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

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 Q Is clinical examination as accurate as ultrasonography for identifying fetuses in non-cephalic presentation in late pregnancy?

Clinical impact ratings GP/FP/Obstetrics ★★★★★★☆ Obstetrics ★★★★☆☆☆

METHODS

Embedded ImageDesign:

blinded comparison of clinical examination and ultrasonography.

Embedded ImageSetting:

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

Embedded ImagePatients:

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

Embedded ImageDescription 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%).

Embedded ImageDiagnostic standard:

ultrasound examination of the fetus using a hand held machine.

Embedded ImageOutcomes:

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 …

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