Breech presentation

1. Big picture

Breech presentation means the fetus presents with the buttocks, feet, or knees instead of the head. It is common in preterm pregnancy but becomes clinically important at term because it increases the risk of birth trauma, cord prolapse, fetal hypoxia, head entrapment, emergency cesarean section, and perinatal morbidity.

For the exam, think in this order:

Breech suspected clinically
        ↓
Confirm by ultrasound
        ↓
Find cause/risk factor
        ↓
Assess gestational age, fetal size, anomalies, placenta, liquor, head flexion
        ↓
At term: offer external cephalic version if suitable
        ↓
If persistent breech: decide planned cesarean vs selected vaginal breech birth

The most important oral-exam sentence:

At term, persistent breech presentation is usually managed by planned cesarean section unless strict criteria for safe vaginal breech birth are fulfilled and an experienced obstetrician is available.

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