Extra pregnancy scan could slash number of breech births according to Norwich research

Adding a third routine scan at the end of pregnancy could be a “game-changer to pregnancy and birth care”, a new study suggests.

Researchers from the maternity team at the Norfolk and Norwich University Hospital and St George’s, University of London, found that an extra appointment could slash the number of unexpected breech births by 70% and the risks of the baby being born with severe health complications.

They hope their findings will lead to a change in National Institute for Health and Care Excellence (Nice) guidelines so all pregnant women are offered a scan in their third trimester.

Pregnant women currently have routine scans at 12 and 20 weeks only, and they are only referred for further observation if they are flagged at risk of a complicated pregnancy.

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

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.”

Doctors compared the rate of unexpected breech births and the health of the newborn baby after different third trimester scan policies were introduced at St George’s University Hospital and the Norfolk and Norwich University Hospital.

At St Georges 16,777 women received the usual scans- but some 7,351 had an extra ultrasound scan at 36 weeks.

At NNUH, 9,694 women were recruited of whom 5,119 women received standard ultrasound scans and 4,575 were 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.

They found both types of third trimester ultrasound scan dramatically reduced the rate of unexpected breech births.

The researchers also found that the babies of women who had the third ultrasound were 16% less likely to be admitted to the neonatal unit for closer monitoring and the mums were less likely to need an emergency caesarean.

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.”

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