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Breech Birth

Breech Birth is a topic covered in the 5-Minute Clinical Consult.

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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

Risk Factors

  • 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

General Prevention

  • 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

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Stephens, Mark B., et al., editors. "Breech Birth." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816199/all/Breech_Birth.
Breech Birth. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816199/all/Breech_Birth. Accessed April 18, 2019.
Breech Birth. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816199/all/Breech_Birth
Breech Birth [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816199/all/Breech_Birth.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Breech Birth ID - 816199 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816199/all/Breech_Birth PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -