Extra scan could help prevent breech deliveries say researchers

Pregnant women could be spared from risky breech deliveries by an extra ultrasound scan at 36 weeks, say researchers.

Breech births, where a baby’s bottom or feet emerge first, can be dangerous for both mother and baby.

Most pregnant women receive a scan at 8-14 weeks, and another between 18-21 weeks, but researchers say that a third scan at 36 weeks would make it easier to detect babies in a breech position.

Breech births

Currently, breech births are diagnosed by midwives and doctors checking on the shape and feel of the mother’s bump, which means that not all are detected in time, and mothers may end up having an emergency caesarean, or a risky vaginal delivery.

Researchers estimate that an additional scan would avoid 4,000 emergency caesareans and save eight babies from dying each year.

Many babies start out in a breech position, but by about 36 weeks gestation they will turn into the ideal head-first position. However, 3-4% of babies are in a breech position near the end of pregnancy.

Research results

For the research by the University of Cambridge, scans were given at 36 weeks to 3,879 pregnant women. Of these, 4.6% (179 women) were found to be breech. In 55% (96) of these cases, there had been no suspicion they were breech until the scan result.

The scan meant women could be offered a manipulation method called external cephalic version, where it is attempted to manually encourage the baby to turn in the womb to a head-first position.

If this didn’t work, or for the women who declined, planned caesareans were arranged.

None of the women opted to attempt a vaginal breech birth, which carries some risk although it is possible, although 19 were able to give birth vaginally following manual manipulation.

Response

The research team say that the service could save the NHS money in terms of care if the scans are carried out at a low cost.

Researcher Professor Gordon Smith said: "If it was under £20 per patient then it would be cost-effective and if it could be done for under £13 then it should save the NHS money in the long run."

Patients paying privately for a scan can pay from £30 to £200 or more.

Professor of obstetrics at King’s College London Prof Andrew Shennan believes the scans would be beneficial, saying: "Breech can be difficult to manage in labour if previously unsuspected, as labour can be quick.

 

"Breech deliveries have some risk, and counselling and decision-making in labour can be challenging. Scans are routinely available now, and minimal skills are required to determine breech presentation. This should be implemented."

Others say that more research is needed before a scan at 36 weeks is introduced; Prof Jean Golding, a professor at the University of Bristol, says bigger, randomised trials are needed first.

Similarly, Prof Basky Thilaganathan, from the Royal College of Obstetricians and Gynaecologists, said more research was needed, but added: "So far, the evidence for its use looks very promising."

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