NHS could save money by giving pregnant women extra scan, researchers say

Thousands of emergency caesarean sections could be avoided in the UK every year by scanning women in late pregnancy, new research suggests.

A routine ultrasound at 36 weeks would help detect babies in breech position, which can lead to complications during labour, according to the study published in journal PLOS Medicine.

Midwives currently check the position of the baby by feeling the mother’s bump, but the researchers said an extra scan could save the NHS money and reduce the risk of problems.

The team, from the University of Cambridge and the University of East Anglia (UEA), performed ultrasounds at 36 weeks in 3,879 women in England having their first child.

They discovered breech presentations, when a baby is lying feet or bottom first, in 179 women (4.6%).

In more than half of these cases (55%), a breech presentation had not previously been suspected.

Dr Ed Wilson, from UEA’s health economics group, said: “We estimate that UK-wide routine scanning could prevent around 15,000 undiagnosed breech presentations, more than 4,000 emergency caesarean sections and between seven and eight baby deaths per year.

“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.

“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.”

Diagnosing breech presentation at 36 weeks allows a woman to try to turn the baby before the labour, the researchers said.

The procedure, called an external cephalic version, involves an obstetrician applying pressure on the mother-to-be’s abdomen.

Women can also plan to have a caesarean section if they would prefer.

Professor Gordon Smith, from the University of Cambridge and chief investigator, 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.”

Hospitals in England offer all women at least two ultrasound scans during their pregnancy, at eight to 14 weeks and between 18 and 21 weeks.

Some women are offered more depending on the health of their baby.

Professor Basky Thilaganathan, spokesman for the Royal College of Obstetricians and Gynaecologists, said: “Identification of a breech baby before labour provides an opportunity to turn the baby into the head-first position to enable a vaginal delivery, or to have a planned caesarean birth.

“These are much safer options than discovering a breech baby during labour which may lead to an unplanned vaginal breech birth or emergency caesarean which both carry increased risks of complications for both mother and baby – especially in a first pregnancy.

“The use of an ultrasound is a quick and safe way to identify the baby’s position and this study demonstrates the health benefits of scanning at 36 weeks.”