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Accuracy of Leopold maneuvers in screening for malpresentation: a prospective study.

This study describes the accuracy of Leopold maneuvers as a screening procedure for fetal malpresentation. The frequency of fetal malpresentation ranges from 15 percent at 32 weeks to 4 percent at term. We prospectively determined fetal presentation by performing Leopold maneuvers on 150 women, followed by a fetal ultrasound examination for comparison. Experienced certified nurse-midwives performed the maneuvers with high sensitivity (88%), specificity (94%), positive predictive value (74%), and negative predictive value (97%) in a population with a 17 percent frequency of fetal malpresentation. We conclude that the maneuvers used by experienced clinicians can be effective as a screening tool for fetal malpresentation, particularly in settings where ultrasound may not be readily available.