Expectant mothers should be routinely provided an ultrasound scan at 36 weeks to detect unsafe breech deliveries, say UK researchers. Currently, most breech births are anticipated by feeling the mother's baby bump.
A breech birth, when a baby is born bottom first instead of head first, occurs in approximately three to five percent of pregnancies at term. Most babies in the breech position are delivered via a cesarean section, which is regarded as safer than vaginal birth.
Researchers believe ultrasounds would prevent 4,000 emergency C-sections and eight baby deaths a year in England. In addition, if the scans are affordable, the NHS money would save money on care, says the University of Cambridge team in the journal PLoS Medicine.
Although many babies start out breech, most turn "head-first" position at 36 weeks. When researchers recently provided scans for 3,879 pregnant women, 179, or 4.6 percent were found to be breech. In 96, or 55 percent, of the pregnancies, the breech birth was not suspected until the scan was performed. By diagnosing a breech birth at 36 weeks, women can be provided a manual attempt at turning the baby in the womb through external cephalic version (ECV), which has a 60 to 75 percent success rate.
For the women who refused (ECV) or in cases where it didn’t prove successful, a C-section was arranged. None of the women chose to attempt a vaginal breech birth, which can be risky. In the end, nineteen of the 179 women were able to deliver vaginally, 110 had a planned C-section and 50 required an emergency C-section.
According to researcher Prof. Gordon Smith, ultrasounds should be able to be provided affordably by incorporating them into standard midwife appointments and facilitating inexpensive portable ultrasound machines. "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," he said.
Private patients usually pay between £30 and £200 for a pregnancy ultrasound scan. Prof. Andrew Shennan, professor of obstetrics at King's College London, said the scans should be made available. "Breech can be difficult to manage in labor if previously unsuspected, as labor can be quick," he said.
"Breech deliveries have some risk, and counseling and decision-making in labor can be challenging. Scans are routinely available now, and minimal skills are required to determine breech presentation. This should be implemented," he added.
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On the other hand, Prof. Jean Golding, emeritus professor of pediatrics and perinatal epidemiology at the University of Bristol, argues that a much larger, randomized trial is needed first. Meanwhile. Prof. Basky Thilaganathan, from the Royal College of Obstetricians and Gynecologists, said more research is necessary but believes "the evidence for its use looks very promising."