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.