{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:25:09Z","timestamp":1783603509044,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003123","name":"Fetal Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003123","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Undiagnosed non\u2010cephalic presentation in labor carries increased risks for both the mother and baby. Routine pregnancy care based on maternal abdominal palpation fails to detect the majority of cases of non\u2010cephalic presentation. The aim of this study was to report the incidence of non\u2010cephalic presentation at a routine scan at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation and the subsequent management of such pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective analysis of prospectively collected data in 45\u2009847 singleton pregnancies that had undergone routine ultrasound examination at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation. Patients with breech or transverse\/oblique presentation were divided into two groups; first, those who would have elective Cesarean section for fetal or maternal indications other than the abnormal presentation, and, second, those who would potentially require external cephalic version (ECV). The latter group was reassessed after 1\u20132\u2009weeks and, if there was persistence of abnormal presentation, the parents were offered the option of ECV or elective Cesarean section at 38\u201340\u2009weeks' gestation. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal and pregnancy characteristics provided a significant contribution in the prediction of, first, non\u2010cephalic presentation at the 35\u2009+\u20090 to 36\u2009+\u20096\u2010week scan, second, successful ECV from non\u2010cephalic to cephalic presentation, and, third, spontaneous rotation from non\u2010cephalic to cephalic presentation that persisted until delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>First, at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks, the fetal presentation was cephalic in 43\u2009416 (94.7%) pregnancies, breech in 1987 (4.3%) and transverse or oblique in 444 (1.0%). Second, multivariable analysis demonstrated that the risk of non\u2010cephalic presentation increased with increasing maternal age and weight, decreasing height and earlier gestational age at scan, was higher in the presence of placenta previa, oligohydramnios or polyhydramnios and in nulliparous than parous women, and was lower in women of South Asian or mixed racial origin than in white women. Third, 22% of cases of non\u2010cephalic presentation were not eligible for ECV because of planned Cesarean section for indications other than the malpresentation. Fourth, of those eligible for ECV, only 48.5% (646\/1332) agreed to the procedure, which was successful in 39.0% (252\/646) of cases. Fifth, the chance of successful ECV increased with increasing maternal age and was lower in nulliparous than parous women. Sixth, in 33.9% (738\/2179) of pregnancies with non\u2010cephalic presentation in which successful ECV was not carried out, there was subsequent spontaneous rotation to cephalic presentation. Seventh, the chance of spontaneous rotation from non\u2010cephalic to cephalic presentation increased with increasing interval between the scan and delivery, decreased with increasing birth\u2010weight percentile, was higher in women of black than those of white racial origin, if presentation was transverse or oblique rather than breech and if there was polyhydramnios, and was lower in nulliparous than parous women and in the presence of placenta previa. Eighth, in 109 (0.3%) cephalic presentations, there was subsequent rotation to non\u2010cephalic presentation and, in 41% of these, the diagnosis was made during labor. Ninth, of the total 2431 cases of non\u2010cephalic presentation at the time of the scan, presentation at birth was cephalic in 985 (40.5%); in 738 (74.9%) this was due to spontaneous rotation and in 247 (25.1%) this was due to successful ECV. Tenth, prediction of non\u2010cephalic presentation at the 35\u2009+\u20090 to 36\u2009+\u20096\u2010week scan and successful ECV from maternal and pregnancy factors was poor, but prediction of spontaneous rotation from non\u2010cephalic to cephalic presentation that persisted until delivery was moderately good and this could be incorporated in the counseling of women prior to ECV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The problem of unexpected non\u2010cephalic presentation in labor can, to a great extent, be overcome by a routine ultrasound examination at 35\u2009+\u20090 to 36\u2009+\u20096\u2009weeks' gestation. The incidence of non\u2010cephalic presentation at the 35\u2009+\u20090 to 36\u2009+\u20096\u2010week scan was about 5%, but, in about 40% of these cases, the presentation at birth was cephalic, mainly due to subsequent spontaneous rotation and, to a lesser extent, as a consequence of successful ECV. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.21902","type":"journal-article","created":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T22:44:18Z","timestamp":1572561858000},"page":"248-256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Value of routine ultrasound examination at 35\u201337\u2009weeks' gestation in diagnosis of non\u2010cephalic presentation"],"prefix":"10.1002","volume":"55","author":[{"given":"H.","family":"De Castro","sequence":"first","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Formuso","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7265-5442","authenticated-orcid":false,"given":"R.","family":"Akolekar","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Medway Maritime Hospital  Gillingham UK"},{"name":"Institute of Medical Sciences, Canterbury Christ Church University  Chatham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20857"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19111"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17419"},{"issue":"584","key":"e_1_2_7_5_1","first-page":"e1","article-title":"Prediction of imminent preeclampsia at 35\u201337\u2009weeks gestation","volume":"220","author":"Ciobanu A","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00131-2"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14915"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20267"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20258"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20243"},{"issue":"486","key":"e_1_2_7_11_1","first-page":"e1","article-title":"Prediction of small for gestational age neonates: screening by maternal factors, fetal biometry, and biomarkers at 35\u201337\u2009weeks' gestation","volume":"220","author":"Ciobanu A","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20391"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20377"},{"issue":"65","key":"e_1_2_7_14_1","first-page":"e1","article-title":"Routine assessment of cerebroplacental ratio at 35\u201337\u2009weeks' gestation in the prediction of adverse perinatal outcome","volume":"221","author":"Akolekar R","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1089"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02840-3"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01143.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2009.01050.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182878b43"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2010.01.004"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39405.539282.BE"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-2824"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14465"},{"key":"e_1_2_7_24_1","doi-asserted-by":"crossref","unstructured":"External Cephalic Version and Reducing the Incidence of Term Breech Presentation: Green\u2010top Guideline No. 20a.BJOG2017;124: e178\u2013e192.","DOI":"10.1111\/1471-0528.14466"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001312"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38919.681563.4F"},{"key":"e_1_2_7_27_1","first-page":"294","article-title":"Antepartum identification of breech presentation","volume":"49","author":"Watson WJ","year":"2004","journal-title":"J Reprod Med"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002778"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90298-4"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1975.tb00710.x"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1994.04010034.x"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19073"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15475"},{"key":"e_1_2_7_34_1","article-title":"External cephalic version for breech presentation before term","volume":"7","author":"Hutton EK","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(92)91347-D"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2014.04.008"},{"key":"e_1_2_7_37_1","article-title":"External cephalic version for breech presentation at term","volume":"4","author":"Hofmeyr GJ","year":"2015","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.21902","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21902","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.21902","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T09:42:34Z","timestamp":1694166154000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.21902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1002\/uog.21902"],"URL":"https:\/\/doi.org\/10.1002\/uog.21902","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]},"assertion":[{"value":"2019-08-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}