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Breech Presentation

Breech presentation is where the the legs and bottom are the presenting (lowest) part of the foetus, instead of the head.


Types

  • Complete breech - Both legs are fully flexed at the hips and knees

  • Incomplete breech - One leg flexed at the hip and extended at the knee

  • Frank breech (aka Extended breech) - Both legs flexed at the hip and extended at the knee

  • Footling breech - Foot is presenting through the cervix with the leg extended

Management

Most babies that are breech turn spontaneously by 36 weeks, so no intervention is needed. If this hasn’t happened, an External Cephalic Version (ECV) will be offered. If ECV fails, woman are given the choice of a vaginal delivery or elective c-section.


N.B. Overall, vaginal birth is safer for the mother, and caesarean section is safer for the baby.


External Cephalic Version (ECV)

This is where the baby is manually turned to lie in the correct (cephalic) position. It carries a 50% success rate.


This is carried out at:

  • 36 weeks if primiparous

  • 37-39 weeks if multiparous


During the procedure, the mother is given:

  • Tocolysis w/Terbutaline (SC) to relax the uterus before the procedure. It reduces the contractility of the myometrium, making it easier for the baby to turn.

  • Anti-D prophylaxis for RhD -ve women



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