Breech presentation

Definition

• Longitudinal lie in which the buttocks or lower extremities enter the maternal pelvis first.

Classification

Types

• Frank breech, complete breech, complete and incomplete footling, knee presentation.
• Favourable for vaginal breech birth: frank breech, normal estimated weight, adequate pelvis, multiparity, an experienced team.

• Frank breech with flexed hips and extended legs, complete breech with flexed hips and knees, and incomplete forms with at least one extended hip, including single and double footling breech, are distinguished.

Occurrence & epidemiology

Epidemiology

• Breech presentation is the commonest malpresentation and affects 3 to 4% of births.

Aetiopathogenesis

Aetiology and risk factors

• Predisposing factors are preterm labour, multiple pregnancy, uterine anomalies and fetal anomalies; abnormal lie or presentation in general also occurs with fetopelvic disproportion and structural uterine changes such as fibroids or synechiae.

Clinical features

More facts from the study questions

• This statement is correct — you were looking for the error.
• The Mauriceau-Smellie-Veit manoeuvre is used for the aftercoming head.
• The numbers were swapped here (36 vs. 63).
• However, the neurological outcome at five years is the same.

Complications

• The presenting breech is a poor dilating wedge; the cervix may remain incompletely dilated so that the larger after-coming head becomes trapped and compresses the umbilical cord, which can cause fetal hypoxaemia.
• With vaginal birth the risk of cord prolapse, birth trauma and perinatal death increases.

Diagnosis

• Whenever a malpresentation is suspected, the diagnosis is confirmed by ultrasound.

Keep learning in the app

Further reading (selection)

1. StatPearls: Breech Presentation (NCBI Bookshelf)
2. StatPearls: Leopold Maneuvers (NCBI Bookshelf)
3. MSD Manual Professional Edition: Fetal Presentation, Position, and Lie (Including Breech Presentation)
4. DocCheck Flexikon, Beckenendlage

Cross-references