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Complete (20%) (Common in multis)



  1. Frank breech (70%) (Common in primi)
  2. Footling breech
  3. Kneeling breech

Frank breech is the most common and is most suitable for vaginal delivery. Footling breech is the least common and has the highest risk of cord prolapse.


MC cause = Prematurity


  1. Multiple pregnancy
  2. Hydrocephalus/spina bifida
  3. Polyhydramnios/oligohydramnios


  1. Congenital malformation of the uterus
  2. Multiparity
  3. CPD
  4. Uterine fibroid/pelvic tumors
  5. Past history


  1. Placenta previa
  2. Cornufundal attachment of placenta
  3. Short cord

Prevalence of Breech Presentation by Gestational Age

Gestational Age (Weeks)

Breech (%)













Methods of Vaginal Delivery

There are three general methods of breech delivery through the vagina:

  1. Spontaneous breech delivery: The infant is expelled entirely spontaneously without any traction or manipulation other than support of the infant.
  2. Assisted breech delivery: The infant is delivered spontaneously as far as the umbilicus, but the remainder of the body is extracted or delivered with operator traction and assisted maneuvers, with or without maternal expulsive efforts. This is considered as the best method of vaginal breech delivery.
  3. Total breech extraction: The entire body of the infant is extracted by the obstetrician. This method is done only in cases of fetal distress.

Incidence of Cord Prolapse

  1. Frank breech - 0.5%.
  2. Complete breech -5%
  3. Footling breech – 15%



Gynecoid and anthropoid pelves are favorable, but android and platypelloid pelvis are unfavorable for vaginal breech delivery.


Various maneuvers for breech delivery:

  1. Kristellar: suprapubic pressure
  2. Pinnard's: arrested lower limbs (put the fingers in popliteal fossa, flex the knee and grasp the foot) (P- Pinnard’s, Popliteal)
  3. Prague's: dorsoposterior breech
  4. Lovset's: nuchal arm. The diagnosis is made by noting the winging of the scapula.

Maneuvers for delivering after-coming head of breech:

  1. Mauriceau-Smellie-Veil: malar flexion and shoulder traction
  2. Bums-Marshall: baby held by ankle and trunk is swung in upward and forward direction
  3. Wizard-Martin: malar flexion and supra-pubic pressure
  4. Pipers forceps: Piper's forceps is the best method to deliver the after-coming head of breech because:
    1. It is a controlled delivery, sudden decompression of the head is avoided
    2. Undue traction on the neck is avoided, so the risk of brachial plexus injury is least

Indications For Cesarean Section in Breech Presentation

  1. Primi with breech
  2. Footling breech
  3. Twins with first baby in breech
  4. Previous LSCS with breech
  5. Preterm breech (risk of intraventricular hemorrhage increases with vaginal delivery)
  6. Stargazing/flying fetus

In perhaps 5% of term breech presentations, the fetal head may be in extreme hyperextension. This presentation is referred to as the stargazer fetus or the flying fetus. With such hyperextension, vaginal delivery may result in injury to the cervical spinal cord. In general, marked hyperextension after labor has begun is considered an indication for cesarean delivery.

Pre term infants undergoing cesarean delivery have a better prognosis.


Occasionally, especially with small preterm fetuses, the incompletely dilated cervix will not allow vaginal delivery of the after-coming head. In such cases, Duhrssen incisions are usually necessary (cut the cervix at 10 and 2 o'clock positions).

External Cephalic Version

The ACOG recommends that efforts should be made to reduce breech presentation by external cephalic version (ECV) whenever possible.


The success rate for external cephalic version ranges from 35% to 85%, with an average of about 60%.


ECV should be performed at 36 weeks of gestation for the following reasons:

  1. If version results in fetal distress and need for immediate LSCS, iatrogenic prematurity is avoided.
  2. The likelihood of spontaneous version is low.
  3. An additional consideration in timing the version is that, although earlier attempts are more likely to be successful, they also are more likely to be associated with spontaneous reversion to breech.

Contraindications for ECV

  1. Multiple pregnancy
  2. Previous LSCS
  3. Severe preeclampsia
  4. Oligo/polyhydramnios
  5. Placenta previa/ contracted pelvis (version should not be attempted if there is a contraindication to vaginal delivery)
  6. BOH

Complications of ECV

  1. Fetal distress
  2. IUFD
  3. Pre-term labor
  4. Abruption
  5. Cord entanglement

Breech Score of Zatuchni and Andros



0 point

1 point

2 points





Gestational age

 39 weeks or more

 38 weeks

 37 weeks or less

Estimated fetal weight

 > 8 pounds

 7-8 pounds

 < 7 pounds

Previous breech> 2.5 kg



 2 or more

Cervical dilatation

 2 cm or less


 4cm or more


 -3 or higher


 -1 or lower

Score of 3 or less is an indication for LSCS




Recurrent breech

When breech recurs in 3 or more consecutive pregnancies, it is called habitual or recurrent breech.


  1. Congenital malformation of uterus (Septate or bicornuate)
  2. Repeated cornufundal attachment of the placenta

Most common in Breech

  1. MC cause prematurity
  2. MC type of breech : Frank / Extended
  3. Incidence: 20% - 28 weeks
                    5% - 34 weeks
                    3% - term
  4. Commonest position – LSA
  5. Engaging diameter of breech – Bitrochanteric (10cm)
  6. Engaging diameter of shoulder – Bisacromial (12 cm)
  7. Engaging diameter of head – suboccipitofrontal (10cm)
  8. Head is born by flexion.

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