A Breakthrough in Detecting Breech Presentations
Accurate knowledge of fetal presentation at term is crucial for ensuring safe deliveries and improving perinatal outcomes. A recent multicenter study published in PLoS Medicine examined the impact of routine third-trimester ultrasound and point-of-care ultrasound (POCUS) on reducing undiagnosed breech presentations and associated neonatal complications. Conducted at St. George’s Hospital (SGH) and Norfolk and Norwich University Hospitals (NNUH) in the UK, the study compared two different ultrasound screening approaches: routine third-trimester ultrasound at SGH and POCUS screening performed by midwives at NNUH.
The study found that before routine ultrasound screening was introduced, 14.2% of breech presentations at SGH and 16.2% at NNUH went undiagnosed. Following the implementation of universal ultrasound screening, these numbers dropped significantly to 2.8% and 3.5%, respectively. Bayesian regression analysis demonstrated a 71% reduction in undiagnosed breech presentations at SGH and a 69% reduction at NNUH, both with a posterior probability greater than 99.9%. These findings suggest that universal ultrasound screening, whether conducted as a routine third-trimester scan or performed via POCUS by trained midwives, significantly improves the ability to detect breech presentations before labor begins.
Improving Neonatal Outcomes with Ultrasound
Beyond its impact on identifying breech presentations, the study also found an association between ultrasound screening and improved neonatal outcomes. The risk of a low Apgar score (less than 7 at five minutes) was significantly reduced, with a 77% decrease at SGH and a 40% decrease at NNUH. The study also noted a moderate to high probability of a reduction in hypoxic-ischemic encephalopathy (HIE) and perinatal mortality, though definitive conclusions could not be made due to the rarity of these events.
Undiagnosed breech presentations pose significant risks for both the mother and baby. When a breech presentation is not detected before labor, it increases the likelihood of an emergency cesarean section, which carries higher risks of complications compared to planned cesarean deliveries. Additionally, vaginal breech births are associated with an increased risk of birth trauma, umbilical cord prolapse, and neonatal distress. Identifying breech presentation in advance allows healthcare providers to discuss management options, such as external cephalic version (ECV) to attempt to turn the baby into a head-down position, planned cesarean delivery, or vaginal breech birth if the necessary expertise is available. Early detection empowers patients and providers to make informed decisions that optimize safety for both mother and baby.
The Role of POCUS in Expanding Access to Ultrasound
One of the most significant findings of the study was the effectiveness of POCUS when used by trained midwives in identifying fetal presentation. While routine third-trimester ultrasound is typically performed by sonographers or physicians in hospital settings, POCUS offers a more accessible and flexible alternative, particularly for midwives working in community-based maternity care.
The study found that midwives who underwent structured ultrasound training were able to accurately assess fetal presentation using POCUS, leading to a substantial reduction in undiagnosed breech cases. The accessibility of handheld ultrasound devices allows midwives to perform these assessments in outpatient clinics, birthing centers, and even home settings, reducing reliance on hospital-based imaging services. This approach has the potential to expand access to ultrasound screening, particularly in areas where access to sonographers or traditional ultrasound machines may be limited. However, the study also emphasized the need for further research on the cost-effectiveness of implementing routine POCUS screening on a broader scale.
Bridging the Training Gap with SonoSim
The study highlights the importance of ultrasound in obstetric care but also underscores the need for proper training to ensure that healthcare providers can accurately perform and interpret ultrasound scans. SonoSim offers structured ultrasound training programs that equip clinicians with the knowledge and hands-on skills needed to assess fetal presentation confidently.
SonoSim’s Basic Obstetric Ultrasound Exam – Six-Step Approach training provides a structured, step-by-step method for assessing pregnancy at the point of care. Designed for point-of-care healthcare professionals who care for pregnant patients, this module is particularly valuable for maternal health providers working in resource-limited settings. It covers key aspects of second- and third-trimester ultrasound assessment that have immediate clinical implications, ensuring that providers can make informed decisions about perinatal care and delivery planning. The training details essential ultrasound techniques for evaluating fetal presentation and lie, fetal cardiac activity, multiple gestations, placental location, amniotic fluid volume, and fetal biometry. Using real patient cases and expert-narrated image findings, learners develop a strong foundation in obstetric ultrasound. Through the patented SonoSimulator®, users gain unlimited scanning opportunities in a risk-free, simulated environment, allowing them to refine their skills before performing exams on actual patients.
As ultrasound technology continues to play an increasingly vital role in prenatal care, investing in high-quality ultrasound education is essential for ensuring its effective use in clinical practice. SonoSim offers comprehensive OB/GYN ultrasound training that supports clinicians at every stage of learning, from foundational principles to advanced diagnostic techniques.