Breech Presentation

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Background Information

Breech presentation:  buttocks or feet are presented

Types:
 
Type Description
Frank breech Buttocks presenting (flexed hips + extended knees)
Complete breech Buttocks presenting (flexed hips + flexed knes)
Single (incomplete) footling breech 1 foot presenting (one legs fully flexed + one leg fully extended)
Double (complete) footling breech 2 feet presenting (both legs fully extended)
 

Guidelines

ALL women should be offered abdominal palpation after 36 weeks to identify possible breech presentation.
  • If breech suspected → confirm with ultrasound

  

Breech presentation suspected / identified before 36 weeks is of limited significance. The fetus is likely to spontaneously revert to cepahlic presentation before 36 weeks.

NICE recommends if breech presentation is confirmed after 36 weeks → discuss the following options:
  • External cephalic version (ECV) (followed by vaginal birth, if successful)
  • Vaginal breech birth - generally not recommended
  • Elective caesarean delivery

If the women prefers vaginal delivery → offer an attempt of ECV

RCOG recommends that women with a breech presentation at term should be offered ECV unless there is an absolute contraindication.

RCOG advises that there are no consensus contraindications but outlined the following:

  • Presence of indications for caesarean delivery
  • Multiple pregnancy (except after delivery of a first twin)
  • Rhesus isoimunisation
  • Vaginal bleeding within 1 week
  • Ruptured membrane 
  • Abnormal CTG
  • Caution if oligohydramnios / hypertension 
 

Description: external manipulation (through maternal abdomen) of fetus into the cephalic presentation

Offer at:
  • Nulliparous → 36 weeks 
  • Multiparous → 37 weeks

Tocolysis with betamimetics (e.g. terbutaline, salbutamol, ritodrine) is recommended by RCOG to improve the success rate of ECV.

Points outlined by RCOG:
  • ~ 50% success rate 
  • After an unsuccessful ECV attempt at 36 weeks, it is unlikely the baby will spontaneously return to cephalic presentation
 
  • Advise women that most people tolerate but it can be a painful procedure
  • Slightly increased rate of caesarean section and instrumental delivery
    • But if ECV is successful, it reduces the chance of caesarean section
Author: Adams Lau
Reviewer:
Last edited: 12/04/25