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Breech presentation

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 19 Aug 2025
Last updated: 21 May 2024

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
Full details

Other diagnostic factors

  • subcostal tenderness
  • pelvic or bladder pain
Full details

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
Full details

Diagnostic tests

1st tests to order

  • transabdominal/transvaginal ultrasound
Full details

Treatment algorithm

INITIAL

<37 weeks' gestation and in labor

≥37 weeks' gestation not in labor

ACUTE

≥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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.

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