II. 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]

III. 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

IV. 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

V. 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

VI. Radiology

VII. 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

VIII. Complications

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Ontology: Breech Presentation (C0006157)

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 コツバンイ, 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
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
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