RCOG Poster Version 4

Evidence-based management of singleton term breech pregnancies in the UK: findings from the ‘Think Breech’ study Mary Sheridan, Susan Bewley, Glenn Robert, Debra Bick

Email: [email protected] Results

The Phase 1 survey was completed by 124 Heads of Midwifery at NHS organisations across the UK with one or more maternity units within the same NHS organisation (72% response rate) covering 478,659 births in the year studied. A range of responses were recorded with respect to the extent to which ECV was provided in the units.

Discussion The three UK units which participated in phase 2 complied extensively with RCOG and NICE guidance for the management of singleton term breech pregnancies. The case study sites had clear referral pathways when breech was suspected and there was evidence that all eligible women were offered ECV.

117 (94%) responders reported that ECV was routinely available at their maternity unit.

Background In the UK around 25,000 women each year will have a breech baby. Current RCOG (2010) and NICE (2008) guidelines recommend external cephalic version (ECV) should be available and offered to all women with uncomplicated term breech presentation.

Objective To identify support for evidence-based management of singleton term breech pregnancies in the UK.

However only 54 units (44% of respondents) could provide details of the number of women who were offered, accepted or had a successful ECV. The Phase 2 findings identified several common themes from the case study sites to support evidence-based term breech management: qImplementation of efficient referral systems to confirm breech presentation at term qThe routine offer of ECV to all eligible women

Method Phase 1 of the study involved a cross sectional survey of evidence-based management of singleton term breech in the UK. A ‘Term Breech Index’ (TBI) was developed to assess compliance with guidance. Phase 2 involved case studies at three UK units identified using the TBI as implementing evidence-based breech management. Data collection included: semi-structured interviews with staff and review of documents.

qRegular audit and feedback of breech management outcomes qSupport for vaginal breech birth if ECV was declined or unsuccessful qA culture of evidence based practice across the unit

Conclusions The use of the TBI to identify high adherence to evidence-based guidelines, improved referral systems to confirm breech presentation at term and use of ECV, could reduce planned caesarean births, improve maternal and infant morbidity outcomes and make more effective use of finite healthcare resources.

Acknowledgements The research participants This is a summary of independent research funded by the National Institute for Health Research (NIHR)/CNO/HEE CAT Doctoral Research Fellowship Programme. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health.

References National Institute for Health and Care Excellence (2008) Antenatal care for uncomplicated pregnancies. London. NICE. Royal College of Obstetricians and Gynaecologists. (2010) External cephalic version and reducing the incidence of Breech Presentation. Greentop Guideline No. 20a. London: RCOG.