Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study.
OBJECTIVE
To examine the diagnostic accuracy of clinical examination to determine fetal presentation in late pregnancy.


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


METHODS
Antenatal clinic in tertiary obstetric hospital in Sydney, Australia.


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


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


METHODS
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.
Nassar
Natasha
N
Centre for Perinatal Health Services Research, School of Public Health, University of Sydney NSW 2006, Australia. natashan@ichr.uwa.edu.au
Roberts
Christine L
CL
Cameron
Carolyn A
CA
Olive
Emily C
EC
D000328:Adult; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007746:Labor Presentation; D009517:New South Wales; D010808:Physical Examination / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis / Q000592:standards*; D012016:Reference Values; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal