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Original ArticleOpen Access
Is it time for routine ultrasound in late pregnancy at Bhumibol Adulyadej Hospital?
Rueangchainikhom W 
,
Prommas S ,
Sarapak S
,
Prommas S ,
Sarapak S 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.
Keywords: Leopold’s maneuvers, Non-vertex presentation, External cephalic version
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.
Keywords: Leopold’s maneuvers, Non-vertex presentation, External cephalic version
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