Accuracy and factors influencing Leopold’s manoeuvres in determining vertex presentation during late third trimester of pregnancy

Abstract

This prospective descriptive study was conducted for examine the accuracy of Leopold’s manoeuvres in determining vertex presentation and to identify factors which may influence the accuracy. Pregnant women gestational age more than 34 weeks were examined using Leopold’s manoeuvre for foetal presentation, and findings confirmed on subsequent ultrasonographic (US) examinations. Our study found Leopold’s manoeuvre for foetal presentation determination during the late third trimester of pregnancy has high sensitivity but low specificity. Accuracy of performance of Leopold’s manoeuvre for foetal presentation and lie were 89 and 96%, respectively. The sensitivity, specificity and PPV for vertex presentation diagnosis were 93.2, 30 and 94.9%, respectively. A larger foetal abdominal circumference decreased the accuracy of performance of Leopold’s manoeuvre (Adjusted OR 0.821, 95% CI 0.703–0.959, p =.013). Using an AC cut-off value of ≥33.01 cm, the sensitivity, specificity, PPV and NPV for accurate vertex presentation diagnosis were 54.3, 57.6, 91 and 13%, respectively.IMPACT STATEMENTWhat is already known about this subject? Leopold’s manoeuvre is a method for assessing fetal presentation. Previous studies have found the overall accuracy of Leopold’s manoeuvre to be 63–88%. What the results of this study add? Leopold’s manoeuvre has high sensitivity but low specificity. Increased fetal AC influences the accuracy of Leopold’s manoeuvre. What the implications are of these finding for clinical practice and/or further research? Fetal non-vertex presentation and fetal AC ≥33.01 cm measured by ultrasonographic examination during late third-trimester pregnancy should be followed for determine the fetal presentation by ultrasonographic examination, patient’ counselling and planning the route of delivery for non-vertex presentation in case of emergency. Further investigations about the cost effectiveness of universal ultrasonographic examination for fetal presentation determination in late third-trimester pregnancy are needed. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.