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Clinical examination had poor sensitivity for detecting non-cephalic presentation in late pregnancy

Clinical impact ratings GP/FP/Obstetrics Obstetrics

Key Words: labour presentation • physical examination • pregnancy complications • prenatal diagnosis

The first 150 words of the full text of this article appear below.

METHODS
Design: blinded comparison of clinical examination and ultrasonography.

Setting: antenatal clinic in tertiary obstetric hospital in Sydney, New South Wales, Australia.

Patients: 1633 women (mean age 31 y) with a singleton pregnancy at 35–37 weeks’ gestation.

Description of test: clinical examination to assess fetal presentation was performed as part of routine antenatal care by residents or registrars (55% of examinations), midwives (28%), or obstetricians (17%).

Diagnostic standard: ultrasound examination of the fetus using a hand held machine.

Outcomes: sensitivity, specificity, and likelihood ratios.

MAIN RESULTS
In 130 women (8.0%), the fetus was in non-cephalic presentation: 6.3% in breech presentation and 1.7% with transverse or oblique lie. The diagnostic characteristics of clinical examination, compared with ultrasonographic assessment of fetal presentation, are shown in the table. Both sensitivity (38%) and specificity (89%) were poor in obese women. In women at the lower end of the gestational age range (34–35 weeks), clinical examination was . . . [Full text of this article]

Gavin Young, MBBS, FRCGP, DRCOG

Temple Sowerby Medical Practice
Penrith, UK