progresses, part of the fetal shoulder and thorax are compressed into the pelvic cavity, the fetal body is folded and bent, the fetal head is folded towards the fetal abdominal side, and it is impacted in one iliac fossa. The fetal buttocks are impacted in the opposite iliac fossa or folded in the upper uterine cavity. The fetal neck is stretched, the upper limbs are extruded into the vagina, forming a neglected (impacted) shoulder presentation. At this time, the uterine contractions continue to strengthen, which is prone to threatened uterine rupture. If not treated in time, uterine rupture will occur.

　　To prevent transverse presentation, regular prenatal examinations should be performed. Before 30 weeks of pregnancy, most breech presentations can be spontaneously converted to vertex presentations and no treatment is needed. If breech presentation still exists after 30 weeks of pregnancy, it should be actively corrected. Common correction methods can be seen in the treatment of breech presentation (in the second trimester).

　　Transverse presentation is mainly diagnosed based on symptoms. Transverse presentation is prone to uterine contraction weakness and premature rupture of membranes. After the membranes are ruptured, the amniotic fluid flows out rapidly, and the fetal upper limbs and umbilical cord are prone to be extruded. Blood and urine routine tests should be performed according to the condition. Ultrasound examination can accurately locate.

　　Transverse presentation has dietary requirements before and after surgery, and correct diet is helpful for the recovery of the mother.

　　1, Foods to avoid before surgery
　　It is forbidden to eat walnuts, milk, dairy products, shrimp, and calcium tablets. Because antibiotics are injected in an emergency during surgery, and these foods cannot be eaten together with antibiotics, otherwise the consequences will be serious.

　　2, Postpartum dietary principles
　　Suitable foods: Eat more foods with a higher water content, such as soups, milk, congee, etc., and do not make the soup too salty.
　　Unsuitable foods: It is not advisable to eat too much cold and raw food, such as cold drinks, cold dishes, cold salads, etc. Fruits and vegetables taken out of the refrigerator should be eaten warm after warming; spicy and warm foods should be avoided, such as garlic, chili, pepper, fennel, alcohol, chives, etc.

　　Transverse presentation is an abnormal mode of delivery. In addition to premature infants, stillbirths, and soft fetal bodies that can be naturally delivered due to extreme folding, it is extremely rare for full-term live fetuses to be naturally delivered. Due to the difficulty of delivery, both mother and child are at great risk. Therefore, transverse presentation must be actively handled and rescue work must be carried out.

　　First, Late pregnancy
　　During this period, if shoulder presentation is found, the correction method is the same as breech presentation. If it is ineffective, external version can be tried to convert to vertex presentation, and the abdominal area is bandaged to fix the fetal head. If it fails, hospitalization for delivery should be advanced.

　　Second, Labor period
　　1, Full-term live fetus with other obstetric indications such as pelvic narrowness, uterine malformation, placenta previa, umbilical cord entanglement or shortness, previous cesarean section history, etc., elective cesarean section should be performed before labor.
　　2, For primiparous women with full-term live fetus, cesarean section is performed during labor.
　　3, For multiparous women with full-term live fetus, cesarean section is usually performed. If the cervix is dilated >5cm, the amniotic membrane is broken soon, and the amniotic fluid has not been completely drained, internal version can be performed under deep ether anesthesia to convert to breech presentation, and then deliver with the full dilation of the cervix.
　　4, Full-term twin pregnancy live fetus: During vaginal delivery of twin pregnancy, if the second fetus is not timely fixed after the first fetus is delivered, it is easy for the second fetus to become breech due to the sudden decrease in uterine cavity volume. In this case, internal version can be performed to end delivery with breech presentation.
　　5. If there are signs of uterine rupture or preterm labor, cesarean section should be performed immediately to save the life of the mother, regardless of whether the fetus is alive.
　　6. If the fetus is dead and there are no signs of uterine rupture, if the cervix is nearly fully dilated, decapitation, fetotomy, or evacuation can be performed under general anesthesia. After the operation, the routine examination of the soft birth canal for injury should be checked, and if there is any injury, it should be repaired in time, and postpartum hemorrhage and puerperal infection should be prevented.

　　Section 3: Strengthen Antenatal Examination
　　If transverse position is found during antenatal examination, it should be corrected in time, and abdominal belts should be wrapped to support the abdominal wall for those with relaxed abdominal walls. If transverse position is found during pregnancy, the cause must be investigated, such as whether there is pelvic narrowness, the cause of blocking the fetus into the pelvis. According to the situation, external version can be performed, or the position can be corrected by lying down, and the patient can be admitted to the hospital in advance to end labor in time.

　　Section 4: Elective External Version
　　1. If the amniotic sac has burst, an immediate vaginal examination should be performed. If the cervix is not fully dilated and the fetus is healthy, cesarean section can be performed; if the cervix is dilated, internal version can be performed under ether anesthesia, and then whether to pull out one foot immediately can be decided according to the degree of cervix dilatation; if it is a premature baby, etc., the fetus can be delivered by internal version and breech extraction to end labor. Now the view of obstetrics is that if it is diagnosed as transverse position, elective cesarean section should be performed in advance, and the prognosis is good.
　　2. Neglecting transverse position, the uterine wall is tightly wrapped around the fetus, it is not suitable to perform version, in order to avoid uterine rupture. If the fetus is dead, decapitation can be performed under deep ether anesthesia; if the fetus is healthy, cesarean section can be performed, but before the operation, a therapeutic short rest should be given, blood transfusion and fluid replacement, and measures to prevent infection should be taken before the operation. If the neglecting transverse position is accompanied by uterine cavity infection, hysterectomy can be performed at the same time as cesarean section to cut off the source of infection.

　　Section 5: Uterine Rupture
　　Emergency rescue should be carried out to remove the fetus, if the incision is fresh and complete, and the mother has no children, repair surgery can be performed under the request of the family; if the uterine rupture is long and the incision is large and irregular, and there is infection, hysterectomy should be performed.

　　Section 6: Hemorrhagic Shock
　　If the puerperal patient has hemorrhagic shock, active blood transfusion and fluid replacement should be performed, and antibiotics should be administered. After the patient stabilizes, surgery is safer.