In breech presentation the baby's buttocks or feet lie lowest in the uterus instead of the head. It is common before 36 weeks, but at term it affects about 3 to 4 percent of pregnancies and changes how delivery is planned.
Key symptoms
- Usually no symptoms; found at a prenatal visit
- Kicks felt low in the pelvis or on the bladder
- Pressure or discomfort under the ribs from the fetal head
- Risk factors: prematurity, twins, uterine anomalies, low amniotic fluid
What you find on exam
- Leopold maneuvers: hard, round head felt at the top of the uterus
- Fetal heart tones heard best above the umbilicus
- Soft presenting part or feet on cervical exam
- Fundal height and maternal vital signs
Tests
- Ultrasound to confirm the presentation and type of breech
- Ultrasound for amniotic fluid, placenta location and fetal growth
- Fetal heart rate monitoring before and after any version attempt
- Blood type and Rh status
Treatment basics
- Offer external cephalic version at about 37 weeks if there are no contraindications
- Rh immune globulin after version if the patient is Rh negative
- Planned cesarean delivery if the baby stays breech, the most common US approach
- Vaginal breech birth only in selected cases with an experienced team
Red flags
- Rupture of membranes with the cord felt or seen (cord prolapse)
- Abnormal fetal heart rate after version
- Vaginal bleeding or constant abdominal pain
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.