A simple patient-initiated intervention to increase antenatal detection of breech presentation at term.

Antenatal detection of breech presentations at 35-37 weeks is necessary to allow adequate time for decision making about external cephalic version (ECV) and/or caesarean section. This study aimed to increase antenatal detection of breech presentation and referral for ECV using an inexpensive patient prompt (a simple brochure encouraging pregnant women to ask how their baby is presenting) and posters reminding clinicians to assess presentation. The interventions were evaluated using a before-after (single time series) study design. The records of women who had a breech presentation in late pregnancy were audited for 12 months before (n = 122) and 12 months after (n = 129) the introduction and implementation of the intervention. There was a statistically significant increase in women with a breech presentation who were assessed antenatally for ECV eligibility, from 75 (61%) before the intervention to 100 (78%) after the intervention. In the before-intervention period, 55 (60%) were identified as eligible for ECV and of these 32 (58%) had an ECV. After the intervention, 80 (75%) were identified as eligible for ECV and 46 (58%) had an ECV. A number of unanticipated events occurred during the study period, so although there was better identification of women eligible for ECV during the after-intervention phase we cannot be sure whether this is an intervention effect or attributable to other reasons. Further, there was no increase in the uptake of ECV nor a reduction in caesarean sections for breech presentation. The difficulties associated with before-after studies are highlighted.