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Section ultrasound could prevent thousands of unnecessary C-sections

Thousands of caesarean section deliveries could be avoided simply by offering women an extra ultrasound scan, a new study has found.

A trial by Cambridge University and the University of East Anglia (UEA) reveals that a second scan approximately one month before delivery date virtually eliminates the risk of undiagnosed breech presentation, where a baby’s buttocks or feet emerge first at birth.

Undiagnosed breech presentations pose a risk for mother and child and often results in an emergency caesarean.

The research team believes that by spotting upside-down babies weeks ahead of birth, around 4,000 of the procedures could be avoided each year.

They performed screening ultrasound test at 36 weeks on 3,879 women going through their first pregnancy in England.

Just under fiver per cent were diagnosed with breech presentation by the scan, but in more than half of these cases there was no prior suspicion that the baby was in the breech position.

Under the current system, where expectant mothers typically receive a scan at around 20 weeks, many of these breech presentations would have been missed, as assessment relies on a doctor feeling the bump and skill levels between practitioners vary widely.

Making the diagnosis at 36 weeks allowed the women to opt for an attempt at turning the baby - called external cephalic version.

The procedure is significantly more likely to be successful a month before pregnancy than if attempted close to birth.

Published in the journal PLOS Medicine, the study estimates that offering a second scan universally would prevent 15,000 undiagnosed breech presentation each year and eight or ten baby deaths.

Gordon Smith, Professor of Obstetrics and Gynaecology at the University of Cambridge and chief investigator of the study 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."

More than a quarter of the roughly 680,000 live births in England and Wales each year are delivered by caesarean.

With the slight majority - 15 per cent of overall births - emergency procedures and the remainder elective.

The rate has increased 33 per cent since 2000, despite years of natural birth campaigns in many NHS hospitals which still sees women occasionally denied the procedure at three-quarters of maternity units.

Caesareans can lead to scarring of the womb, which heightens the risk of complications during future births, such as from bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth.

Guidelines from the National Institute for Health and Care Excellence (Nice) state women who ask for a caesarean should be offered one if, after support and discussion with a doctor, they feel it is best for them.

Dr Ed Wilson, from UEA, said: “If ultrasound screening could be provided at such a low cost, for example by making it a part of a standard midwife appointment, routinely offering ultrasound scans could well represent a good use of NHS resources."

He added: "We also looked into the costs of additional scans and found that if scans could be done for less than £12.90 each, it could be cost-saving to the NHS.”

Image Credit: AP

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