Malpresentations: Breech


The presentation is said to be Breech when the presenting part at labour is not the head but the buttocks. Breech presentation is the commonest malpresentation. Although 40% of babies are breech at 20 weeks, 25% will be at 32 weeks only 3% are breech at term. It is normal, during pregnancy, for the buttocks of the fetus to come to lie in the fundus of the uterus.

Conditions predisposing towards breech presentation;

  1. contracted pelvis
  2. bicornuate uterus (developmental abnormality)
  3. uterine fibroid
  4. placenta praevia
  5. oligohydramnios (less of liquor around the fetus)

Ultrasound may show the cause and influence the management.

Extended breech presentation is commonest – i.e. flexed at the hips but extended at the knees. Flexed breeches sit with hips and knees both flexed so that the presenting part is a mixture of buttocks, external genitalia and feet.

Footling breeches are the least common. The feet are the presenting part and this type has the greatest risk (5-20%) of cord prolapse.

Diagnose of breech presentation should be made antenatally, both by clinical examination and Ultrasound.

How is Breech presentation Managed?

  1. Manipulation – also known as External cephalic version (ECV) – turning the breech by manoeuvring it through a forward, less commonly backward, somersault. Resorted to only if vaginal delivery is planned. Traditionally carried out at 34-36 weeks.

    2. Success rate ~53%.

    This is not attempted in: placenta praevia, multiple pregnancy, small-for-date babies, in mothers with uterine scars, pre-eclampsia or hypertension or those who have a bad obstetric history.

Mode of delivery - Caesarean section is often advocated on the unproven grounds of safety. Your doctor should discuss all options with you. Breech delivery will be considered if:

  • Experienced obstetrician available.
  • Estimated fetal weight 2500-3500g by ultrasound scan
  • No evidence of growth retardation.
  • Good shape/size of pelvis
  • No placenta praevia
  • Normal volume of liquor.
  • No pre-eclampsia; no fetal distress

If all criteria are met fetal loss may be <1% (possibly much less).

Check baby for hip dislocation (incidence): also if vaginal delivery, for paralysis and signs for Central Nervous System injury.