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Abdominal palpation to determine fetal position at the onset of labour: an accuracy study

Webb, Sara Samantha (2010)
M.Phil. thesis, University of Birmingham.

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Abstract

Since the late 19th Century, abdominal palpation of the gravid uterus has been routine, worldwide obstetric practice to determine fetal position. A systematic review showed a dearth of research on the accuracy of this ubiquitous test. A test accuracy study was carried out prospectively to assess accuracy of abdominal palpation (index test) to identify the Left-Occipito-Anterior (LOA) fetal position at the onset of labour, in nulliparous women over 37 weeks’ gestation, with ultrasound as the reference standard. Trained observers blind to the index test results performed the ultrasound independently. Midwives palpation data on the position of 629 women were obtained and 61 (9%) fetuses were verified as LOA by ultrasound. The sensitivity, specificity and likelihood ratio of abdominal palpation to detect LOA position were 34% (23-46), 71% (67-74) and 1.2 (0.83-1.74) respectively. Higher accuracy was achieved by midwives with experience > 5 years (OR 4.02; 1.2-12.9) and those who worked in the community (OR 0.15; 0.03-0.9). Accuracy of abdominal palpation to determine LOA fetal position at the onset of labour is poor. If future research demonstrates that the optimal fetal position of LOA exists, midwives will need to confirm fetal position at the onset of labour by ultrasound to prognosticate.

Type of Work:M.Phil. thesis.
Supervisor(s):Khan, Khalid and MacArthur, Christine
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Clinical & Experimental Medicine, Department of Obstetrics & Gynaecology
Subjects:R Medicine (General)
RG Gynecology and obstetrics
Institution:University of Birmingham
ID Code:820
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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