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Breech presentation
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
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.
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] Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. [2] Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New York: McGraw-Hill Professional; 2002. 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
Other diagnostic factors
- subcostal tenderness
- pelvic or bladder pain
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
Diagnostic tests
1st tests to order.
- transabdominal/transvaginal ultrasound
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, natasha nassar, phd.
Associate Professor
Menzies Centre for Health Policy
Sydney School of Public Health
University of Sydney
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
CLR declares that she has no competing interests.
Jonathan Morris, MBChB, FRANZCOG, PhD
Professor of Obstetrics and Gynaecology and Head of Department
JM declares that he has no competing interests.
Peer reviewers
John w. bachman, md.
Consultant in Family Medicine
Department of Family Medicine
Mayo Clinic
JWB declares that he has no competing interests.
Rhona Hughes, MBChB
Lead Obstetrician
Lothian Simpson Centre for Reproductive Health
The Royal Infirmary
RH declares that she has no competing interests.
Brian Peat, MD
Director of Obstetrics
Women's and Children's Hospital
North Adelaide
South Australia
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
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
JH is an author of a number of references cited in this topic.
Differentials
- Transverse lie
- Caesarean birth
- Mode of term singleton breech delivery
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