Breech Delivery

Updated: Dec 28, 2015
  • Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD  more...
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Overview

Background

Breech presentation occurs when the fetus presents to the birth canal with buttocks or feet first. This presentation creates a mechanical problem in delivery of the fetus.

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Pathophysiology

The buttocks and feet of the fetus do not provide an effective wedge to dilate the cervix. The umbilical cord may prolapse, and/or the aftercoming head may get trapped during delivery.

The 3 types of breech presentation are as follows:

  • Frank (65%): Hips of the fetus are flexed, and knees are extended.
  • Complete (10%): The hips and knees of the fetus are flexed.
  • Incomplete (25%): The feet or knees of the fetus are the lowermost presenting part.
    • Single footling: One of the lower extremities is lowermost.
    • Double footling: Both of the lower extremities are lowermost.
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Epidemiology

Frequency

United States

Incidence is correlated to gestational age (see the Table below). However, the overall frequency is 3-4% at delivery. [1]

Table. Gestational age and frequency of breech birth (Open Table in a new window)

Gestational Age, Weeks Breech, %
21-24 33
25-28 28
29-32 14
33-36 9
37-40 3-4

International

The international incidence has been reported at 3-4%. [2]

Mortality/Morbidity

See the list below:

  • Many complications are associated with a breech presentation in labor. This may be due to the underlying etiology of the breech presentation, such as fetal anomalies or polyhydramnios. In addition, complications can occur as a result of umbilical cord compression due to the unusual presentation to the maternal pelvis.
  • Increased birth trauma: The inexperienced provider is more likely to pull on the fetus prematurely, and to perform the maneuvers to faciliate delivery incorrectly, increasing the risk of traumatic injury. In addition, as the duration of umbilical cord compression increases, the practitioner may try to deliver the infant more rapidly than advisable, thus increasing the incidence of birth trauma.
  • Incidence of prolapsed umbilical cord depends on type of breech presentation.
    • Footling, 17% incidence
    • Complete, 5% incidence
    • Frank, 0.5% incidence
  • Umbilical cord abnormalities: Cord length may be reduced, and, in footling breeches, there is an increased risk of the cord coiling around a leg of the fetus.

Age

Older maternal age is a consideration. [3]

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