Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study

doi:10.1136/bmj.38919.681563.4F

BMJ 2006;333:578-580 (16 September), doi:10.1136/bmj.38919.681563.4F (published 4 August 2006)

Research

Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study

Natasha Nassar, research associate¹, Christine L Roberts, research director¹, Carolyn A Cameron, research associate¹, Emily C Olive, research fellow in obstetrics¹

¹ Centre for Perinatal Health Services Research, School of Public Health, University of Sydney NSW 2006, Australia

Correspondence to N Nassar natashan{at}ichr.uwa.edu.au

Abstract

Objective To examine the diagnostic accuracy of clinical examinationto determine fetal presentation in late pregnancy.

Design Cross sectional analytic study with index test of clinicalexamination and reference standard of ultrasonography.

Setting Antenatal clinic in tertiary obstetric hospital in Sydney,Australia.

Participants 1633 women with a singleton pregnancy between 35and 37 weeks' gestation attending antenatal clinics.

Intervention Fetal presentation assessed by clinical examinationduring routine antenatal care, followed by ultrasonography toconfirm the diagnosis.

Main outcome measures Sensitivity, specificity, and positiveand negative predictive values of clinical examination comparedwith ultrasonography. Diagnostic rates by maternal characteristics.

Results Ultrasonography identified non-cephalic presentationin 130 (8%) women, comprising 103 (6.3%) with breech and 27(1.7%) with transverse or oblique lie. Sensitivity of clinicalexamination for detecting non-cephalic presentation was 70%(95% confidence interval 62% to 78%) and specificity was 95%(94% to 96%). The positive predictive value and negative predictivevalue were55% and 97%, respectively.

Conclusions Clinical examination is not sensitive enough fordetection and timely management of non-cephalic presentation.

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