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At time of delivery, the sacrum or lower limbs are the presenting fetal part.
- Frank breech: Fetal hips flexed and knees extended with feet near the face. Sacrum presents first (40–60% of breech presentations at term).
- Footling or incomplete breech: Foot or knee presents first (25–35%).
- Complete breech: Hips and knees flexed. Feet and sacrum present together (5–15%).
Early gestational age is highly associated with breech presentation, and risk decreases as gestational age advances.
- 22% of fetuses <28 weeks are breech.
- 3–4% of singleton term fetuses
- <10% of breech fetuses at term will spontaneously vert to cephalic.
Associated with many fetal anomalies, including anencephaly, head or neck tumors, hydrocephalus, trisomies 21 and 18, Potter syndrome, myotonic dystrophy; associated with maternal müllerian uterine anomalies
- Early gestational age is number one risk factor.
- History of breech birth
- Low-birth-weight infant
- Female gender
- Fetal anomalies (9% of term breech and 17% of preterm breech)
- Advanced maternal age
- Oligohydramnios, polyhydramnios
- Nulliparity, multiple gestation
- Uterine anomalies, fibroids, or pelvic tumors
- Pelvic contractures or irregularly shaped pelvis, such as android or platypelloid
- Little evidence to support abnormal placentation (placenta previa, cornual-fundal) as a risk factor
- Prenatal folate therapy to decrease risk of neural tube defects
- Tight 1st-trimester glucose control in diabetics decreases anomalies.
- Prenatal screening to diagnose chromosomal or fetal anomalies
- Routine assessment of fetal presentation at 36 weeks to afford time for trial of external cephalic version (ECV)
Commonly Associated Conditions
- Increased risk of cord prolapse (0.4% in cephalic presentation compared with 0.5% in frank breech, 4–6% in complete breech, and 15–18% in footling breech)
- Congenital hip dysplasia has higher incidence in infants with breech presentation at term; more common in female infants than male