Breech Delivery

Abstract

Breech presentation occurs when the fetal pelvis or lower extremities present at the maternal pelvic inlet. The three main types of breech are frank breech (both hips flexed and both knees extended), complete breech (both hips and both knees flexed), and incomplete (footling or kneeling) breech (one or both hips are partially flexed). Vaginal breech delivery is associated with more neonatal morbidity and mortality than cephalic birth. The clinical diagnosis of breech presentation is made by abdominal palpation. A prelabor vaginal examination is limited in aiding clinical diagnosis but findings of the soft breech, feet, anal orifice or genitalia through a dilated cervix are contributory. Clinical criteria considered necessary for safe vaginal birth, include an estimated fetal weight of 2000–4000g, absence of hyperextension of the fetal neck, a clinically adequate pelvis, a frank or complete breech presentation, good fetal growth, and a team skilled in vaginal breech delivery and neonatal resuscitation in attendance.