From the Research
The most reliable method for assessing fetal presentation is through ultrasound, specifically transabdominal sonography, as it provides definitive confirmation of presentation when physical examination is inconclusive. This method is particularly useful in cases of maternal obesity, multiple pregnancy, or polyhydramnios, where physical examination may be challenging 1.
Methods of Assessing Fetal Presentation
The following methods can be used to assess fetal presentation:
- Leopold's maneuvers, a physical examination consisting of four systematic palpations of the maternal abdomen
- Ultrasound, including transabdominal and transperineal sonography
- Vaginal examination, which can assess presentation by feeling the presenting part through the cervix if dilation has begun
Ultrasound Assessment
Ultrasound assessment of fetal head position is feasible in a busy labor ward and is more accurate than digital examination, particularly in cases of obstructed labor 2. Transabdominal sonography can be used to evaluate fetal head position, and landmarks such as the fetal orbits, midline, and occiput can be visualized 1. The angle of progression and occipot-spine angle can also be measured to quantify the degree of flexion in fetuses in non-occipot-posterior or occipot-posterior position 1.
Clinical Significance
Accurate assessment of fetal presentation is crucial for planning delivery and can help identify potential complications, such as cephalic malpresentation and malposition, which can increase the risk of perinatal complications 3. Intrapartum ultrasound can aid in decision-making regarding delivery and can help predict and diagnose difficult and prolonged labor 2.
Recommendation
Ultrasound, specifically transabdominal sonography, should be used as the primary method for assessing fetal presentation, particularly in cases where physical examination is inconclusive or challenging 1. This method provides definitive confirmation of presentation and can help identify potential complications, ultimately improving outcomes for mothers and babies.