Intended for healthcare professionals

Research

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

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38919.681563.4F (Published 14 September 2006) Cite this as: BMJ 2006;333:578

Handheld Dopplers Can Rule Out Breech

Of course, a handheld Doppler is a form of ultrasound. It uses the
Doppler shift effect to detect motion and then translates that motion into
sound. Different kinds of movement in the uterus typically are
represented by different sounds produced by the Doppler: baby movement,
placental souffle, maternal pulsations in the uterine arteries, fetal
pulsations in the umbilical cord or large vessels, or the rhythmic
contractions of the fetal heart.

Just a little bit of experimentation can quickly build skill in
detecting the difference between the sounds of the fetal heart and the
other sounds so that an attentive practitioner can locate the fetal heart
fairly quickly. The difference in heart location for a breech is very
different from that of a vertex baby.

I consider it responsible practice to use this skill at every
prenatal appointment after 32 weeks to confirm a vertex presentation,
especially if palpation isn't convincing. It is also helpful to be
attentive to the issue of fetal rotational orientation (anterior /
transverse / posterior) so that a woman carrying a baby in a posterior
position can also be attentive to this issue.

This test can be done with just a few extra seconds of time for a
skilled practitioner. For those who do not have access to a Doppler,
listening to the fetal heart directly with the ear is also very sensitive
to the location of the fetal heart.

Competing interests:
None declared

Competing interests: No competing interests

09 August 2006
Veronica G. (Ronnie) Falcao
Midwife
Mountain View, CA, USA 94041