Breech Presentation

Overview – Breech Presentation

Breech presentation refers to a fetal position where the buttocks or lower extremities present first, rather than the head. This occurs in around 3–4% of pregnancies at term and can lead to increased risks during labour and delivery. Management requires careful assessment, and often includes attempts at correction via external cephalic version or planned caesarean delivery. Understanding the subtypes and clinical decision-making around breech presentation is essential for obstetric care.

Definition

• Breech presentation = fetal buttocks or lower limbs are the presenting part in labour.
• Subtypes include:
  • Complete breech (10%): hips and knees both flexed
  • Frank breech (60%): hips flexed, knees extended; buttocks against cervix
  • Incomplete/footling breech (30%): one or both hips/knees extended; feet or knees present first

Risk Factors

• Contracted maternal pelvis
• Abnormally shaped uterus (e.g. fibroids, uterine anomalies)
• Pelvic tumours
• Placenta previa
• Polyhydramnios or oligohydramnios
• Prematurity
• Multiple gestation
• Congenital fetal malformations

Epidemiology

• Occurs in 3–4% of pregnancies at term

Management

External Cephalic Version (ECV)

• Aim: to reposition a singleton fetus into cephalic presentation using ultrasound guidance
• Success rate ≈ 65%
• Indications:
  • 36 weeks gestation
  • Single fetus
  • Unengaged presenting part
  • Reactive non-stress test
  • Not in active labour
• Contraindications:
  • Previous caesarean section
  • Oligohydramnios
  • Premature rupture of membranes (PROM)
  • Placenta previa
  • Intrauterine growth restriction (IUGR)
• Administer Anti-D immunoglobulin to Rh-negative mothers after ECV

Vaginal Breech Delivery

• Only in selected cases with appropriate facilities and experienced staff
• Avoid traction on the fetus
• Encourage maternal pushing during second stage
• Continuous fetal monitoring is required

Caesarean Section

• Recommended if:
  • Breech has not descended by 2 hours into labour
  • Cord presentation
  • Fetal anomalies incompatible with vaginal birth (e.g. hydrocephalus, macrosomia, IUGR)

Prognosis

• Complications of ECV: placental abruption, cord compression, rupture of membranes, labour onset, fetal bradycardia, rhesus sensitisation
• Breech presentation is associated with higher perinatal morbidity and mortality, especially if not appropriately managed

Summary – Breech Presentation

Breech presentation occurs in 3–4% of pregnancies and involves the fetal buttocks or lower limbs presenting first during labour. Management includes external cephalic version where appropriate and consideration of caesarean section depending on maternal and fetal factors. For more information on managing delivery complications, see our Obstetrics Overview page.