Document Detail

Is it time for routine ultrasound in late pregnancy at Bhumibol Adulyadej Hospital?
MedLine Citation:
PMID:  20873072     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: At term, about 3-5% of the presentations are breech. Vaginal breech deliveries are associated with increased maternal and fetal morbidity and mortality, but delivery by cesarean section in an emergency does not eliminate all maternal and perinatal morbidity. The use of external cephalic version can produce considerable cost savings in the management of the breech fetus at term. The accuracy in the assessment of fetal presentation and position is essential. OBJECTIVE: To study the accuracy of Leopold's maneuvers in the assessment of fetal presentation and position at Bhumibol Adulyadej Hospital. MATERIAL AND METHOD: Prospective cohort study of 1,528 singletons, pregnant women at gestational age between 34-40 weeks who attended antenatal care unit at Bhumibol Adulyadej Hospital between November 1, 2006 and March 30, 2009. All cases were examined by either residents or staff by using Leopold's maneuvers. The results of the examinations were recorded as cephalic or non-cephalic presentation. After that, the subjects were re-examined by the staff in the maternal and fetal medicine unit using ultrasound for gold standard. Maternal age, weight, height, gestational age, parity, estimated fetal weight, amniotic fluid index, placental site, and fetal presentation were recorded. The results of the two methods of examination were then analyzed for comparison and calculated in terms of means, standard deviation, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: The results of Leopold's maneuvers with 95% confidence interval revealed sensitivity 63.17 +/- 10.84%, specificity 93.35 +/- 1.25%, positive predictive value 34.04 +/- 7.82%, negative predictive value 97.98 + 0.74%, and accuracy 92.08 +/- 1.35%. CONCLUSION: Leopold's maneuvers are inexpensive, easy to perform, and noninvasive but the accuracy of such assessments vary depending on many factors especially experience of operators. The caregivers can reduce perinatal morbidity and mortality if they can diagnose all of non-vertex presentation in near term pregnancy. Routine use of ultrasound in near term pregnancy to diagnose non-vertex presentation has more benefit than cost.
Wibool Rueangchainikhom; Sinart Prommas; Saravut Sarapak
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the Medical Association of Thailand = Chotmaihet thangphaet     Volume:  93     ISSN:  0125-2208     ISO Abbreviation:  J Med Assoc Thai     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-28     Completed Date:  2010-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7507216     Medline TA:  J Med Assoc Thai     Country:  Thailand    
Other Details:
Languages:  eng     Pagination:  1019-23     Citation Subset:  IM    
Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Bangkok, Thailand.
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MeSH Terms
Breech Presentation / diagnosis*,  epidemiology
Hospitals, Urban
Physical Examination / standards*
Pregnancy Outcome
Pregnancy Trimester, Third
Prospective Studies
Reference Values
Sensitivity and Specificity
Thailand / epidemiology
Time Factors
Ultrasonography, Prenatal
Version, Fetal / methods*,  statistics & numerical data
Young Adult

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