36wk scan reintroduced

[DrVonPatak]

Wrote this on AIBU, but not too many bites there!

Opening a champagne bottle here!!!

Colleagues in Cambridge finally persuaded the government to reintroduce the 36 week scan for fetal position!!! Yaaahooo!!!!

Took the effort of a lot of people across the country and if any of them are reading this, you know who you are, I am using this opportunity to say a massive thank you!!!

The idea is to check for breach position at 36wks, when the chances for spontaneous turning are quite slim, and to aim for an elective CS to prevent traumatic birth and up to 8 neonatal deaths per year. With a bit of luck, this will include macrosomic babies too.

Oh does that mean that this will now be countrywide? It has been happening in my area for the last three years (I had mine last week in fact!), but I did find it odd that friends living close by but in a different county don't get one.

I think it's great! A friend of mine had her baby diagnosed as breech at her 36 week scan, so it definitely helps!

What I found a bit odd with my scan last week is that one of the measurements they took was off the scale, when everything else was average, but they decided not to do anything about it? Which I am a bit concerned about, especially considering this particular measurement was off the scale at my 20 week scan too. Hopefully it's nothing to worry about!

Really? Because there's no evidence behind it so I'd be amazed if it happened.

Now introducing 3rd trimester scans for growth and Doppler should be done and there's evidence to support that. But not for fetal position. Can't see our hospital doing this, we struggle with scan slots as it is.

Have you got a link for the 8 neonatal deaths per year? Or links to studies inspiring the lobby for this reintroduction? Just spent 15 minutes trying to find it myself (breech position at term seems a bizarre omission from the mmbrace report I now notice!). No agenda, I'm a midwife with a generally positive attitude to vaginal breech delivery for multips and obviously if this is misguided I'd be keen to know!

Also was aware of this being mooted for growth and placental function to prevent stillbirths rather than neonatal deaths.

journals.plos.org/plosmedicine/article?id=10.1371/journal.pm

For those claiming there is no evidence behind it (besides common sense, like used in other 27 EU countries, Canada, Australia, New Zealand...)

journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002778

Sorry, the link didn't seem to work.

If this one fails, kindly google:

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

Your link doesn't work. Evidence based practice underpins policy not common sense. My common sense and years of experience tells me it's not necessary when midwives are skilled in palpation and will only get it wrong in a fraction of cases..Not enough to make it financially worthwhile. Plus the move to a continuity of care model should l reduce the amount of missed breech.

Ok. Firstly am i missing the figures of missed breech in the control group who just had palpation? I'm on my phone so might have missed it but without this the research is meaningless.

with breech presentation at 36 weeks. For most women (96), there had been no prior suspicion of noncephalic presentation*

Of course there wouldn't be. Midwives don't bother about presentation much prior to 36 weeks as they can turn on their own so knowing at 34 weeks isn't significant. Plus how do they know the fetus hadn't been cephalic the week before the scan? Seems a poorly designed study.

I'd be more interested in a study which scanned 3500 women immediately after a 36w palpitation to see how many were missed.

So, you're saying it is advisable to let a couple of babies suffer lifelong/fatal consequences of midwife mistakes for the benefit of a financial end point?

And you quote your common sense?

No-one in my trust seems to know about it. I wonder when it will start? I've got 20wk scan next week.

They only offer growth scans or a scan is they suspect the baby is breech at 36wk MW apt. No routine 36 week scan offered.

This is great news. Anecdotal of course, but I had a surprise footling breech after being palpated regularly. They realised after an examination when I was in labour, in fact even after being transferred from birth centre to hospital and being palpated there the staff weren't convinced until I got a portable ultrasound (and a foot became evident).

I ended up with a crash section and it was all quite traumatic so anything to avoid that happening to others and fine by me.

I'm saying the nhs will never fund such a scheme to save 8 babies. Especially when the study you link to seems very flawed.

Like it or not NICE are unlikely to recommend something which Will cost so much to save 8 lives. Sad but true. Everything is weighed up on a cost benefit and accountants run the nhs.

Is that only when midwives are unsure of position? They were telling me what DC were doing from about 30 weeks. They checked where bum and head were and then checked they got them the correct way around with the Doppler. Also prodding baby so they could see where they kicked.

So this scan is just to check baby’s position?

Not to check baby’s growth, placenta function & blood flow or anything like that?

Seems like a missed opportunity if so.
My youngest DC was induced at 37 weeks because he’d stopped growing. His growth problem was only picked up because issues with my previous pregnancies meant I was getting extra scans.

The growth issue my baby had is a big risk factor for stillbirths.
The blood flow through the placenta, and therefore the placenta function, can be checked on ultrasound, and detecting a failing placenta early can reduce still births and save babies lives.

So.... why ignore that and purely focus on baby’s position?
A skilled midwife might be able to detect a breech baby by feeling the bump but there’s no way to check the placenta is working properly without a scan.

And I wasn't commenting on my common sense OP, so no need for the snarky face. Rude. You said it was common sense to change practice and I simply pointed out it doesn't work like that.

There's a lot of life saving medical treatment the nhs don't provide even though it would seem to make sense for them to do so.

It’s widely known that a scan at 36 weeks / more regular dopplar scans help prevent stillbirth. It has always been known. The problem is that the NHS just didn’t care before the stillbirth target was introduced. I expect the doppler scans to be introduced next.

And I didn't say there was no evidence, I asked for it, that's all!

I think the OP has misunderstood the purpose of the third trimester scan in other countries. They do a growth and Doppler scan, it's nothing to do with presentation. Obviously that's an added bonus. But doing it just for presentation reasons only would be silly.

From what I heard on the radio this morning it says it aims to reduce the need for (I think it was) 8000 emergency cesearean sections a year.

Link To The study www.nhs.uk/news/pregnancy-and-child/scan-mums-be-36-weeks-breech-births-says-study/

It hasn't been reintroduced

www.nhs.uk/news/pregnancy-and-child/scan-mums-be-36-weeks-breech-births-says-study/

It states there's more work to be done before considering a 36 week scan nationwide.

It's honestly one of the worst bits of research I've seen in years and I spend my working life reading such stuff and in a previous job writing hospital policies.

My hospital has done 36 week scans as standard for years bit it's a doppler scan checking the placenta and blood flow. I believe the evidence for this preventing stillbirth is strong so I was really surprised to hear on the news 36 week scans are being introduced but for positioning.

Oxfordshire carries out 36wk scans as standard to check for position and has done for at least 3 years.