Breech Presentation

Question 1

What is the most common presentation of breech?

Answer 1

A frank breech where hips an flexed and kneeds fully extended

Question 2

What breech position carries a higher perinatal mortality?

Answer 2

A footling breech (Incomplete or complete) breech.

Question 3

What are the risk factors for breech presentation?

Answer 3

• Uterine malformations, fibroids
• Placenta praevia
• Polyhydramnios or oligohydramnios
• Fetal abnormality (e.g. CNS malformation, chromosomal disorders)
• Prematurity (due to increased incidence earlier in gestation)

Question 4

What more commonly occurs, regarding the cord, in breech?

Answer 4

Cord prolapse (Cord comes out first)

Question 5

How is Breech managed?

Answer 5

• < 36 weeks - many will spontaneously turn.
• 36 weeks - External Cephalic Version (ECV) can be tried but this has a succcess rate of 60%. (Do ECV at 36 weeks in nulliparous and 37 weeks in multiparous)
• If still breech - C-Section or vaginal delivery.

Question 6

What are 2 things the RCOG says to tell the mother with regards to breech, C-section and delivery?

Answer 6

1. Planned C-section reduces perinatal mortality and neonatal morbidity than if delivered vaginally.
2. Long term health outcomes of the baby are not influenced if breech birth.