🤸 Breech presentation

🔑 Key Learning

• Breech = foetus positioned buttocks/feet-first; occurs in 3–4% of term pregnancies
  • Types: Frank, Complete, Footling
  • Diagnosis made via abdominal palpation, confirmed by ultrasound
• Management:
  • <36 weeks: often resolves spontaneously
  • ≥36 weeks: offer External Cephalic Version (ECV)
    • If Rhesus-negative, ECV = indication for anti-D prophylaxis
    • If ECV fails: consider C-section vs vaginal delivery (risk-balanced)
• Complications of breech delivery: head entrapment, cord prolapse, birth trauma, asphyxia

🧬 Definition and Types

Breech = foetal buttocks or feet nearest the cervix

Types of Breech:

• Frank breech – hips flexed, knees extended (most common)
• Complete breech – hips and knees both flexed
• Footling breech – one or both feet presenting first

👀 Clinical Presentation

• Often asymptomatic, detected on routine antenatal palpation
• Suspected breech confirmed via ultrasound
• Foetal buttocks or feet palpable in maternal pelvis

💊 Management

<36 weeks gestation

• No intervention needed – likely to spontaneously rotate to cephalic

≥36 weeks (nulliparous) or ≥37 weeks (multiparous)

• Offer ECV to turn foetus manually
  • External cephalic version (ECV) attempts to turn the foetus to a cephalic (head-first) position by applying gentle pressure on the pregnant abdomen to manually rotate the foetus.
  • The success rate is approximately 60%.
  • Safer vaginal birth if successful

Failed ECV

• Decision between:
  • Planned C-section (safer for baby)
  • Vaginal breech delivery (may be safer for mother)

🔴 Rhesus-negative mothers

• ECV is an indication for anti-D prophylaxis
• Prevents rhesus sensitisation (maternal antibodies against foetal RBCs)

⚠️ Complications

• Foetal head entrapment
• Umbilical cord prolapse
• Birth trauma (e.g. brachial plexus injury)
• Perinatal asphyxia

📝 Exam Clues & Clinchers

• Frank breech, hips flexed, knees extended → most common subtype
• ≥36 weeks, breech → offer ECV
  • Rhesus-negative + ECV → give anti-D
• Failed ECV + breech + primiparous → likely C-section