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BMJ. 2006 Sep 16;333(7568):578-80. Epub 2006 Aug 4.

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

Author information

1
Centre for Perinatal Health Services Research, School of Public Health, University of Sydney NSW 2006, Australia. natashan@ichr.uwa.edu.au

Abstract

OBJECTIVE:

To examine the diagnostic accuracy of clinical examination to determine fetal presentation in late pregnancy.

DESIGN:

Cross sectional analytic study with index test of clinical examination and reference standard of ultrasonography.

SETTING:

Antenatal clinic in tertiary obstetric hospital in Sydney, Australia.

PARTICIPANTS:

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

INTERVENTION:

Fetal presentation assessed by clinical examination during routine antenatal care, followed by ultrasonography to confirm the diagnosis.

MAIN OUTCOME MEASURES:

Sensitivity, specificity, and positive and negative predictive values of clinical examination compared with ultrasonography. Diagnostic rates by maternal characteristics.

RESULTS:

Ultrasonography identified non-cephalic presentation in 130 (8%) women, comprising 103 (6.3%) with breech and 27 (1.7%) with transverse or oblique lie. Sensitivity of clinical examination 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 predictive value were 55% and 97%, respectively.

CONCLUSIONS:

Clinical examination is not sensitive enough for detection and timely management of non-cephalic presentation.

PMID:
16891327
PMCID:
PMC1570002
DOI:
10.1136/bmj.38919.681563.4F
[Indexed for MEDLINE]
Free PMC Article

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