This Week in Maternity - Screening for breech presentation study and South Dakotas high sleep related infant death rate
A study recently published has looked at the impact that screening for breech presentation at 36 weeks has on the birth. The study ‘Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis’ found that screening could lower the risk of breech delivery.
Researchers from Cambridge recruited 4000 women to the study. The women all received a scan at 36 weeks to help determine the position of the baby with 4.6% with a breech presentation. Those with a breech presentation were either given an ECV or counselled on their options – Cesarean section or vaginal birth.
Of the 179 women with a breech presentation more than half were previously undiagnosed. ECV was tried for 84 women but was only successful in 12. The types of delivery for the 179 women were:
The study also looked at the financial/economic implications of introducing the 36 week scan. The cost for adding the additional ultrasound would be £4.27 million annually however some of this would be offset by savings made from avoiding the complications associated with a breech delivery.
The study concludes:
‘This study shows that implementation of universal late-pregnancy ultrasound to assess foetal presentation would virtually eliminate undiagnosed intrapartum breech presentation in nulliparous women. If this procedure could be implemented into routine care, for example, by midwives conducting a routine 36-wkGA appointment and using a portable ultrasound system, it is likely to be cost effective. Such a programme would be expected to reduce the consequences to the child of undiagnosed breech presentation, including morbidity and mortality.’
The full study is available here.
Why are South Dakotas infant death rates so high?
Figures published on infant mortality rates due to sleep related disorders show that the rates in South Dakota are much higher than the national average.
The rate of 157.3 deaths per 100,000 births is 43% higher than the national average. Although the rate has been decreasing over the past 25 years the decrease has tapered off in the last few year. Sleep related cause include sudden infant death syndrome, accidental suffocation and strangulation. Between 2013 and 2017 95 babies in South Dakota died of sleep related causes following discharge from hospital.
Some of the possible risk factors contributing to sleep related deaths include:
To try and address the higher rate in South Dakota there are initiatives being implemented.
The America Academy of Paediatrics recommends a number of steps to support safe sleeping that includes placing the child on their back to sleep, keeping soft objects and bedding away from the sleeping area, avoiding smoking during pregnancy and after birth and avoid overheating.
This article details further information about the statistics and recommendations.