Adding a third scan at the end of pregnancy could be a “game changer”, a study suggests.
Women have scans at 12 and 20 weeks but only get referred for another if a potential risk is identified.
Researchers believe having one in the third trimester could cut unexpected breech births by 70%, as well as the chance of babies being born with severe health complications.
About 4% of babies are unexpectedly in a breech position – with the child’s feet or bottom first – at the end of pregnancy, data suggests.
This puts them at higher risk of needing to go to the neonatal unit, brain injury or even death.
“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,” said study leader Asma Khalil, professor of obstetrics and maternal foetal medicine at St George’s, University of London.
“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.”
The study compared unexpected breech births and the baby’s health after different third-trimester scan policies were introduced at two hospitals.
Some 7,351 of more than 24,000 women who took part at St George’s University Hospital NHS Foundation Trust had an extra ultrasound at 36 weeks.
At Norfolk and Norwich University Hospital NHS Foundation Trust, 5,119 of nearly 9,700 women had two standard ultrasounds, while the rest also had a hand-held scan at 36 weeks.
‘Safer, healthier births’
The study found both methods of third-trimester scan significantly reduced unexpected breech births.
They were 71% lower with the standard ultrasound and 69% lower with the hand-held scan.
Babies whose mothers had been given a third scan were also 16% less likely to be admitted to a neonatal unit and were 40-77% less likely to have a low Apgar score after birth.
Apgar assesses heart rate, appearance and skin colour, muscle function, reflexes and ability to breathe.
Mothers who had the third scan were also less likely to need an emergency caesarean.
“For the first time we’ve shown that just one extra scan could save mothers-to-be from trauma, an emergency C-section, and their babies from having severe health complications which could otherwise have been prevented,” said Prof Khalil.
“Our research comes at a time when there’s a spotlight on the safety of maternity services and provides the NHS with a clear solution to help enable maternity units better prepare for safer, healthier births.”
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She hopes more midwives can be trained to use the hand-held device so women can have a third scan at home or at hospital and that national guidelines will change.
A spokesman for the National Institute for Health and Care Excellence said it already had guidelines on “identifying and managing breech presentation” but that it would review the study to see if they needed updating.
It said it currently recommended “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.”
