Sensitive touch?9th August 2006
A study published on bmj.com concludes that the routine examination doctors use to check if a baby is lying in the correct position before birth is not sensitive enough; there is room for improvement by all pregnancy care providers, suggest the authors.
In late pregnancy the position of a baby in the womb is important because if it is not lying in the normal head-down position (cephalic presentation) vaginal delivery may be difficult or impossible. Researchers in Australia examined the diagnostic accuracy of palpating the abdomen to assess fetal presentation, as little is known about the accuracy of this procedure in late pregnancy.
Women with a single pregnancy at 35-37 weeks’ gestation attending an antenatal clinic at an obstetric hospital in Sydney were identified. Each of the 1633 women underwent clinical examination to assess the position of their baby, followed by an ultrasound scan to confirm the diagnosis.
Clinical examination detected 70% of non-cephalic presentations, with correct diagnosis greater for women with lower body mass index and a previous pregnancy.
Costs, resource availability, and the potential deskilling of care providers need to be considered if routine ultrasonography were to be introduced, although accuracy of diagnosis would be improved. However, the authors conclude that lower rates of accuracy found among overweight or obese women suggest that ultrasonography in late pregnancy for these women is required.
Clinical examination to assess fetal presentation is a relatively simple procedure and the researchers suggest that variability in accuracy rates by examiner and level of experience mean that there is room for improvement by all pregnancy care providers.
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Sunday 2nd March 2008 @ 14:47
My daughter-in-law had her first baby, a 10lb breech, last year. It was only detected when the midwife tried to rupture the scrotum, when she was in late second stage of labour.
If palpation is not 100% reliable then surely it is cost effective to scan? The cost of a brain damaged baby (let alone the cost of clinical negligence claims) must surely far outweigh the costs of the necessary scanners. They need only be crude scanners and high level scanning skills would not be required. Scans are used to measure the amount of urine in the bladder before catheterisation. Surely this is much more important?
Perhaps practitioners should ask if they have already lost their skills and if mothers and babies should suffer because they are too proud to admit it.
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