title: Detecting Breech Presentation Before Labour: Lessons From a Low-Risk Maternity Clinic.
abstract: OBJECTIVE
  Evaluation of fetal position is an important part of prenatal care. A woman with a breech presentation may need referral for external cephalic version, for assisted breech delivery, or to schedule a Caesarean section. In many centres, a breech presentation undetected until labour will result in an emergency Caesarean section, a less desirable alternative for both the mother and the health care system. The anecdotal reports of undiagnosed breech presentations at a busy maternity clinic prompted a study to quantify the missed breech presentations and to evaluate the effectiveness of the current detection process, with the aim of allowing no more than 1% of breech presentations to remain undetected until labour.
  
  
  METHODS
  We performed a retrospective analysis of 102 breech deliveries over a 14 month period to quantify missed breech presentations, and used a prospective physician survey documenting how fetal presentation was determined at 186 prenatal visits over four months to analyze the current detection process.
  
  
  RESULTS
  We found that approximately 8% of breech presentations were undetected until labour. We concluded that within the limitations of the small sample size evaluated, the current practice of using a vaginal examination to verify fetal presentation determined by abdominal palpation (Leopold's manoeuvres) may not be more accurate than abdominal palpation alone.
  
  
  CONCLUSIONS
  The current detection process resulted in an unacceptably high rate of missed breech presentations. The results of this study prompted the clinic's acquisition of bedside ultrasound capability to assess fetal position.
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary AB.
authors.forename: Bill
authors.initials: B
authors.lastname: Ressl
authors.affiliation: Departments of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary AB.
authors.forename: Maeve
authors.initials: M
authors.lastname: O'Beirne
mesh_terms: D001946:Breech Presentation / Q000175:diagnosis*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D012189:Retrospective Studies
keywords: breech presentation; prenatal care; prenatal diagnosis; quality improvement