Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head.
Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.
Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies.
Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned cesarean section, the optimal gestation being 37 and 39 weeks, respectively.
Planned cesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term.
Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. There is good current evidence regarding effective management of breech presentation in late pregnancy using external cephalic version and/or planned cesarean section.
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
- premature fetus
- small for gestational age fetus
- fetal congenital anomalies
- previous breech delivery
- uterine abnormalities
- abnormal amniotic fluid volume
- placental abnormalities
- female fetus
1st investigations to order
- transabdominal/transvaginal ultrasound
<37 weeks' gestation
≥37 weeks' gestation not in labor
≥37 weeks' gestation in labor: no imminent delivery
≥37 weeks' gestation in labor: imminent delivery
- Transverse lie
- Antenatal corticosteroids to reduce neonatal morbidity and mortality
- Caesarean birth
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