Background
Breech presentation occurs when the fetus presents to the birth canal with buttocks or feet first. This presentation creates a mechanical problem in delivery of the fetus.
Pathophysiology
The buttocks and feet of the fetus do not provide an effective wedge to block and dilate the cervix. The umbilical cord may prolapse, and/or the head may get trapped during delivery.
The 3 types of breech presentation are as follows:
- Frank (65%): Hips of the fetus are flexed, and knees are extended.
- Complete (10%): The hips and knees of the fetus are flexed.
- Incomplete (25%): The feet or knees of the fetus are the lowermost presenting part.
- Single footling: One of the lower extremities is lowermost.
- Double footling: Both of the lower extremities are lowermost.
Epidemiology
Frequency
United States
Incidence is correlated to gestational age (see Table 1 below). However, the overall frequency is 3-4% at delivery.[1]
Table 1. Gestational age and frequency of breech birth (Open Table in a new window)
| Gestational Age, Weeks | Breech, % |
| 21-24 | 33 |
| 25-28 | 28 |
| 29-32 | 14 |
| 33-36 | 9 |
| 37-40 | 7 |
Mortality/Morbidity
- Many complications can result from breech presentation. They are generally related to complications of the fetal abnormalities that may be the primary reason for the breech presentation and those related to umbilical cord compression resultant from abnormal progression through the maternal pelvis.
- Increased birth trauma: As the duration of umbilical cord compression increases, the practitioner tries to deliver the infant more rapidly than advisable, thus increasing the incidence of birth trauma.
- Incidence of prolapsed umbilical cord depends on type of breech presentation.
- Footling, 17% incidence
- Complete, 5% incidence
- Frank, 0.5% incidence
- Umbilical cord abnormalities: Cord length may be reduced, and, in footlings, there is an increased risk of the cord coiling around the legs of the fetus.
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| Gestational Age, Weeks | Breech, % |
| 21-24 | 33 |
| 25-28 | 28 |
| 29-32 | 14 |
| 33-36 | 9 |
| 37-40 | 7 |

