Utility of Leopold maneuvers in screening for malpresentation

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Diagnostic Accuracy Studies

Background:

• Malpresentation, particularly nonvertex presentation, is a common pregnancy complication.
• Accurate screening for malpresentation is crucial for appropriate management and improved perinatal outcomes.
• Leopold maneuvers are a traditional clinical method for assessing fetal presentation.

Purpose of the Study:

• To prospectively evaluate the diagnostic accuracy of Leopold maneuvers for screening nonvertex presentation in the third trimester.
• To compare the effectiveness of Leopold maneuvers against ultrasound, the established gold standard for fetal presentation assessment.

Main Methods:

• Prospective study design involving pregnant individuals in their third trimester.
• Leopold maneuvers were performed as a screening test for nonvertex presentation.
• Ultrasound examination was utilized as the diagnostic gold standard to confirm fetal presentation.
• Statistical analysis included calculation of sensitivity, specificity, positive predictive value, and negative predictive value, along with kappa statistic for agreement.

Main Results:

• Leopold maneuvers demonstrated poor performance in screening for nonvertex presentation.
• Sensitivity was 28%, specificity 94%, positive predictive value 24%, and negative predictive value 95%.
• The correlation between Leopold maneuvers and ultrasound findings was low (kappa = 0.13), suggesting limited agreement beyond chance.

Conclusions:

• Leopold maneuvers are not a reliable screening tool for nonvertex presentation in the third trimester.
• Ultrasound remains the preferred method for accurate assessment of fetal presentation.
• Clinical examination findings from Leopold maneuvers should be interpreted with caution due to their low predictive values.