Intended for healthcare professionals


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

BMJ 2006; 333 doi: (Published 14 September 2006) Cite this as: BMJ 2006;333:578

Diagnosing Breech at Term

Many thanks to Nassar and colleagues for confirming what I experience
in a busy state hospital in South Africa: that a significant proportion of
breech presentations or transverse lies are missed on routine palpation at
antenatal clinic at term. These malpresentations or abnormal lies are
missed both by doctors and midwives. It is understandable,(though still
not acceptable), given the heavy patient load that the care providers at
the clinic have to get through.

The other important time for diagnosis of breech is when the woman
goes into labour and presents to the labour ward. Not infrequently,
breeches that have been missed at the last antenatal visit are again
missed on initial palpation in labour, making a poor outcome for the baby
more likely.

The main reason for these mistakes is obvious to me. It is not due to
a lack of skill on the part of the care providers. It is due to a lack of
focus on the need to exclude a breech or abnormal lie at the crucial
times: the 36 week antenatal visit and the first palpation in labour. If
asked specifically to exclude a breech presentation, the care provider can
do this confidently and correctly in all but a few cases. The problem is
forgetting to think about it.

Doing routine scans at 36 weeks is therefore not apropriate. What is
required is regular inservice education emphasising the need to look out
for breech presentations at 36 weeks and on admission in labour, and the
reasons why it is important to do so.In cases where the care provider
suspects a breech or is unsure, then an ultrasound scan is indicated to
confirm the presentation.

Competing interests:
None declared

Competing interests: No competing interests

15 September 2006
Neil F. Moran
Head, Department of Obstetrics and Gynaecology
Mahatma Gandhi Memorial Hospital, Mount Edgecombe, KwaZulu-Natal, 4300, South Africa