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recurance

Aniyah Winston

25 Jul 2018 · Coroner Alison Mutch · Manchester (South)

This report repeats 1 earlier warning. See the linked reports.

The coroner's concerns

  1. 1. undetected breech births

    “The inquest heard that [the deceased] was an undetected breech birth. By the time it was identified she was breech her mother was fully dilated. The inquest heard that there are undetected breech births are not uncommon and present particular challenges for those involved in care during labour. The inquest was told that it is the case that pre delivery scans are not routinely carried out to try and reduce the number of undetected breeches and midwives/doctors rely on external examination. The inquest”

Linked reports

Repeats an earlier warningLeo Deady19 Dec 2013 · 4 years 7 months earlier
Identical hazardConfidence 0.92 · high

Earlier report

“there is a small but significant rate of breech presentation nationally and that a significant proportion of breech presentations go undiagnosed.”
Original on judiciary.uk ↗

This report

“pre delivery scans are not routinely carried out to try and reduce the number of undetected breeches and midwives/doctors rely on external examination.”
Full chain: Missed breech presentation due to lack of routine prenatal scanning

Responses

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error