From the Guidelines
Babies with breech presentation delivered by Caesarean section should undergo hip ultrasound screening due to the increased risk of developmental dysplasia of the hip (DDH). This recommendation is based on the American Academy of Pediatrics (AAP) guidelines, which suggest selective ultrasound screening for girls with breech presentation at birth, as well as other high-risk groups 1. The AAP guidelines emphasize the importance of early detection and treatment of DDH, as it can lead to long-term complications if left undiagnosed or untreated. Some key points to consider include:
- The risk of DDH is increased in babies with breech presentation, regardless of the delivery method
- Hip ultrasounds are typically performed between 4-6 weeks of age, allowing time for minor instability to resolve naturally
- Early detection and treatment of DDH are crucial to prevent long-term complications, such as abnormal gait, pain, and early-onset arthritis
- The AAP recommends selective ultrasound screening for high-risk groups, including girls with breech presentation at birth 1. It is essential to follow these guidelines to ensure the best possible outcomes for babies with breech presentation, in terms of reducing morbidity, mortality, and improving quality of life. The current evidence suggests that hip ultrasound screening is a necessary step in the management of babies with breech presentation, even if they are delivered by Caesarean section, as it allows for early detection and treatment of potential hip problems 1.
From the Research
Breech Presentation Babies Delivered by C-Section and Hip Ultrasounds
- Breech presentation babies are at a higher risk of developmental dysplasia of the hip (DDH) due to their position in the womb 2.
- The American Academy of Pediatrics (AAP) recommends ultrasound hip imaging at 6 weeks of age for breech females and optional imaging for breech males, even if the physical exam is normal 3.
- A study found that out of 151 breech infants with a normal physical exam who had a precautionary hip ultrasound, 140 (93%) were read as normal, and none had a dislocated hip 3.
- However, another study suggested that late hip dysplasia after a normal ultrasound in breech babies may be less common than previously reported, and recommended surveillance with follow-up visits after 12 months of age 4.
- The use of hip ultrasounds for breech presentation babies delivered by C-section is a topic of debate, with some studies suggesting that it may not be necessary for all babies with a normal physical exam 3, 4.
- Factors such as age, gender, and laterality, as well as the severity of hip dysplasia, can influence the success rate of Pavlik harness treatment in infants with DDH 5.
- The decision to perform a hip ultrasound on a breech presentation baby delivered by C-section should be made on a case-by-case basis by the examining physician, taking into account the individual baby's risk factors and physical exam results 3, 6.