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

BMJ. 2006 Sep 16;333(7568):578-80. doi: 10.1136/bmj.38919.681563.4F. Epub 2006 Aug 4.


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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Early Diagnosis
  • Female
  • Humans
  • Labor Presentation*
  • New South Wales
  • Physical Examination / standards*
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Trimester, Third
  • Prenatal Diagnosis / standards*
  • Reference Values
  • Sensitivity and Specificity
  • Ultrasonography, Prenatal