Additional routine ultrasounds benefit mothers and babies, and could save costs, study finds

A study led by researchers at the University of Cambridge and published this week in PLOS Medicine has found that offering universal late pregnancy ultrasounds at 36 weeks’ gestation eliminates undiagnosed breech presentation of babies, lowers the rate of emergency caesarean sections and improves the health of mothers and babies.

The Pregnancy Outcome Prediction study, which was funded by the National Institute for Health Research, found that routine late ultrasounds could spot previously undiagnosed breech presentation (when a baby’s buttocks or feet emerge first at birth, increasing the risk of perinatal morbidity and mortality).

Researchers performed research screening ultrasounds at 36 weeks’ gestation in 3879 women having first pregnancies in England. 179 women (4.6%) were diagnosed with breech presentation by the research scan. However, in over half of these cases (55%) there was no prior suspicion that the baby was presenting in the breech position.

Making the diagnosis at 36 weeks allowed women to opt for an attempt at turning the baby, called external cephalic version. For the women who declined this procedure, or where it was unsuccessful, a planned caesarean section was arranged. None of the women opted to attempt a vaginal breech birth, which is known to be associated with an increased risk of complications, particularly in first pregnancies.

Across the UK, the analysis estimated that routine scanning could prevent around 15,000 undiagnosed breech presentations, more than 4,000 emergency caesarean sections and 7 to 8 baby deaths per year. If a scan could be done for less than £12.90 then it could be cost-saving to the NHS. This could be possible once midwives are instructed how to perform the simple technique, using inexpensive portable equipment.

Professor Gordon Smith from the Department of Obstetrics and Gynaecology at the University of Cambridge said: “We believe the study highlights an opportunity to identify women at increased risk of a complicated birth. It seems likely that screening for breech presentation near term could be introduced in a cost-effective manner and this should be considered by the NHS and other health systems.”

Adapted from a press release from PLOS.

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