U.S. flag

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

Cover of StatPearls

StatPearls [Internet].

Breech presentation.

Caron J. Gray ; Meaghan M. Shanahan .

Affiliations

Last Update: November 6, 2022 .

  • Continuing Education Activity

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

  • Describe the pathophysiology of breech presentation.
  • Review the physical exam of a patient with a breech presentation.
  • Summarize the treatment options for breech presentation.
  • Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.
  • Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation.  Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

  • Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 28 weeks or less, 25% are breech.

Specifically, following one breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Prior cesarean delivery has also been described by some to increase the incidence of breech presentation two-fold.

  • Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in the breech presentation are those that affect fetal motility or the vertical polarity of the uterine cavity. [6] [7]

Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

  • Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus 
  • Placentation: Placenta previa as the placenta is occupying the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
  • Uterine leiomyoma: Mainly larger myomas located in the lower uterine segment, often intramural or submucosal, that prevent engagement of the presenting part.
  • Prematurity
  • Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
  • Congenital anomalies:  Fetal sacrococcygeal teratoma, fetal thyroid goiter
  • Polyhydramnios: Fetus is often in unstable lie, unable to engage
  • Oligohydramnios: Fetus is unable to turn to vertex due to lack of fluid
  • Laxity of the maternal abdominal wall: Uterus falls forward, the fetus is unable to engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, while complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

  • History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex.

Any of these findings should raise suspicion and ultrasound should be performed.

Diagnosis of a breech presentation can be accomplished through abdominal exam using the Leopold maneuvers in combination with the cervical exam. Ultrasound should confirm the diagnosis.

On ultrasound, the fetal lie and presenting part should be visualized and documented. If breech presentation is diagnosed, specific information including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously) should be documented.

  • Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000 compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, there was no significant difference in maternal morbidity or mortality between the two groups. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at two years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors since have argued that there are still some specific situations that vaginal breech delivery is a potential, safe alternative to planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these specific criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by one report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age will determine the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note, due to lack of recruitment, no prospective clinical trials are examining this issue.

  • Differential Diagnosis
  • Face and brow presentation
  • Fetal anomalies
  • Fetal death
  • Grand multiparity
  • Multiple pregnancies
  • Oligohydramnios
  • Pelvis Anatomy
  • Preterm labor
  • Primigravida
  • Uterine anomalies
  • Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

  • Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor and delivery nurse, anesthesiologist and a neonatologist. The ultimate decison rests on the obstetrician. To prevent complications, today cesarean sections are performed and experienced with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

  • Review Questions
  • Access free multiple choice questions on this topic.
  • Comment on this article.

Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

  • Cite this Page Gray CJ, Shanahan MM. Breech Presentation. [Updated 2022 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

In this Page

Bulk download.

  • Bulk download StatPearls data from FTP

Related information

  • PMC PubMed Central citations
  • PubMed Links to PubMed

Similar articles in PubMed

  • [What effect does leg position in breech presentation have on mode of delivery and early neonatal morbidity?]. [Z Geburtshilfe Neonatol. 1997] [What effect does leg position in breech presentation have on mode of delivery and early neonatal morbidity?]. Krause M, Fischer T, Feige A. Z Geburtshilfe Neonatol. 1997 Jul-Aug; 201(4):128-35.
  • The effect of intra-uterine breech position on postnatal motor functions of the lower limbs. [Early Hum Dev. 1993] The effect of intra-uterine breech position on postnatal motor functions of the lower limbs. Sival DA, Prechtl HF, Sonder GH, Touwen BC. Early Hum Dev. 1993 Mar; 32(2-3):161-76.
  • The influence of the fetal leg position on the outcome in vaginally intended deliveries out of breech presentation at term - A FRABAT prospective cohort study. [PLoS One. 2019] The influence of the fetal leg position on the outcome in vaginally intended deliveries out of breech presentation at term - A FRABAT prospective cohort study. Jennewein L, Allert R, Möllmann CJ, Paul B, Kielland-Kaisen U, Raimann FJ, Brüggmann D, Louwen F. PLoS One. 2019; 14(12):e0225546. Epub 2019 Dec 2.
  • Review Breech vaginal delivery at or near term. [Semin Perinatol. 2003] Review Breech vaginal delivery at or near term. Tunde-Byass MO, Hannah ME. Semin Perinatol. 2003 Feb; 27(1):34-45.
  • Review [Breech Presentation: CNGOF Guidelines for Clinical Practice - Epidemiology, Risk Factors and Complications]. [Gynecol Obstet Fertil Senol. 2...] Review [Breech Presentation: CNGOF Guidelines for Clinical Practice - Epidemiology, Risk Factors and Complications]. Mattuizzi A. Gynecol Obstet Fertil Senol. 2020 Jan; 48(1):70-80. Epub 2019 Nov 1.

Recent Activity

  • Breech Presentation - StatPearls Breech Presentation - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

statistics

Select a Community

  • MB 1 Preclinical Medical Students
  • MB 2/3 Clinical Medical Students
  • ORTHO Orthopaedic Surgery

Are you sure you want to trigger topic in your Anconeus AI algorithm?

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Breech Presentation

https://upload.medbullets.com/topic/120379/images/breech_ultrasound.jpg

  • A 28-year-old G1P0 woman at 37 weeks of gestation presents to her obstetrician for a prenatal care appointment. She describes feeling some soreness under her ribs in the past few weeks and feels her baby kicking in her lower abdomen. An ultrasound is performed and is seen in the image. The obstetrician describes management approaches, including an external cephalic version before labor.
  • flexion of the hips and knees
  • some deflexion of one hip and knee
  • flexion of both hips with extension of both knees
  • 3-4% of all deliveries
  • 22-25% of births before 28 weeks of gestation
  • 7-15% of births at 32 weeks of gestation
  • 3-4% of births at term
  • prematurity
  • uterine malformations
  • uterine fibroids
  • polyhydramnios
  • placenta previa
  • multiple gestations
  • subcostal discomfort (due to fetal head in the uterine fundus)
  • feeling of kicking in the lower abdomen
  • presence of soft mass (buttocks) and absence of hard fetal skull on transabdominal examination of the lower uterine segment
  • when cervix is dilated
  • detection of breech presentation prior to 37 weeks does not warrant intervention
  • fetal head in the uterine fundus
  • buttocks in the lower uterine segment
  • extension angle > 90 degrees
  • at 37 weeks gestation or later
  • perform trial of vaginal delivery if the version is successful
  • may be planned for breech presentation, without a trial of external cephalic version
  • may be performed if trial of vaginal delivery is unsuccessful after external cephalic labor
  • ↑ up to 4-fold with breech presetnation
  • associated with malformations, prematurity, and intrauterine fetal demise
  • 17% of preterm breech deliveries
  • 9% of term breech deliveries
  • abnormalities include CNS malformations, neck masses, and aneuploidy
  • - Breech Presentation

Please Login to add comment

 alt=

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

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 investigations

1st investigations 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

Use of this content is subject to our disclaimer

Help us improve BMJ Best Practice

Please complete all fields.

I have some feedback on:

We will respond to all feedback.

For any urgent enquiries please contact our customer services team who are ready to help with any problems.

Phone: +44 (0) 207 111 1105

Email: [email protected]

Your feedback has been submitted successfully.

breech presentation ka matlab

SlidePlayer

  • My presentations

Auth with social network:

Download presentation

We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!

Presentation is loading. Please wait.

Breech presentation By Dr. Khattab KAEO Prof & Head of Obstetrics and Gynaecology Department Faculty of Medicine, Al-Azhar University, Damietta.

Published by Rosamund Harrison Modified over 8 years ago

Similar presentations

Presentation on theme: "Breech presentation By Dr. Khattab KAEO Prof & Head of Obstetrics and Gynaecology Department Faculty of Medicine, Al-Azhar University, Damietta."— Presentation transcript:

breech presentation ka matlab

Malposition of the fetal head By dr. sallama kamel

breech presentation ka matlab

The mechanism of normal labour By Dr. sallama kamel

breech presentation ka matlab

Fetal Malpresentation

breech presentation ka matlab

Antenatal care X iu Xiu Jiang. Terms Fetal lie Fetal lie the relationship of the long axis of the fetus to that of the mother. the relationship of the.

breech presentation ka matlab

MALPRESENTATION &MALPOSITION.

breech presentation ka matlab

Leopold’s - Abdominal Palpation for Fetal Position

breech presentation ka matlab

Breech Management By Dr. Khattab KAEO Prof & Head of Obstetrics and Gynaecology Department Faculty of Medicine, Al-Azhar University, Damietta.

breech presentation ka matlab

FACE PRESENTATION DIGNOSTIC LANDMARKS-EYES,NOSE MOUTH AND CHIN POSITION-MENTO ANTERIOR/POSTERIOR,MENTO TRANSVERSE MANAGEMENT GUIDELINES-FETUS IS DEAD OR.

breech presentation ka matlab

Malpresentation Dr. Abdalla H. Elsadig MD. Definitions Presentation: Presentation: Is the lowermost part of the fetus occupying the lower uterine segment.

breech presentation ka matlab

Malpresentaton and Breech presentation. Definitions Position The relationship of a defined area on the presenting part to the mother’s pelvis (Denominator)

breech presentation ka matlab

BREECH DELIVERY Deepa Mishra M. Sc. Nursing (OBG).

breech presentation ka matlab

Antenatal Check Up: Abdominal Examination

breech presentation ka matlab

MECHANISM OF LABOUR Lateefa Al Dakhyel FRCSC, FACOG Assistant professor & consultant Obstetric & gynecology department Collage of medicine King Saud University.

breech presentation ka matlab

Dr. Udin Sabarudin Department of Obstetrics & Gynecology Medicine School of Padjadjaran University Bandung MECHANISM OF LABOR IN BREECH PRESENTATION.

breech presentation ka matlab

Abdominal Palpation for Fetal Position

breech presentation ka matlab

Presentation and prolapse of the umbilical cord

breech presentation ka matlab

Examination of the obstetric patient

breech presentation ka matlab

DR. HAZEM AL-MANDEEL OB/GYN ROTATION-COURSE 481 Multiple Pregnancy.

breech presentation ka matlab

Dr. ROZHAN YASSIN KHALIL FICOG,CABOG, HDOG, MBChB 2011.

breech presentation ka matlab

بسم الله الرحمن الرحيم Breech presentation. Incidence -Incidence of breech presentations at term is 3- 4%. -The incidence falls with gestational age,

About project

© 2024 SlidePlayer.com Inc. All rights reserved.

imj_logo

Breech presentation – An overview

  • Umoiyoho AJ

Introduction Breech presentation is a form of mal-presentation in which the fetal buttocks or lower extremities occupy or is in direct relationship with the maternal pelvic inlet. It is the commonest form of mal-presentation of the fetus. Its incidence decreases with advancing age from 25% at 28 Weeks, through 15% at 32 Weeks to 2-4% at term[1-3].

It accounts for 3-4% of infants born at term or at least 20,000 babies per year in the United Kingdom[3-5].  It is commoner in preterm babies and may be associated with both fetal and maternal anomalies. There has been intense debate about the safest mode of delivery for breech babies[5,6]. Depending on the attitude of the fetus, breech presentation has been classified as: (a) Frank or Extended breech presentation when the fetal hips are flexed and the knees extended. It is also called 'pike'. This accounts for 50-70% of breech presentations and is commoner in Primigravidae; (b) Complete or Flexed breech presentation when both the hips and the knees are flexed. It is also described as 'cannon ball' and accounts for 5-10% of breech presentations. It is commoner in Multiparous women. (c) Footling or Incomplete breech presentation when one or both hips are extended. Here the foot (or feet) lies below the fetal buttock and either it or the knee(s) may be presenting[3,5,7].

breech presentation ka matlab

Additional Files

  • Review Articles

Copyright (c) 2007 Umoh AV, Abah MG, Umoiyoho AJ

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License .

Most read articles by the same author(s)

  • Abah MG, Edu EB, Abah IG, Motilewa OO, Prevalence and determinants of foetal outcome among teenagers delivered in a tertiary health facility in South-South Nigeria , Ibom Medical Journal: Vol. 15 No. 1 (2022)
  • Abah IG, Nwafor NN, Abah MG, Ben I, Heterotopic pregnancy in natural conception – A case report , Ibom Medical Journal: Vol. 15 No. 1 (2022)
  • Ekwere ME, Bandele EO, Peters GE, Umoh AV, Peters EJ, The health impact and lung function indices of adult residents of Ibeno Community exposed to gas flaring in south-south Nigeria , Ibom Medical Journal: Vol. 14 No. 4 (2021)
  • Umoh AV, Umoiyoho AJ, Abasiattai AM, Bassey EA, James SR, Gestational age at first antenatal visit in Uyo, Nigeria , Ibom Medical Journal: Vol. 1 No. 1 (2006)
  • Inyang-Etoh EC, Umoiyoho AJ, Abasiattai AM, Reasons for delay to perform emergency caesarean section among parturients in a tertiary health care facility in south-south Nigeria , Ibom Medical Journal: Vol. 6 No. 2 (2013)
  • Idung AU, Umoh AV, Lifestyle diseases: A review , Ibom Medical Journal: Vol. 5 No. 1 (2012)
  • Inyang-Etoh EC, Umoiyoho AJ, Quality of life of women awaiting vesicovaginal fistula repair in Uyo, Akwa Ibom State, Nigeria , Ibom Medical Journal: Vol. 5 No. 1 (2012)

ISSN: 1597-7188 [Print]

eISSN: 2735-9964 [Online]

Indexed bodies

ibom medical journal indexed bodies

Current Issue

Information.

  • For Readers
  • For Authors
  • For Librarians

More information about the publishing system, Platform and Workflow by OJS/PKP.

Breech Presentation

Caron J. Gray ; Meaghan M. Shanahan .

Affiliations

Last Update: November 6, 2022 .

Continuing Education Activity

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. This activity reviews the cause and pathophysiology of breech presentation and highlights the role of the interprofessional team in its management.

Objectives:

  • Describe the pathophysiology of breech presentation.
  • Review the physical exam of a patient with a breech presentation.
  • Summarize the treatment options for breech presentation.
  • Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by breech presentation.

Introduction

Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete breech can have any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended). [1] [2] [3]

Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation.  Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies. [4] [5] These are discussed in more detail in the pathophysiology section.

Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are breech, and 28 weeks or less, 25% are breech.

Specifically, following one breech delivery, the recurrence rate for the second pregnancy was nearly 10%, and for a subsequent third pregnancy, it was 27%. Prior cesarean delivery has also been described by some to increase the incidence of breech presentation two-fold.

Pathophysiology

As mentioned previously, the most common clinical conditions or disease processes that result in the breech presentation are those that affect fetal motility or the vertical polarity of the uterine cavity. [6] [7]

Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the fetus to turn into the vertex presentation in the third trimester include:

  • Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus 
  • Placentation: Placenta previa as the placenta is occupying the inferior portion of the uterine cavity. Therefore, the presenting part cannot engage
  • Uterine leiomyoma: Mainly larger myomas located in the lower uterine segment, often intramural or submucosal, that prevent engagement of the presenting part.
  • Prematurity
  • Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus, inability to move effectively
  • Congenital anomalies:  Fetal sacrococcygeal teratoma, fetal thyroid goiter
  • Polyhydramnios: Fetus is often in unstable lie, unable to engage
  • Oligohydramnios: Fetus is unable to turn to vertex due to lack of fluid
  • Laxity of the maternal abdominal wall: Uterus falls forward, the fetus is unable to engage in the pelvis.

The risk of cord prolapse varies depending on the type of breech. Incomplete or footling breech carries the highest risk of cord prolapse at 15% to 18%, while complete breech is lower at 4% to 6%, and frank breech is uncommon at 0.5%.

History and Physical

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a breech presentation.

During a cervical exam, findings may include the lack of a palpable presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech, palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring, caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal vertex.

Any of these findings should raise suspicion and ultrasound should be performed.

Diagnosis of a breech presentation can be accomplished through abdominal exam using the Leopold maneuvers in combination with the cervical exam. Ultrasound should confirm the diagnosis.

On ultrasound, the fetal lie and presenting part should be visualized and documented. If breech presentation is diagnosed, specific information including the specific type of breech, the degree of flexion of the fetal head, estimated fetal weight, amniotic fluid volume, placental location, and fetal anatomy review (if not already done previously) should be documented.

Treatment / Management

Expertise in the delivery of the vaginal breech baby is becoming less common due to fewer vaginal breech deliveries being offered throughout the United States and in most industrialized countries. The Term Breech Trial (TBT), a well-designed, multicenter, international, randomized controlled trial published in 2000 compared planned vaginal delivery to planned cesarean delivery for the term breech infant. The investigators reported that delivery by planned cesarean resulted in significantly lower perinatal mortality, neonatal mortality, and serious neonatal morbidity. Also, there was no significant difference in maternal morbidity or mortality between the two groups. Since that time, the rate of term breech infants delivered by planned cesarean has increased dramatically. Follow-up studies to the TBT have been published looking at maternal morbidity and outcomes of the children at two years. Although these reports did not show any significant difference in the risk of death and neurodevelopmental, these studies were felt to be underpowered. [8] [9] [10] [11]

Since the TBT, many authors since have argued that there are still some specific situations that vaginal breech delivery is a potential, safe alternative to planned cesarean. Many smaller retrospective studies have reported no difference in neonatal morbidity or mortality using these specific criteria.

The initial criteria used in these reports were similar: gestational age greater than 37 weeks, frank or complete breech presentation, no fetal anomalies on ultrasound examination, adequate maternal pelvis, and estimated fetal weight between 2500 g and 4000 g. In addition, the protocol presented by one report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket. Oxytocin induction or augmentation was not offered, and strict criteria were established for normal labor progress. CT pelvimetry did determine an adequate maternal pelvis.

Despite debate on both sides, the current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned cesarean section for delivery sometime after 39 weeks.

Regarding the premature breech, gestational age will determine the mode of delivery. Before 26 weeks, there is a lack of quality clinical evidence to guide mode of delivery. One large retrospective cohort study recently concluded that from 28 to 31 6/7 weeks, there is a significant decrease in perinatal morbidity and mortality in a planned cesarean delivery versus intended vaginal delivery, while there is no difference in perinatal morbidity and mortality in gestational age 32 to 36 weeks. Of note, due to lack of recruitment, no prospective clinical trials are examining this issue.

Differential Diagnosis

  • Face and brow presentation
  • Fetal anomalies
  • Fetal death
  • Grand multiparity
  • Multiple pregnancies
  • Oligohydramnios
  • Pelvis Anatomy
  • Preterm labor
  • Primigravida
  • Uterine anomalies

Pearls and Other Issues

In light of the decrease in planned vaginal breech deliveries, thus the decrease in expertise in managing this clinical scenario, it is prudent that policies requiring simulation and instruction in the delivery technique for vaginal breech birth are established to care for the emergency breech vaginal delivery.

Enhancing Healthcare Team Outcomes

A breech delivery is usually managed by an obstetrician, labor and delivery nurse, anesthesiologist and a neonatologist. The ultimate decison rests on the obstetrician. To prevent complications, today cesarean sections are performed and experienced with vaginal deliveries of breech presentation is limited. For healthcare workers including the midwife who has no experience with a breech delivery, it is vital to communicate with an obstetrician, otherwise one risks litigation if complications arise during delivery. [12] [13] [14]

Review Questions

  • Access free multiple choice questions on this topic.
  • Comment on this article.

Disclosure: Caron Gray declares no relevant financial relationships with ineligible companies.

Disclosure: Meaghan Shanahan declares no relevant financial relationships with ineligible companies.

Help Center Help Center

  • Help Center
  • Trial Software
  • Product Updates
  • Documentation
  • Report Components

Create Complete PowerPoint Presentations

You can create a complete PowerPoint presentation with the PPT API. Creating a complete presentation programmatically allow you to use different templates for the same content. To get started, see Create a Presentation Programmatically .

Examples and How To

Use the MATLAB API for PowerPoint (PPT API) to generate a presentation.

Create a MATLAB ® program to generate a PowerPoint presentation.

A PowerPoint template specifies the fixed content and default layout and appearance of the slides in a presentation.

To add a slide to a presentation, use the PPT API to add slide based on a slide layout defined in the PowerPoint presentation template.

To use the PPT API to add, or replace, content in a PowerPoint presentation:

You can create a Text object using an mlreportgen.ppt.Text constructor, specifying a character vector.

To create a Paragraph object, use the mlreportgen.ppt.Paragraph constructor.

Create a table using an mlreportgen.ppt.Table object.

To create a picture for a presentation, use the mlreportgen.ppt.Picture constructor.

In a presentation, you can create an internal link, from one slide to another slide, or an external link to a location outside of the presentation.

You can use the PPT API to update content programmatically in an existing PowerPoint presentation.

Format a presentation by using style sheets, format objects, or format properties.

Featured Examples

Generate a Presentation From the Results of a MATLAB Application

Generate a Presentation From the Results of a MATLAB Application

Use the PPT API to generate a PowerPoint presentation about modeling the U.S. population.

MATLAB Command

You clicked a link that corresponds to this MATLAB command:

Run the command by entering it in the MATLAB Command Window. Web browsers do not support MATLAB commands.

Select a Web Site

Choose a web site to get translated content where available and see local events and offers. Based on your location, we recommend that you select: .

  • Switzerland (English)
  • Switzerland (Deutsch)
  • Switzerland (Français)
  • 中国 (English)

You can also select a web site from the following list:

How to Get Best Site Performance

Select the China site (in Chinese or English) for best site performance. Other MathWorks country sites are not optimized for visits from your location.

  • América Latina (Español)
  • Canada (English)
  • United States (English)
  • Belgium (English)
  • Denmark (English)
  • Deutschland (Deutsch)
  • España (Español)
  • Finland (English)
  • France (Français)
  • Ireland (English)
  • Italia (Italiano)
  • Luxembourg (English)
  • Netherlands (English)
  • Norway (English)
  • Österreich (Deutsch)
  • Portugal (English)
  • Sweden (English)
  • United Kingdom (English)

Asia Pacific

  • Australia (English)
  • India (English)
  • New Zealand (English)

Contact your local office

IMAGES

  1. types of breech presentation ultrasound

    breech presentation ka matlab

  2. Breech Presentation

    breech presentation ka matlab

  3. Breech Presentation and Turning a Breech Baby in the Womb (External

    breech presentation ka matlab

  4. Breech Baby

    breech presentation ka matlab

  5. Breech Presentation

    breech presentation ka matlab

  6. Breech Presentation Causes Mnemonic

    breech presentation ka matlab

VIDEO

  1. 4 Pregnancy things to take care (Personal Experience)! #viral 🤰 #pregnancycare #pregnancy #youtube

  2. Breech Presentation

  3. AMITY UNIVERSITY KE BACHHE😅

  4. Breech presentation

  5. breech presentation #cow#calf#viral

  6. MiddleCorn's BrawlEx Hack Pack (The Beta)

COMMENTS

  1. Overview of breech presentation

    The main types of breech presentation are: Frank breech - Both hips are flexed and both knees are extended so that the feet are adjacent to the head ( figure 1 ); accounts for 50 to 70 percent of breech fetuses at term. Complete breech - Both hips and both knees are flexed ( figure 2 ); accounts for 5 to 10 percent of breech fetuses at term.

  2. Breech Presentation

    The incidence of breech presentation is approximately 20% at 28 weeks gestation, 16% at 32 weeks gestation and 3-4% at term. Therefore, breech presentation is more common in preterm labour. Most fetuses with breech presentation in the early third trimester will turn spontaneously and be cephalic at term.

  3. Breech presentation management: A critical review of leading clinical

    No. 384 — management of breech presentation at term [2019] The Society of Obstetricians and Gynaecologists of Canada (SOGC) Canada: GRADE methodology framework: 1: 12/14 (85.7) 82: Y: National Clinical Guideline: the management of breech presentation [2017] Institute of Obstetrician and Gynaecologists, Royal College of Physicians of Ireland ...

  4. Management of breech presentation

    Introduction. Breech presentation of the fetus in late pregnancy may result in prolonged or obstructed labour with resulting risks to both woman and fetus. Interventions to correct breech presentation (to cephalic) before labour and birth are important for the woman's and the baby's health. The aim of this review is to determine the most ...

  5. Breech Presentation

    Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face, in a pike position. The complete breech has the ...

  6. PDF Management of breech presentation

    The most widely quoted study regarding the management of breech presentation at term is the 'Term Breech Trial'. Published in 2000, this large, international multicenter randomised clinical trial compared a policy of planned vaginal delivery with planned caesarean section for selected breech presentations.

  7. Breech Presentation

    Breech Presentation. A 28-year-old G1P0 woman at 37 weeks of gestation presents to her obstetrician for a prenatal care appointment. She describes feeling some soreness under her ribs in the past few weeks and feels her baby kicking in her lower abdomen. An ultrasound is performed and is seen in the image.

  8. Breech presentation- Meaning in Hindi

    Breech presentation ka hindi mein matalab, arth aur prayog. Tags for the word Breech presentation: Hindi meaning of Breech presentation, What Breech presentation means in hindi, Breech presentation meaning in hindi, hindi mein Breech presentation ka matlab, pronunciation, example sentences of Breech presentation in Hindi language.

  9. Types of breech presentations

    Types of breech presentations. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) — dedicated to using leading-edge science to save and improve lives around the world. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge.

  10. PDF Management of breech presentation

    Breech presentation can be seen in 3-4% of all term pregnancies. Fetuses that present in breech, both frank and complete, are at increased risk of trauma and hypoxia during delivery. The results from the term breech trial had led to an increase in the number of cesarean sections, but stull the best mode of delivery remains controversial.

  11. Management of Breech Presentation

    Observational, usually retrospective, series have consistently favoured elective caesarean birth over vaginal breech delivery. A meta-analysis of 27 studies examining term breech birth, 5 which included 258 953 births between 1993 and 2014, suggested that elective caesarean section was associated with a two- to five-fold reduction in perinatal mortality when compared with vaginal breech ...

  12. Breech Presentation

    Summary. This chapter presents an easy-to-follow algorithm for obstetric management of the risks associated with breech presentation. The diagnosis of breech presentation can be made by physical examination vaginal examination or ultrasound. Ultrasound will also determine the type of breech: frank, complete or incomplete/footling breech.

  13. Breech presentation

    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.

  14. Breech Presentation: Overview, Vaginal Breech Delivery ...

    Overview. Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of ...

  15. Breech presentation By Dr. Khattab KAEO Prof & Head of Obstetrics and

    10 Differential diagnosis: Frank breech is to be differentiated from vertex during abdom exam, because the extended legs may prevent ballottement of the head & the small breech may be mistaken for the head. On PV exam, it should be differentiated from face as the anus may be mistaken for the mouth. However, the anus reflexly grips on the examin. finger & we can recognise the sacral spines.

  16. Breech presentation management: A critical review of leading clinical

    1. Background. The management of breech presentation continues to cause academic and clinical contention globally [[1], [2], [3]].In recent years, research has shown that if certain criteria are met, and appropriately experienced and skilled clinicians are available, Vaginal Breech Birth (VBB) is a safe option [[4], [5], [6]].However, with Caesarean Section (C/S) rates for breech presentation ...

  17. Breech presentation

    Breech presentation is a form of mal-presentation in which the fetal buttocks or lower extremities occupy or is in direct relationship with the maternal pelvic inlet. It is the commonest form of mal-presentation of the fetus. Its incidence decreases with advancing age from 25% at 28 Weeks, through 15% at 32 Weeks to 2-4% at term [1-3].

  18. Breech progression angle: new feasible and reliable transperineal

    INTRODUCTION. Breech presentation occurs in about 4% of pregnancies at term and is more frequent in nulliparous women and in preterm deliveries 1-3.The Term Breech Trial (TBT) evaluated the labor outcome of fetuses in breech presentation and demonstrated a lower incidence of perinatal morbidity and mortality among women who delivered by Cesarean section compared with in those who delivered ...

  19. Breech presentation: its predictors and consequences. An analysis of

    Introduction. The prevalence of pregnancies with breech presentation is surprisingly similar globally, involving 3-4% of fetuses by the time of labor 1-4.There is some uncertainty regarding the exact etiology of breech presentation, although several risk factors are well described in the literature, such as older maternal age, primiparity, lower fetal weight, lower gestational age at ...

  20. Breech Presentation

    Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first. The three types of breech presentation include frank breech, complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and the legs are straight with the feet near the fetal face ...

  21. breech presentation

    Neonatal birth injuries. …Abnormal fetal presentation - Fetal presentation other than a vertex position, particularly breech presentation, is associated with an increase in the risk of birth injury with vaginal delivery. Delivery …. Face and brow presentations in labor. …value for predicting the outcome of labor .

  22. Breech: Types, Risk Factors, Treatment, Complications

    At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.

  23. Create Complete PowerPoint Presentations

    Create a MATLAB ® program to generate a PowerPoint presentation. A PowerPoint template specifies the fixed content and default layout and appearance of the slides in a presentation. To add a slide to a presentation, use the PPT API to add slide based on a slide layout defined in the PowerPoint presentation template.