Detecting Breech Presentation Before Labour: Lessons From a Low-Risk Maternity Clinic

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Prenatal Diagnostics

Background:

• Accurate fetal position assessment is crucial in prenatal care to manage breech presentations and avoid emergency Cesarean sections.
• Undetected breech presentations at labor can lead to suboptimal delivery outcomes for mother and child, and increased healthcare costs.
• Anecdotal evidence suggested a high rate of missed breech presentations at a busy maternity clinic, necessitating a formal evaluation.

Purpose of the Study:

• To quantify the incidence of undetected breech presentations at the time of labor.
• To evaluate the effectiveness of the current fetal presentation detection process in prenatal visits.
• To reduce the rate of undetected breech presentations to no more than 1%.

Main Methods:

• A retrospective analysis of 102 breech deliveries was conducted over 14 months to determine missed breech presentations.
• A prospective physician survey over four months analyzed fetal presentation determination methods at 186 prenatal visits.
• The study compared abdominal palpation (Leopold's maneuvers) with vaginal examination for accuracy.

Main Results:

• An estimated 8% of breech presentations were not detected until the onset of labor.
• The current practice of using vaginal examination to verify abdominal palpation findings did not show superior accuracy.
• The study identified limitations due to a small sample size in definitively concluding accuracy differences.

Conclusions:

• The existing detection methods for fetal presentation are insufficient, leading to an unacceptably high rate of missed breech cases.
• The findings underscored the need for enhanced diagnostic tools for fetal position assessment.
• The study's results directly influenced the clinic's decision to implement bedside ultrasound for fetal position evaluation.