• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Can Universal Ultrasound Screening for Breech Presentation Reduce Fetal Mortality and be Cost-Effective?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Breech presentation can remain undiagnosed until a woman is in labor, with potential increased fetal morbidity and mortality
  • Wastlund et al. (PLoS Medicine, 2019) investigated universal ultrasound screening for breech presentation at 36 weeks from and sought to assess outcomes and cost-effectiveness

METHODS:

  • Prospective cohort study
    • Pregnancy Outcome Prediction study (POP)
  • Participants
    • Nulliparous women
  • Research screening ultrasound exam at 36 weeks gestation
    • Presentation | Biometry | Doppler | Placental location
    • Findings blinded unless
      • Breech | Low lying placenta | Fetal abnormality (e.g., anomaly or low fluid)
  • If a breech ( management based on RCOG guidance)
    • External cephalic version (ECV) if no contraindication
    • Failed ECV: Vaginal breech or elective cesarean
  • Fetal outcomes
    • Mode of delivery | Birth weight | Gestational age at delivery
  • Cost-Benefit Analysis
    • Compared universal ultrasound to current practice
    • Costs obtained from English National Health Service (NHS)

RESULTS:

  • 3,879 women participated in the study
  • Breech presentation at 36 weeks
    • 4.6% diagnosed with breech
    • Most unsuspected: 1/40 among undiagnosed women
    • No breech presentations were missed using ultrasound
  • ECV
    • Attempted: 46.9%
    • Success rate: 14.3%
  • Delivery
    • Vaginal: 10.6%
    • Elective cesarean: 61.5%
    • Emergency cesarean: 27.9%

Economic analysis

Compared to current practice, late pregnancy ultrasound would

  • Identify 14,826 otherwise undiagnosed breech presentations across England annually
  • Reduce emergency section and vaginal breech delivery
    • Emergency cesarean: Reduction of 0.7% | Approx. 4,196 pregnancies across England annually
    • Vaginal breech delivery: Reduction of 1.0 % | Approx. 6,061 pregnancies across England annually
  • Prevent 7.89 neonatal mortalities annually
  • This strategy would be cost-effective if fetal presentation could be assessed for ≤£19.80 (approx. $26 USD)/ woman

CONCLUSION:

  • Benefits of universal late-term ultrasound for nulliparous women include
    • Eliminating undiagnosed breech presentation
    • Reducing fetal mortality in breech presentation
  • Authors conclude this strategy is cost-effective if price brought down to approx. <£20.00/ woman
  • Cost-effectiveness analysis will not be generalizable to other countries because costs differ
    • However, calculations were based on a simple scan to primarily identify the presenting part

Learn More – Primary Sources:

Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

How Does External Cephalic Version Compare to Expectant Management
Professional Recommendations: Delivery of Breech Presentation at Term
External Cephalic Version – 18 Years Experience

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site