Summary
Definition
History and exam
Key diagnostic factors
- buttocks or feet as the presenting part
- fetal head under costal margin
- fetal heartbeat above the maternal umbilicus
Other diagnostic factors
- subcostal tenderness
- pelvic or bladder pain
Risk factors
- premature fetus
- small for gestational age fetus
- nulliparity
- fetal congenital anomalies
- previous breech delivery
- uterine abnormalities
- abnormal amniotic fluid volume
- placental abnormalities
- female fetus
Diagnostic tests
1st tests to order
- transabdominal/transvaginal ultrasound
Treatment algorithm
<37 weeks' gestation and in labor
≥37 weeks' gestation not in labor
≥37 weeks' gestation in labor: no imminent delivery
≥37 weeks' gestation in labor: imminent delivery
Contributors
Authors
Natasha Nassar, PhD
Associate Professor
Menzies Centre for Health Policy
Sydney School of Public Health
University of Sydney
Sydney
Australia
Disclosures
NN has received salary support from Australian National Health and a Medical Research Council Career Development Fellowship; she is an author of a number of references cited in this topic.
Christine L. Roberts, MBBS, FAFPHM, DrPH
Research Director
Clinical and Population Health Division
Perinatal Medicine Group
Kolling Institute of Medical Research
University of Sydney
Sydney
Australia
Disclosures
CLR declares that she has no competing interests.
Jonathan Morris, MBChB, FRANZCOG, PhD
Professor of Obstetrics and Gynaecology and Head of Department
Perinatal Medicine Group
Kolling Institute of Medical Research
University of Sydney
Sydney
Australia
Disclosures
JM declares that he has no competing interests.
Peer reviewers
John W. Bachman, MD
Consultant in Family Medicine
Department of Family Medicine
Mayo Clinic
Rochester
MN
Disclosures
JWB declares that he has no competing interests.
Rhona Hughes, MBChB
Lead Obstetrician
Lothian Simpson Centre for Reproductive Health
The Royal Infirmary
Edinburgh
Scotland
Disclosures
RH declares that she has no competing interests.
Brian Peat, MD
Director of Obstetrics
Women's and Children's Hospital
North Adelaide
South Australia
Australia
Disclosures
BP declares that he has no competing interests.
Lelia Duley, MBChB
Professor of Obstetric Epidemiology
University of Leeds
Bradford Institute of Health Research
Temple Bank House
Bradford Royal Infirmary
Bradford
UK
Disclosures
LD declares that she has no competing interests.
Justus Hofmeyr, MD
Head of the Department of Obstetrics and Gynaecology
East London Private Hospital
East London
South Africa
Disclosures
JH is an author of a number of references cited in this topic.
References
Key articles
Impey LWM, Murphy DJ, Griffiths M, et al; Royal College of Obstetricians and Gynaecologists. Management of breech presentation: green-top guideline no. 20b. BJOG. 2017 Jun;124(7):e151-77.Full text Abstract
Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015 Jul 21;(7):CD000166.Full text Abstract
Royal College of Obstetricians and Gynaecologists. External cephalic version and reducing the incidence of term breech presentation. Mar 2017 [internet publication].Full text
Cluver C, Gyte GM, Sinclair M, et al. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. Cochrane Database Syst Rev. 2015 Feb 9;(2):CD000184.Full text Abstract
de Hundt M, Velzel J, de Groot CJ, et al. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014 Jun;123(6):1327-34. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Transverse lie
More DifferentialsGuidelines
- Caesarean birth
- Mode of term singleton breech delivery
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer