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 …