II. 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]
III. Types
IV. 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
V. 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
VI. Radiology
VII. 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
- Technique 1: Knee chest
- Footling or Incomplete Breech
- Frank or Complete Breech
- Attempt External Cephalic Version
- If external version fails
- Complete Breech with foot protruding through Cervix
- Dangerous! (Very high risk)
- Emergent Cesarean Section
VIII. Complications
- Premature Rupture of Membranes
- Cord prolapse
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| Definition (NCI) | A fetal presentation in which the baby descends into the birth canal with hips, buttocks or its foot first during delivery.(NICHD) |
| Definition (MSH) | A malpresentation of the FETUS at near term or during OBSTETRIC LABOR with the fetal cephalic pole in the fundus of the UTERUS. There are three types of breech: the complete breech with flexed hips and knees; the incomplete breech with one or both hips partially or fully extended; the frank breech with flexed hips and extended knees. |
| Concepts | Pathologic Function (T046) |
| MSH | D001946 |
| SnomedCT | 199356002, 156257003, 199352000, 156157009, 199353005, 6096002, 249101006 |
| English | Breech Fetal Presentation, Breech Labor Presentation, Fetal Presentation, Breech, Labor Presentation, Breech, Presentation, Breech, Presentation, Breech Fetal, Presentation, Breech Labor, Breech presentation NOS, Breech presentation unspecif., Breech presentation unspecified, Position of breech presentatn, Malpos fetus breech present, breech presentation of fetus (diagnosis), breech presentation of fetus, a buttocks presentation was observed, breech presentation (physical finding), buttocks presentation, buttocks presentation (physical finding), breech presentation, Breech Presentation [Disease/Finding], breech presentations, Breech presentation NOS (finding), Breech delivery (disorder), Breech delivery, Breech presentation (disorder), Breech presentation unspecified (finding), Breech presentation, Positions of breech presentation, Malposition of fetus in breech presentation, Breech presentation (finding), Positions of breech presentation (observable entity), breech; presentation, presentation; breech, Breech Presentation |
| Swedish | Sätesbjudning |
| Japanese | ｺﾂﾊﾞﾝｲ, 骨盤位, 分娩殿位, 分娩臀位, 殿位, 臀位 |
| Czech | poloha plodu koncem pánevním, Poloha koncem pánevním |
| Finnish | Perätila |
| Russian | RODY, PREDLEZHANIE IAGODICHNOE, IAGODICHNOE PREDLEZHANIE, PREDLEZHANIE IAGODICHNOE, PLOD, PREDLEZHANIE IAGODICHNOE, ПЛОД, ПРЕДЛЕЖАНИЕ ЯГОДИЧНОЕ, ПРЕДЛЕЖАНИЕ ЯГОДИЧНОЕ, РОДЫ, ПРЕДЛЕЖАНИЕ ЯГОДИЧНОЕ, ЯГОДИЧНОЕ ПРЕДЛЕЖАНИЕ |
| Italian | Pesentazione podalica del feto, Presentazione di podice, Presentazione podalica |
| Spanish | presentación de nalgas (entidad observable), posiciones fetales en la presentación pélvica, posición inadecuada del feto en presentación pelviana, posiciones fetales en la presentación de nalgas, posiciones fetales en la presentación pelviana, posiciones fetales en la presentación pélvica (entidad observable), presentación pelviana no especificada, presentación podálica no especificada, presentación de nalgas, SAI (hallazgo), presentación podálica, SAI, presentación de nalgas, SAI, presentación de nalgas no especificada (hallazgo), presentación de nalgas no especificada, presentación pelviana, SAI, presentación de nalgas, presentación pelviana, presentación pélvica (hallazgo), presentación pélvica, Presentación de nalgas, Presentación Fetal de Nalgas, Presentación de Nalgas, Presentación de Parto de Nalgas |
| Croatian | POROĐAJ ZATKOM |
| Polish | Ułożenie pośladkowe płodu, Ułożenie pośladkowe |
| Hungarian | Medencevégű fekvés |
| Norwegian | Seteleie |
| Dutch | ligging; stuit, stuit; ligging, stuitligging, Ligging, stuit-, Stuitligging |
| Portuguese | Apresentação de nádegas, Apresentação Pélvica de Parto, Apresentação Pélvica Fetal, Apresentação Pélvica |
| German | Steisslage, Beckenendlagen-Geburt, Beckenendlage, Fetale Beckenendlage, Steißlage |
| French | Présentation du siège, Présentation par le siège |
Ontology: Complete breech presentation (C0233283)
| Concepts | Finding (T033) |
| MSH | D001946 |
| SnomedCT | 49168004 |
| French | Présentation du siège complète |
| English | complete breech presentation of fetus (diagnosis), complete breech presentation of fetus, Complete breech presentation, complete breech presentation, complete breech presentation (physical finding), Complete breech, Flexed breech, Complete breech presentation (finding), Breech, Complete, Complete Breech, Buttocks presentation |
| Spanish | presentación completa de nalgas, presentación podálica completa, presentación de nalgas completa, presentación pelviana completa, presentación pélvica completa (hallazgo), presentación pélvica completa |
| Norwegian | Komplett seteleie, Flektert seteleie, Sete-fot-leie |
Ontology: Frank Breech Presentation (C0233286)
| Concepts | Finding (T033) |
| MSH | D001946 |
| SnomedCT | 18559007 |
| English | frank breech presentation of fetus, frank breech presentation of fetus (diagnosis), frank breech presentation, frank breech presentation (physical finding), frank breech, extended breech, Frank breech presentation, Extended breech, Frank breech, Frank breech presentation (finding), Breech Presentation, Frank, Presentation, Frank Breech, Frank Breech Presentation |
| Spanish | presentación podálica franca, presentación de nalgas franca, presentación pelviana franca, presentación pélvica franca (hallazgo), presentación pélvica franca |
| Norwegian | Ekstendert seteleie, Rent seteleie |
Ontology: Footling breech presentation (C0426147)
| Concepts | Finding (T033) |
| SnomedCT | 249097002 |
| English | footling breech presentation, footling breech presentation (physical finding), Fetal foot presenting, Fetal leg presenting, Footling breech presentation (finding), Footling breech presentation |
| Spanish | presentación de nalgas, presentación en podálica (hallazgo), presentación en podálica, presentación podálica (hallazgo), presentación podálica |
