Do specific maternal sensations experienced in late pregnancy correlate to a breech presenting baby? Evaluation of a simple maternal questionnaire.

Abstract

To investigate the effectiveness of a structured questionnaire completed at 36 weeks gestation in predicting breech presentation. Questionnaire-based study. Tertiary NHS Foundation Trust. Women attending for a universally offered 36-week fetal growth scan. Completion of a previously designed maternal questionnaire detailing sensation of fetal movements during the past week, immediately before a routine growth scan. Between September 01, 2018 and September 30, 2019, 2341 questionnaires were handed out and 2053 were returned. Analysis was performed in 1938 (94.4%) completed questionnaires. Recorded presentation was breech in 109 (5.6%), transverse/oblique in 15 (0.8%), and cephalic in 1814 (93.6%). Women "thinking their baby was breech" had a high positive likelihood ratio, at 11.8 (95% CI 7.4-19.1), but poor sensitivity (27.3%). "Feeling kicks low down or near the bladder" was sensitive for non-cephalic presentation (76.3%) but with poor specificity (48.9%). The questions "kicks low" ("no") (P= 0.013, aOR 2.18 [1.18-4.04]) and 'thinks cephalic ("no")' (P= 0.001, aOR 0.12 (0.04-0.43) were independent risk factors for a non-cephalic presentation. The questions posed in this questionnaire could aid the detection of breech presentation, but do not perform better than published data on palpation. Missing a breech presentation near term through palpation alone is well reported. Combining the concept of palpation to exclude breech presentation and these questions may help focus a clinician and improve both palpation skills and breech detection. As a minimum, a woman who believes her baby is breech should be taken seriously.