Introduction
Breech presentation is a common complication that affects about 3-4% of pregnancies at term. This number increases among preterm labor, as spontaneous correction of the presenting part is also likely.
Breech presentation is defined as when the lower parts of the fetus’ body, such as the legs or buttocks, present towards the cervix while the head lies far away. This is considered as opposed to the Vertex presentation, meaning that the baby’s head is presenting for delivery.
In this post, we aim to discuss risk factors, subtypes, and the practical implications of this prenatal complication to offer a better understanding and awareness to our beloved audience.
It is important to seek professional medical care when facing such a complication, for the best outcome of your pregnancy.
Breech Risk Factors
While this complication cannot be solely attributed to a single condition, various maternal, placental, and fetal factors increase the risk of Breech presentation.
Maternal factors include uterine conditions (such as fibroma, leiomyoma, and history of previous breech presentation), anatomical pelvic restrictions, pelvic tumors causing compression on the uterus, and grand multiparity (defined as a history of 5 or more deliveries).
Placenta Previa is another risk factor associated with Breech presentation.
Fetal risk factors include prematurity, high or low levels of amniotic fluid (referred to as poly-/oligo-hydramnios), multiple gestations (twin, triplets), congenital fetal malformations, fetal tone and movement abnormalities, chromosomal abnormalities, and developmental disorders (such as anencephaly)
While many of these conditions may not be modifiable upon discovery, it is important to maintain a close observation of your pregnancy’s progress and complications under the care of an experienced and expert healthcare professional to identify modifiable risk factors and arrange for appropriate and timely therapeutic measures, when indicated.
Breech Subtypes
Regarding the anatomical lie of the presenting parts, Breech is divided into complete, incomplete, and Frank subtypes.
Complete Breech which accounts for 10% of presentations is when the fetus’s hips and knees are both flexed into the belly.
Incomplete Breech refers to partial flexion of both or one hip, while both or one knee presents below the buttocks, meaning that the feet or knees present first. This may also be called “footling” or “kneeling” Breech. These subtypes account for about 30% of presentations.
Lastly, Frank Breech refers to extended knees and flexed hips, meaning the buttock presents first while descending from the uterus. This is the most common subtype (about 60%), and it also accounts for most vaginal deliveries with Breech complications.
Breech Management
The management depends on various factors, including the timing of the discovery of this malpresentation. These factors are considered by your healthcare provider when discussing management plans to reach an optimal outcome and minimize the associated risks.
Serial monitoring of the mother and fetus is indicated, such as physical examination, fetal movement and heart rate monitoring, Non-Stress Test (NST), and ultrasound studies to determine the subtype of Breech, fetal well-being, and movements, fetal head and abdomen sizes and positions, number of gestations, amniotic fluid index, placental assessment, and estimated date of delivery.
In select cases, the healthcare provider might consider some maneuvers to turn the fetus around and restore the Vertex presentation. This is called the External Cephalic Version (ECV) maneuver, which must be carefully weighed by an expert and experienced obstetrician while considering any related complications to prevent any possible injuries to the fetus.
Given the extent of complications, it is important to consider the possibility of Cesarean delivery when a Breech presentation is discovered, while some uncomplicated cases may progress via natural or assisted vaginal delivery.
Breech Possible Complications
Breech Presentation impacts different aspects of prenatal care, delivery, and post-delivery maternal and neonatal care. These complications include the poor progression of the delivery, the risk of injury to the baby’s limbs or nerve plexus, low birth weights, congenital anomalies, placental abruption, cord prolapse, or other cord complications, and a higher rate of mortality.
In rare occasions, these might lead to severe fetal hypoxia and indicate urgent Cesarean Delivery with a higher risk for fetal demise.
Conclusion
Breech Presentation is one of the common complications of labor, which is related to some maternal, placental, and fetal risk factors, such as multiple gestations and amniotic fluid abnormalities.
The subtypes of Breech include complete, incomplete, and Frank (most common) presentations.
It is important to closely monitor the progress of your pregnancy if complicated by Breech, collaborating closely with an experienced healthcare provider. It might be useful to have early discussions with your hcp regarding the possibility of Cesarean delivery, given the high rates of complications with Breech.
