Introduction
In breech presentation the fetal buttocks or feet present. It occurs in about 20% at 28 weeks but only 3–4% at term, because most fetuses turn.
Types
Causes
Preterm birth (most common), uterine anomalies and fibroids, placenta praevia, poly- or oligohydramnios, multiple pregnancy, fetal anomalies (hydrocephalus, anencephaly, neuromuscular disease), short cord. Often no cause is found.
Diagnosis
Hard round head in the fundus, fetal heart above the umbilicus; on vaginal examination the soft buttocks, anus and sacrum (or feet). Confirm by ultrasound.
Management at term
- External cephalic version (ECV) from 36–37 weeks: about 50% success; under tocolysis and CTG monitoring; anti-D if RhD-negative. Contraindications: placenta praevia, recent bleeding, ruptured membranes, abnormal CTG, multiple pregnancy (except the second twin), when caesarean is needed anyway.
- If the breech persists: planned caesarean section is generally preferred (Term Breech Trial), but vaginal breech birth is an option for selected women with an experienced attendant: frank or complete breech, estimated weight 2.5–3.8 kg, flexed head, adequate pelvis, no other complications.