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Independents' Day

Clinical exam inaccurate for breech presentation

How well does the clinical examination identify breech presentation in late-stage pregnancy?

How well does the clinical examination identify breech presentation in late-stage pregnancy?


These researchers evaluated 1,633 pregnant women between 35 and 37 weeks' gestation. The women were an average 31 years old, 31 per cent were obese and 61 per cent white.

The clinical examination was performed by 60 different clinicians; 28 per cent by midwives, 17 per cent by obstetricians and the rest by residents or registrars.

The examination consisted of palpation of the abdomen; vaginal examination was not performed.

Subsequently, ultrasound (the gold standard) was performed on all women by an examiner unaware of the results of the clinical examination.

Non-cephalic presentation was identified by ultrasound in 8 per cent of the women; most of the presentations were breech (6.3 per cent).

Non-cephalic presentation was correctly identified by clinical examination in 70 per cent of women and cephalic presentation was correctly diagnosed in 95 per cent (sensitivity = 70 per cent; specificity = 95 per cent).

Given a rate of 8 per cent non-cephalic presentation, the positive predictive value of the clinical examination was only 55 per cent.

Level of evidence

2b (


Nassar N et al. Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross-sectional analytic study. BMJ 2006;333:578-580.

Bottom Line

Clinical examination of a pregnant woman for cephalic presentation will miss a non-cephalic presentation 30 per cent of the time.

A clinical diagnosis of non-cephalic presentation will only be correct 55 per cent of the time, given a typical rate of occurrence (8 per cent).

More than half the examiners in this study were in training, and it is possible that clinicians with more experience will have better identification rates.

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