Third-Trimester Ultrasound Improves Neonatal Outcomes

A retrospective study conducted at St. George’s (SGH) and Norfolk and Norwich University Hospitals (NNUH) in the United Kingdom investigated the influence of routine third-trimester ultrasound on undetected breech presentations.
Researchers led by Samantha Knights of the Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospitals NHS Foundation Trust, and Smriti Prasad of the Fetal Medicine Unit, St. George’s University Hospitals NHS Foundation Trust discovered that a policy of routine third-trimester ultrasound was associated with a reduction in term breech presentations and an improvement in neonatal outcomes in a paper published in PLOS Medicine. A baby’s head is positioned downward (vertex position) and exits the vagina first in an ideal birth. The baby’s buttocks or feet are downward in the breech position.

Breech babies are frequent in early pregnancy, but most of them will move to a head-down position on their own by week 36. Breech position issues normally do not manifest themselves until it is time to birth and can go undiscovered until late in the third trimester. Breech position during birth happens in approximately 3% to 4% of full-term pregnancies and is more common in pregnancies.

Complications can be serious since arms and legs become dislocated or shattered when they are out of position. The umbilical chord may be improperly positioned, cutting off oxygen and perhaps causing nerve or brain damage. Breech vaginal birth has been linked to an increase in neonatal death and morbidity, as well as mother morbidity.

Correct fetal position at term knowledge is vital for delivering knowledgeable pregnancy and delivery care. Knowing ahead of time gives women the ability to choose how to proceed. Physical manipulation (external cephalic version) may be attempted, which involves placing hands on the abdomen and applying firm pressure to turn the baby to a head-down position. Cesarean or vaginal birth can be chosen, each with its own set of risks and benefits.

The authors of the paper, “Impact of point-of-care ultrasound and routine third-trimester ultrasound on undiagnosed breech presentation and perinatal outcomes: An observational multicentre cohort study,” point to substantial evidence that clinical examination is not accurate enough for determination of fetal presentation, with unacceptably high rates of missed breech presentations at term.

The study compared the before and after results of the routine third-trimester ultrasound in two hospitals to determine the efficacy of the additional protocol. Women who had numerous pregnancies, were born prematurely (before 37 weeks), had a congenital anomaly, or were receiving a planned cesarean procedure for the breech presentation were excluded.

Prior to implementation, there were 16,777 births at SGH and 5,119 at NNUH, with 7,351 and 4,575 born following. In both groups, the rate of breech presentation in labor was consistent (3% to 4%), which is the statistically predicted rate. In the SGH cohort, the percentage of all term breech presentations that were undiagnosed was 14.2% (82/578) before and 2.8% (7/251) after the implementation of additional screening, a 71% reduction. In the NNUH cohort, the percentage of all term breech presentations that were undiagnosed was 16.2% (27/167) before and 3.5% (5/142) after the implementation, a 69% reduction. The researchers found that both third-trimester ultrasound by sonographers and POCUS utilized by trained midwives effectively reduced the number of undetected breech presentations at birth and resulted in fewer associated newborn problems.

Source Link