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Breech Birth

Jessica Johnson, MD, MPH and Amy L. Wiser, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

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...

DIAGNOSIS

HISTORY

  • Often asymptomatic and discovered on exam or ultrasound (US)

  • Often found emergently in preterm premature rupture of membranes (PPROM)

PHYSICAL EXAM

  • Fetal anus/sacrum/genitals/feet palpab...

TREATMENT

GENERAL MEASURES

  • The options of ECV, elective trial of labor (TOL), or elective cesarean section should be discussed with the patient (1)[C].

    • Favorable characteristics for successful ECV may i...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Bilateral hip US of the neonate at 6 weeks' corrected gestational age of life to rule out developmental dysplasia of the hip. However, dysplasia is 3.72 times mor...

REFERENCES

Burgos J, Melchor JC, Pijoán JI, et al. A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term. Int J Gynaecol Obs...

ADDITIONAL READING

  • American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 161: external cephalic version. Obstet Gynecol.  2016;127...

SEE ALSO

Placenta Previa; Preterm Labor 

CODES

ICD10

  • O32.1XX0 Maternal care for breech presentation, unsp

  • O64.1XX0 Obstructed labor due to breech presentation, unsp

  • O32.8XX0 Maternal care for other malpresentation of fetus, not applicable or un...

CLINICAL PEARLS

  • ECV should be offered to all women without contraindications with a breech presentation, ideally at 37 weeks.

  • Planned vaginal delivery by an experienced provider is reasonable in select...

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