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Breech Presentation
Aka: Breech Presentation, Breech, Frank Breech, Full Breech, Complete Breech, Footling Breech, Incomplete Breech
- See Also
- Breech Delivery
- Malpresentation
- External Cephalic Version
- Epidemiology: Incidence of Breech Presentation
- Gestational age 21 to 24 weeks: 33% Breech
- Gestational age 25 to 28 weeks: 28% Breech
- Gestational age 29 to 32 weeks: 14% Breech
- Gestational age 33 to 36 weeks: 9% Breech
- Gestational age 37 to 40 weeks: 7% Breech
- Gestational age 40 weeks: 3-4% Breech (1 in 25 live births)
- Scheer (1976) Am J Obstet Gynecol 12:269 [PubMed]
- Types
- Frank Breech (45-50%)
- Hips flexed over anterior body
- Knees extended
- Complete Breech or Full Breech (10-15%)
- Hips flexed
- Knees flexed
- Footling Breech or Incomplete Breech (35-45%)
- One or both hips and knees extended
- One or both feet presenting
- Risk Factors
- Prematurity
- Multiple prior pregnancies
- Polyhydramnios or oligohydramnios
- Uterine abnormalities
- Fetal abnromalities (e.g. Down Syndrome, Hydrocephalus)
- Macrosomia
- Twin Gestation
- Breech Presentation in prior pregnancy
- Absolute Cephalopelvic Disproportion
- Signs
- Leopold's Maneuvers
- Longitudinal Fetal Lie
- Firm lower pole
- Limbs to one side
- Hard head at uterine fundus
- Head may be obscured by maternal ribs
- Fetal heart tone auscultation
- Breech Fetal heart best heard above Umbilicus
- Cervical examination
- No hard head palpated in Pelvis
- Fontanels and Sutures not palpable
- Soft buttocks palpated with hard irregular Sacrum
- Skin of buttocks is smooth
- Feet may be presenting part in Pelvis
- Radiology
- Obstetric Ultrasound
- Management
- General
- Evaluate for cause in all Breech Presentation
- Consider postural Exercises for patient
- Technique 1: Knee chest
- Knee-chest position for 15 minutes
- Repeat 3 times daily for 5 days
- Consider pelvic rocking while performing
- Technique 2: Deep trendelenburg position
- Patient supine with hips elevated 9-12 inches
- Perform 10 minute, once to twice daily
- Consider pelvic rocking while performing
- Questionable efficacy but considered safe
- Footling or Incomplete Breech
- Cesarean Section
- Frank or Complete Breech
- Attempt External Cephalic Version
- If external version fails
- Cesarean Section or
- Breech Delivery
- Complete Breech with foot protruding through Cervix
- Dangerous! (Very high risk)
- Emergent Cesarean Section
- Complications
- Premature Rupture of Membranes
- Cord prolapse