Breech presentation occurs in 3-4% of deliveries, with associated increased perinatal mortality linked to specific risk factors like prematurity and fetal abnormalities. The document outlines types of breeches and discusses external cephalic version (ECV) as a procedural option for improving outcomes, while highlighting associated risks and contraindications. It also details the types of vaginal breech deliveries and their potential complications.

1. DR. RAZAQ O. MASHA, FRCOG
Consultant, Ob/Gyn Dept.

2. Breech presentation occurs in 3-4% of
all deliveries. The percentage of
breech deliveries decreases with
advancing gestational age from 25% of
births prior to 28 weeks gestation to 7%
of births at 32 weeks gestation to 1-3%
of births at term

3. PREDISPOSING FACTORS
 Prematurity
 Uterine malformations or fibroids
 Placenta praevia
 Fetal abnormalities, (e.g. CNS
malformations, neck masses)
 Multiple gestations
Fetal abnormalities are observed in 17% of preterm
breech deliveries and 9% of term breech deliveries.
Perinatal Mortality is increased 2-4 fold with breech
presentation, regardless of the mode of delivery.
Deaths are most often associated with malformations,
prematurity and intrauterine fetal demise.

4. TYPES OF BREECHES:
 Frank breech (50-70%) – Hips flexed,
knees extended
 Complete breech (5-10%) – Hips
flexed, knees flexed
 Footling or incomplete (10-30%) One
or both hips extended, foot presenting

5. EXTERNAL CEPHALIC VERSION (ECV)
This is the trans-abdominal manual rotation of
the fetus into a cephalic presentation.
 Improved outcome may be related to the
use of non stress tests both before and
after ECV
 Improved selection of low-risk fetuses
 Rh immune globulin to prevent
isoimmunization

6. PROCEDURE:
 Prepare for the possibility of
caesarean delivery.
 Perform a non-stress test – to
confirm fetal well being.
 Perform the ECV, in or near a
delivery suite
 After ECV, repeat the non-stress
test.
 Administer Rh immune globulin to
women who are Rh- negative

7. RISKS:
 Precipitation of labour or premature
rupture of membranes
 Abruptio placentae
 Feto-maternal haemorrhage
 Cord entanglement
 Fractured fetal bones

8. CONTRAINDICATIONS:
 Multiple gestations
 Contra indications to vaginal
delivery (e.g. herpes simplex virus
infection, placenta praevia)
 Non reassuring fetal heart rate
tracing

9. VAGINAL BREECH DELIVERY
The three types of vaginal breech deliveries
are described:
 Spontaneous breech delivery. No
traction or manipulation of the infant is
used. This occurs predominantly in very
preterm deliveries.
 Assisted breech delivery: The most
common type of vaginal breech delivery.
 Total breech extraction. Use for a non
cephalic second twin and caesarean
deliveries

10. RISKS:
♣ Lower apgar scores
♣ Fetal head entrapment
♣ Cervical spine injury
♣ Cord prolapse