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.

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.