The role of external version in the intrapartum management of the transverse lie presentation.

External version under tocolysis was applied and studied prospectively as an alternative to routine cesarean delivery in the laboring patient with a transverse lie presentation. After sonographic confirmation and signing of informed consent, 12 patients with a transverse lie presentation and intact membranes agreed to participate in the current investigation. For these 12 patients, 10 (83%) presentations were successfully converted to a longitudinal lie (nine cephalic, one breech) and two (17%) remained transverse. Of the 10 patients with successful conversions, six (60%) delivered vaginally while four required cesarean delivery. In two (20%) patients external version was unsuccessful and both patients were delivered by cesarean. With the exception of one infant with congenital anomalies, neonatal outcome was excellent in the study population. Overall, the use of external version in the laboring patient with a transverse lie presentation was associated with a 50% reduction in the cesarean section rate. While these results are encouraging, further experience is still needed to more clearly define the maternal and fetal risks associated with this procedure.