Breech Presentation

Aka: Breech Presentation, Breech, Frank Breech, Full Breech, Complete Breech, Footling Breech, Incomplete Breech

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