New research suggests extra pregnancy scan could significantly reduce number of breech births

According to a recent study by Norfolk and Norwich University Hospital (NNUH) and St George’s, University of London, adding a third routine scan towards the end of pregnancies could be “a game-changer to pregnancy and birth care”, slashing the number of unexpected breech births by 70% - therefore reducing risks of the baby being born with severe health complications.

A breech position means the baby is feet or bottom first. This puts them at increased risk of being admitted to the neonatal unit, brain injury due to a lack of oxygen, and even death.

Routine scans are currently offered to pregnant women at 12 and 20 weeks only, and referrals for further observation only take place if the mother to be is flagged as being at risk of a complicated pregnancy.

The researchers hope their new findings will lead to a change in National Institute for Health and Care Excellence (Nice) guidelines, resulting in all pregnant women being offered a scan in their third trimester.

Asma Khalil, professor of obstetrics and maternal foetal medicine at St George’s said: “It’s vital we know how the baby is lying towards the end of pregnancy as we want to avoid a breech birth if at all possible.

“The two routine scans are far too early to tell us how the baby will be positioned at the time of labour and that’s why a third scan at 36-37 weeks could be a game-changer to pregnancy and birth care.”

Study and findings

During the study, doctors compared the rate of unexpected breech births and the health of the newborn baby after different third trimester scan policies were introduced at both St George’s University Hospital and NNUH.

At St Georges a total of 16,777 women received the usual scans with around 7,351 having an extra ultrasound scan at 36 weeks. 9,694 women were studied at NNUH, of whom 5,119 women received standard ultrasound scans and 4,575 given a “point-of-care” ultrasound scan at 36 weeks using a hand-held, device that brings the scan up on a phone or tablet.

Researchers found both types of third trimester ultrasound scan significantly reduced the rate of unexpected breech births. They also found that the women were less likely to need an emergency caesarean, and the babies of women who had the third ultrasound were 16% less likely to be admitted to the neonatal unit for closer monitoring.

Fran Harlow, consultant obstetrician at the NNUH, said: “This paper demonstrates the huge impact and improvement in patient care by carrying out an additional scan in the third trimester.

“At NNUH all our midwives have been trained to routinely perform hand-held, bedside ultrasound scans using a machine smaller than a tablet, to look at the position of the baby. We are delighted that this study has shown that the benefits to the mother and baby are equivalent to a formal scan performed by an ultra-sonographer.

“We hope that the data provides the stimulus for a national policy of third trimester scanning.

A Nice spokesman said: “The safety of mothers and their babies is at the forefront of our committee’s mind when they produce evidence-based recommendations.

“Our antenatal care guideline covers whether ultrasound scans should routinely be offered after 28 weeks for uncomplicated single baby pregnancies and provides several recommendations on identifying and managing breech presentation. The guideline recommends midwives examine women’s abdomens by touch at all appointments after 36 weeks to identify possible breech presentation for women carrying one baby.

“If breech presentation is suspected, an ultrasound scan is used to confirm if this is the case. We welcome technological development and the generation of new evidence in this important area, and we will review this study to see if our recommendations need to be updated.”

Helen Budge, partner in PRD's Clinical Negligence team, comments:

“Breech delivery significantly increases the risk that a baby will suffer injury during birth, particularly when it is unexpected. If breech presentation is diagnosed before delivery, there are many options available to manage the risk, including turning the baby or an elective Caesarean section. 

"Advances in technology, such as the use of handheld scanners, clearly have the potential to make childbirth safer for women and babies.”

Helen is a partner in PRD's expert Clinical Negligence team. She has around 20 years of experience providing legal advice and support to claimants who have suffered serious injuries and has specialised in medical negligence cases for the last 15. If you would like to speak to Helen with regards to Clinical Negligence, please call 0800 027 2557 or contact Helen directly.