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Researchers Warn That Routine Physical Examination Could Miss Breech Presentation

Researchers have warned that routine pregnancy examinations to check a baby is in a good position before birth are not sensitive enough//. The researchers have explained that simple palpation, which is the feeling of the mother's bump could miss about 24 in 100 cases of abnormal lie, where in a baby is not in the normal head-down position. They further stated that it is very important for a doctor to know the lie of the baby as certain positions like foot first or breech would make the vaginal delivery difficult or impossible. The British Medical Journal has said that a routine ultrasound tests may be needed for proper diagnosis.

He researchers from the University of Sydney had studied 1,633 women who were in their 35th to 37th week of pregnancy and were attending an antenatal clinic at a local obstetric hospital. The researchers had examined every woman in the usual way to assess the position of the baby, and were later made to an ultrasound scan to confirm the position.

The researchers explained that on simple palpation they had detected 70% of the babies who were not in the ideal head-down position but had missed the other 30%. The researchers clarified further that if these figures were to be applied to a general maternity population of around 1,000 women, the clinical examination would identify only about 101 women as having an abnormal lie, but in which case only 56 would this be correct and 24 women with abnormal lie would be missed altogether.

The researchers have also suggested that the routine ultrasound scans for women late in pregnancy might help spot more babies with the possibility of abnormal lie, they also did stress that the cost effectiveness of such screening would have to be considered before any services could be given out. Sue Macdonald of the Royal College of Midwives said, “It is possible that some babies in breech position are missed and this reinforces the need to use information from this r esearch to inform current education and training of midwives and obstetricians.”

Questioning as to whether routine ultrasound checks would be cost and resource effective, she added that the exact long term effects of the scans on the baby are not yet known, and there could be a case of the doctors starting to rely heavily on the scans and becoming less skilled at physical examination. She said, “The use of scans as a second opinion, when there is difficulty in palpation, perhaps for overweight women, is already used. However, it is crucial that women are provided with unbiased information and with the choice about whether they have an additional scan or not.”
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