Routine Ultrasonographies Benefit Mothers and Babies


Additional routine ultrasound can eliminate undiagnosed breech presentation and reduce emergency cesarean sections

Ingrid Torjesen

Wednesday, April 17, 2019

Offering ultra-sonographies of late pregnancy in 36 weeks would benefit mothers and babies and save costs, published research * Plos Medicine suggests.

The study found that an additional routine ultrasound could eliminate undiagnosed pelvic presentation of infants, decrease the rate of emergency cesareans, and improve the health of mothers and babies.

The research team carried out the ultrasound screening at 36 weeks of gestation in 3,879 women who had their first pregnancy in England. A total of 179 women (4.6%) were diagnosed with a pelvic presentation, and in more than half of these cases (55%) there was no prior suspicion that the baby was in breech position. Midwives and doctors are now attempting to detect fogged births by feeling the belly of the pregnant mother to assess the baby's position.

Detection of breech position at 36 weeks allowed women to opt for an attempt to turn the baby, called the external cephalic version (ECV). For women who refused this procedure, or where they did not succeed, a planned cesarean section was organized.

None of the women opted to attempt a pelvic vaginal delivery, which is known to be associated with an increased risk of complications, especially in the early gestations.

Dr. Ed Wilson, of the UEA's Health Economics Group at Norwich Medical School, said: "We estimate that routine sweeping in the UK could prevent about 15,000 undiagnosed pelvic presentations, more than 4,000 emergency cesareans, and seven to eight deaths of babies per year.

"We also looked at the costs of additional scans and found that if scans could be made for less than £ 12.90 each, it could be a savings for the NHS.

"If ultrasound screening could be performed at such a low cost, for example, by making it part of a standard midwife consultation, the routine ultrasound offer could represent a good use of NHS resources."

Professor Andrew Shennan, a professor of obstetrics at King's College in London, said: "The breech can be difficult to administer in labor if it was previously unsuspected, since labor can be rapid."

He added: "Scans are routinely available now, and minimal skills are needed to determine the pelvic presentation. This should be implemented.

Professor Gold Golding, professor emeritus of pediatric and perinatal epidemiology at the University of Bristol, said that a major advantage of detecting early pelvic is the opportunity to change the baby's presentation using a procedure known as ECV. However, she noted that there was a low success rate in CVD in the study, raising the question of whether current obstetricians are sufficiently trained in the procedure.

"While the current view is that a full-term delivery should be delivered by caesarean delivery, this is not a benign procedure, and there are long-term consequences for the mother (eg increased risk of endometriosis) and the risk of obesity into adulthood), "she said.

* Wastlund D, Moraitis AA, Dacey A, and others. Screening for Breech Presentation Using Universal Ultrasound of Last Pregnancy: A prospective cohort study and cost-effectiveness analysis. PLOS Posted: April 16, 2019. DOI: 10.1371 / journal.pmed.1002778


Source link