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Use of endo‐vaginal ultrasound to optimize visualization of the distal fetal spine in breech presentations.

Endovaginal ultrasound was used to evaluate the spine of 13 second‐trimester fetuses in which transbdominal images were considered equivocal due to suboptimal visualization of the distal spine and where the fetus was in a breech presentation. Endovaginal sonography demonstrated a small defect in the distal spine and a meningomyelocele in one of the 13 cases. In all of the remaining 12 cases, endovaginal sonography resulted in improved visualization of morphologic detail, providing sufficient information regarding bony anatomy to exclude splaying of the posterior elements. Additionally, in 10 cases the intact skin surface overlying the distal spine, which was not seen by transbdominal sonography, was well demonstrated by endovaginal ultrasound. The authors recommend that endovaginal ultrasound be considered to optimize visualization of the distal fetal spine when transbdominal images are inconclusive and the fetus is in a breech presentation.