Around 1% of women go into labour with a breech baby that midwives did not detect by feeling the abdomen. At 36 weeks, midwives currently rely on hand palpation to tell whether a baby is head-down, but this misses 30–40% of breech presentations. This study tests whether a hand-held ultrasound device, used by midwives at the routine 36-week check, can spot breech babies more accurately than palpation alone. If the device proves accurate and acceptable, it could prevent the shock of discovering an undiagnosed breech during labour—a situation linked to post-traumatic stress disorder for mothers and partners. It would also give women time to make informed choices about delivery, such as planned caesarean or external cephalic version. The research will also assess training needs for midwives and whether the approach is cost-effective by reducing emergency interventions and neonatal intensive care admissions. This is an applied diagnostic study with direct implications for maternity care. If successful, it could change a standard antenatal check across the NHS, quietly improving safety and psychological outcomes for thousands of women each year.
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Research question: What is the diagnostic accuracy of point of care ultrasound (PoCUS) for detecting breech presentation at term? Population: Women with singleton live pregnancy at 35-37 weeks of gestation. Intervention: Hand-held PoCUS for fetal presentation undertaken by midwives Comparator: Examination for fetal presentation conducted by a sonographer using conventional ultrasound equipment on the same women and on the same day as the hand-held PoCUS. Outcome: Accuracy of PoCUS & clinical abdominal palpation for detection of breech presentation at term. Background: While over 95% of babies at term are cephalic presentation, 3-4% are breech and of these 30-40% are missed at routine antenatal checks that rely on midwives using their hands (abdominal palpation). Hence 1% of women in labour have babies that are unexpectedly breech, allowing little time for informed choice about the safest way for baby to be delivered. A sudden change in birth expectations is associated with postnatal post-traumatic stress disorder for women and birth partners. Aims: 1) To assess the accuracy of midwives detecting breech presentation using a hand-held PoCUS compared to conventional sonographer ultrasound 2) To assess acceptability of the hand-held PoCUS with midwives & pregnant women 3) To evaluate the cost effectiveness of midwives using hand-held PoCUS 4) To evaluate the training needs of midwives undertaking hand-held PoCUS through surveys and questionnaires 5) To explore if undetected breech presentation in labour will be reduced with routine use of PoCUS Primary Outcome: Diagnostic accuracy (sensitivity & specificity) of midwife conducted hand-held PoCUS for detection of breech presentation at term compared to ‘gold standard’ conventional ultrasound. Secondary outcomes: (a) acceptability to midwives and pregnant women of hand-held PoCUS (b) resource use including mode of birth and neonatal intensive care unit (NICU) admission and length of stay obtained from patient records (c) evaluation of training requirements for midwives using hand-held PoCUS (d) Proportion of breech presentations that remain undiagnosed in labour (e) change in management (f) positive pregnancy outcome (g) Infant Quality of Life Instrument (IQI). Secondary outcomes b, f & g form the cost-effectiveness analysis. Methods: Multicentre observational study in 10 maternity units. At 36 week hospital or community antenatal visit, eligible participants will be identified by the midwife & following consent abdominal palpation to determine fetal presentation and hand-held PoCUS are undertaken. Same-day conventional ultrasound for fetal presentation with a sonographer is offered in a dedicated clinic. Timelines for delivery: Initial 6 months: regulatory steps & team training Active recruitment: 18 months Post recruitment: 2 months collection & validation of data; analysis in last 4 months. Anticipated impact and dissemination: Step 1: Participant facing, targeting service users & staff across all sites to ensure inclusivity and transparency. Dissemination of plain English progress reports via newsletter emailed to those involved & informatic summaries displayed across the participating Trusts on staff and service user notice boards. Step 2: Focus on wider dissemination of the research beyond study centres with dedicated study website, Twitter & Instagram feeds. Step 3: Clinical and academic conference presentations & submissions to high impact clinical journals.
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