Breech presentation

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Oct 2024

Last updated: 21 May 2024

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.

Definition

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.[1][2] 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

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

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

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.

Differentials
- Transverse lie
More Differentials
Guidelines
- Caesarean birth
- Mode of term singleton breech delivery
More Guidelines
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Breech presentation

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

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

Disclosures

Christine L. Roberts, MBBS, FAFPHM, DrPH

Disclosures

Jonathan Morris, MBChB, FRANZCOG, PhD

Disclosures

Peer reviewers

John W. Bachman, MD

Disclosures

Rhona Hughes, MBChB

Disclosures

Brian Peat, MD

Disclosures

Lelia Duley, MBChB

Disclosures

Justus Hofmeyr, MD

Disclosures

Differentials

Guidelines

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Log in or subscribe to access all of BMJ Best Practice

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