BMJ  2006;333:562-563 (16 September), doi:10.1136/bmj.38971.476863.AB

Editorial

Non-cephalic presentation in late pregnancy

Best diagnosed by ultrasound at 36 weeks

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

Caesarean section rates continue to increase around the world. Although non-cephalic presentation is not the most common indication for caesarean section, it may be one of the most preventable.¹ Timely diagnosis of this condition, and an attempt at external cephalic version at about 36 weeks' gestation, has been shown to safely reduce the need for caesarean section.^1-3 However, timely and efficient diagnosis of fetal malpresentation requires a screening test with a high sensitivity and high specificity.

In this issue of the BMJ Nassar and colleagues report a cross sectional study of the diagnostic accuracy of clinical examination for the detection of non-cephalic presentation in late pregnancy.⁴ Their findings are worrying: non-cephalic presentation was correctly diagnosed in only 70% (91/130) of cases and in only 38% of obese women (3/8). The authors correctly point out that missing the diagnosis of non-cephalic presentation precludes the ability to offer external cephalic version . . . [Full text of this article]

Department of Family Medicine and Community Health, University of Pennsylvania Health System, 2 Gates, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
(james.nicholson@uphs.upenn.edu)

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

Natasha Nassar, Christine L Roberts, Carolyn A Cameron, and Emily C Olive
BMJ 2006 333: 578-580. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Young, G. (2007). Clinical examination had poor sensitivity for detecting non-cephalic presentation in late pregnancy. Evid. Based Med. 12: 54-54 [Full text]  
• (2006). Don't Trust Palpation -- It Might Be a Fetal Lie. JWatch Women's Health 2006: 3-3 [Full text]  

Rapid Responses:

Read all Rapid Responses

Vaginal exam rather than ultrasound

Kirsten Duckitt
bmj.com, 28 Sep 2007 [Full text]