Breech presentation occurs when the fetus is positioned longitudinally with the buttocks or feet closest to the cervix. This is the most common malpresentation and is more likely to occur earlier in gestation. Predisposing factors include maternal fibroids or uterine anomalies, and fetal abnormalities like anencephaly. Management options include external cephalic version (ECV) to rotate the fetus, vaginal delivery if the breech is extended or flexed, or elective cesarean section. ECV has a higher success rate in multiparous women and is performed after 37 weeks to reduce cesarean delivery. Vaginal breech delivery requires experienced assistance and careful fetal monitoring due to risks of cord pro

1. Breech Presentation
Dr. Ramya Pathiraja
Senior Lecturer
Department of Obstetrics and Gynecology
Faculty of Medical Sciences
University of Sri Jayewardenepura
Sri Lanka

2. In breech presentation fetus lies
longitudinally with the buttocks or feet
closest to the cervix.
This is the most common malpresentation.
More common at earlier gestations.
Perinatal mortality is increased by 2-4 folds
with breech presentation.

3. Three types of breech
1.extended (most common)
2.flexed/complete
3.footling

4. Extended breech
Flexed breech

5. Footling

6. Predisposing factors
-Maternal
Fibroids
Congenital uterine anomalies
Uterine Surgery
-Fetal
Multiple gestation
Prematurity
Placenta previa

7. Fetal abnormality eg.anencephaly
Oligohydroamnios
Polyhydroamnios
Fetal neuronal problems

8. No clinical significance before 37 weeks of gestation
unless in preterm labour.
Should be confirmed by USS, documenting,
fetal biometry
amniotic fluid volume
placental site
anomalies

9. Three management options available
1.ECV
2.Vaginal delivery
3.Elective caesarean section

10. ECV
reduces the incidence of LSCS.
Success rate depends on operator and higher
in multiparity women.
Performed at 37 completed weeks.

11. Should not lasts more than 10 minutes, Perform
with a tocolytic.
Perform CTG before and after the procedure.
Administer Anti-D to Rh negative mothers.

13. Contraindication for ECV
Fetal anomaly (hydrocephalus)
Placenta praevia
Oligohydroamnios/ polyhydroamnios
History of APH
Multiple gestation
Pre eclampsia/HT
Previous caesarean/myomectomy scar

14. Risks of ECV
Placental abruption
Premature rupture of membranes
Cord accidents
Trans placental haemorrhages
fetal bradycardia

15. Vaginal delivery of breech
Only the extended or flexed presentations can be
delivered vaginally.
There should be no evidence of hydrocephalus
and/or hyperflexion of head.
Adequate feto-pelvic proportions should be
needed.
During labour
Fetal well being should be carefully monitored.
Experienced health professional should be present.

16. Minimal intervention
episiotomy
Delivery of the buttocks with minimal
assistance
Delivery of legs
If legs are flexed deliver spontaneously.
if extended use Pinard’s manoeuver.

17. Delivery of shoulders
When anterior shoulder is in the anterior-
posterior diameter spine and scapula
becomes visible. Then deliver arms by
Loveset’s manoeuvre (not needed routinely).
Delivery of head
Using Mauriceau-smellie veit manoeuvre or
Burns-Marshall technique or by long handle
forceps

18. Complications
cord prolapse (particularly in footling or flexed
breech) can cause rapid severe hypoxia in the
fetus.
Increased risk of CTG abnormalities as cord
compression is common.

19. Foot prolapse(in footling breech).
Mechanical difficulties can damage visceral
organs or brachial plexus can get damaged if
traction is exerted.
In larger fetuses delay in delivery of head can
lead to prolonged compression of cord and
asphyxia.
In smaller fetuses uncontrolled rapid delivery
can cause tentorial tears and intracranial
bleeding.

20. Majority of breeches are delivered by LSCS to
avoid these risks.
Maneuvers for cesarean delivery are similar to
those for vaginal breech delivery.
Still, an entrapped head is a possible outcome
during cesarean delivery as the uterus
contracts after delivery of the body.