This document discusses breech presentation, which occurs when the fetus is in a longitudinal lie with the buttocks or feet presenting at the pelvic brim instead of the head. The incidence is about 3-4% and spontaneous correction usually occurs by 34 weeks. Breech presentations are classified as complete or incomplete. Etiologies include prematurity, factors preventing version, fetal abnormalities, and multiparity. Diagnosis involves clinical examination and sonography to determine type and position of breech.

1. Breech
Presentatio
n
By,
Ashrith K.C.
Shimoga Institute Of
Medical Sciences,
Shimoga, K’taKa, India

2. Definition
The presentation that the
fetus is in longitudinal lie and the
podalic pole presents at pelvic
brim.

3. Incidence
 Thus in 3 out of 4, spontaneous correction into
vertex presentation occurs at 34th week.
 The incidence is low in hospitals where high parity
births are minimal and routine cephalic version is

4. Types of breech

5.  Complete ( Flexed breech )
flexed at hips and flexed at knees.
the presenting part consists of two buttocks,
external genitalia and two feet.
it’s commonly present in multiparae(10%).

6.  Incomplete Breech
due to varying degree of extension of thighs or
legs at podiac pole.
3 varieties possible:
» Frank breech ( breech with extended legs )
» Footling presentation (25%)
» Knee presentation

7. » Frank breech ( breech with
extended legs )
the thighs are flexed on the trunk
and the legs are extended at the knee
joints.
the presenting part consists of
two buttocks and external genitalia only.
commonly present in
primigravidae (70%); due to tight

8. » Footling presentation (25%)
both the thighs and legs are
partially extended bringing legs to
present at brim.

9. » Knee presentation
thighs are extended but knees
are flexed, bringing the knees down to
present at the brim.

10. Clinical Varieties
 Uncomplicated Breech
defined as one where there is no other associated obstetric
complications apart from breech, prematurity being excluded.
 Complicated Breech
when presentation is associated with conditions which
adversely influence prognosis such as prematurity, twins, contracted
pelvis, placental praevia etc.
Extended legs, extended arms, cord prolapse or difficulty during
breech delivery should not be called complicated breech but are
called abnormal or complicated breech delivery.

11. Etiology
 Smaller size of foetus and comparatively larger volume of
amniotic fluid allow the foetus to undergo spontaneous
version by kicking movements until by 36th week when the
position becomes stabilized.
 Known factors responsible for breech presentation:
»Prematurity
»Factors preventing spontaneous version
»Favourable adaptation
»Undue mobility of foetus
»Foetal abnormality

12. » Prematurity: commonest cause of breech
presentation.
» Factors preventing spontaneous version:
a) breech with extended legs
b) Twins
c) Oligohydramnios
d) Congenital malformation of uterus like septate
or bicornuate uterus
e) Short cord; relative or absolute
f) Intrauterine death of foetus

13. » Favourable adaptation:
a) Hydrocephalous; big head can be well
accommodated in wide fundus
b) Placenta praevia
c) Contracted pelvis
d) Cornufundal attachment of placenta; minimizes
the space of fundus where smaller head can be placed
comfortably.
» Undue mobility of foetus:
a) Hydramnios
b) Multiparae with lax abdominal wall

14. » Foetal abnormality:
a) trisomies 13, 18, 21
b) anencephaly
c) myotonic dystrophy due to alteration of foetal muscular
tone and
mobility.
Recurrent Breech:
On occasion the breech presentation recurs in successive
pregnancies. When it recurs in 3 or more consecutive
pregnancies, it’s called Recurrent Breech.
Cause:
» Congenital malformation of uterus; Septate or
bicornuate

15. Diagnosis
» Clinical:
a) Per abdomen
b) Per vaginam
» Sonography:

16. » Clinical diagnosis:

17. » Sonography:
1) It confirms the clinical diagnosis
2) It can detect foetal congenital abnormality
3) Type of breech
4) It measures biparietal diameter, gestational age
and approximate weight of foetus
1) Localises the placenta
2) Assessment of liquor volume (Important for ECV)
3) Attitude of the head

18. Positions:
The sacrum is the denominator of the breech and there are 4
positions.
In anterior positions, the sacrum is directed towards
iliopubic eminence.
In posterior positions the sacrum is directed to sacro-
iliac joint.
The positions are:
(1.) 1st position – Left sacro-anterior (LSA) – being
comonest
(2.) 2nd position – Right sacro-anterior (RSA)

19. Thank you