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Breech Presentation: Causes, Diagnosis and Delivery

Breech presentation occurs when a baby is positioned bottom-first or feet-first in the womb near the end of pregnancy instead of head-down. It affects birth planning and delivery options.

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Things worth knowing about "Breech Presentation"

Breech presentation occurs when a baby is positioned bottom-first or feet-first in the womb near the end of pregnancy instead of head-down. It affects birth planning and delivery options.

What Is Breech Presentation?

Breech presentation is an obstetric term describing the position of an unborn baby in the uterus when the buttocks, feet, or knees are positioned to be delivered first, rather than the head. Under normal circumstances, most babies rotate into a cephalic presentation (head-down position) by the 36th week of pregnancy. When this rotation does not occur, the baby is said to be in breech presentation, which requires careful obstetric planning for a safe delivery.

Frequency

Breech presentation occurs in approximately 3 to 5 percent of pregnancies at term. It is considerably more common in earlier stages of pregnancy, when the baby still has ample space to move and change position.

Types of Breech Presentation

Frank breech: The buttocks are positioned downward with the legs stretched upward toward the head (most common type).
Complete breech: The buttocks point downward with the hips and knees flexed, so the baby appears to be sitting cross-legged.
Footling breech: One or both feet are the lowest part, positioned to enter the birth canal first.
Kneeling breech: One or both knees are the presenting part (rare).

Causes and Risk Factors

In many cases, no specific cause for breech presentation can be identified. However, several factors may increase the likelihood of a breech position:

Premature birth (the baby has more room to move)
Multiple pregnancies (e.g., twins)
Abnormal levels of amniotic fluid (polyhydramnios or oligohydramnios)
Placenta praevia (abnormal placental placement)
Uterine abnormalities or fibroids
Previous caesarean sections
Certain fetal abnormalities

Diagnosis

Breech presentation is typically detected through an ultrasound examination performed during routine prenatal care. External palpation using the Leopold maneuvers may also suggest the position of the baby. From the 36th week of pregnancy onward, the position of the baby is routinely checked to allow timely planning of the delivery.

Treatment and Management Options

External Cephalic Version (ECV)

External Cephalic Version (ECV) is a medical procedure in which a trained obstetrician applies firm but gentle pressure to the outside of the abdomen to manually turn the baby into a head-down position. ECV is usually performed from 36 weeks of gestation in a hospital setting with continuous fetal monitoring. The success rate is approximately 50 to 60 percent.

Positioning Exercises and Complementary Methods

Some pregnant individuals try specific exercises (e.g., the knee-chest position), yoga, or complementary therapies such as moxibustion (a form of acupuncture-related therapy) to encourage the baby to turn spontaneously. Scientific evidence for these approaches is limited, though they are generally considered safe.

Mode of Delivery

If the baby remains in breech presentation, two main delivery options are available:

Planned caesarean section: This is the most commonly recommended delivery method for breech presentation in many countries, as it is associated with lower risks to the baby.
Vaginal breech birth: In selected cases and under specific conditions (experienced obstetric team, suitable maternal anatomy and fetal position), a vaginal delivery may be possible. This option requires thorough individual counseling and careful risk assessment.

References

Deutsche Gesellschaft fuer Gynaekologie und Geburtshilfe (DGGG) - Guideline on Breech Presentation, AWMF Register No. 015/051 (2021).
Hofmeyr GJ, Kulier R, West HM. - External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews, 2015.
Impey LWM et al. - RCOG Green-top Guideline No. 20b: Management of Breech Presentation. BJOG, 2017.

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