At 34 weeks multigravida with previous two normal delivery now have unstable lie due to: (AIIMS Nov. 2012)
a. Unstable lie means changing lie.
b. Unstable lie refers to the frequent changing of fetal lie and presentation in late pregnancy (usually refers to pregnancies > 37 weeks)
c. Factors contributing to it include:
i. High parity
ii. Placenta praevia
iv. Pelvic inlet contracture and / or fetal macrosomia
v. Pendulous abdomen
vi. Uterine abnormalities (e.g. bicornuate uterus or uterine fibroids).
vii. Fetal anomaly (e.g. tumours of the neck or sacrum, hydrocephaly, abdominal distension)
d. In oligohydroamnios there may be malpresentations but lie would not be changing, due to less liqor. Uterine anomalies would be congenital & should have manifested in previous two pregnancies.
e. Placenta previa prevents the head from getting engaged & is also associated with malpresentation & hence there is a possibility of unstable lie in these case.
f. Risk factors for placenta previa are:
a. Increasing age and increasing parity (present in this case)
b. Past history (12 times risk of another placenta previa)
c. Previous LSCS
d. Multiple pregnancy
e. Prematurity (present in this case)