Gestational context
34 to 40 weeks
booking
12w
anatomy
24w
28w
36w
term
Recognition
- Leopold's manoeuvres: a hard, ballotable head at the fundus and a soft, irregular breech in the pelvis. Confirm with ultrasound at 36 weeks.
- Frank breech (hips flexed, knees extended, the commonest), complete (hips and knees flexed), footling (one or both feet presenting; highest cord prolapse risk).
- Causes: prematurity, polyhydramnios or oligohydramnios, uterine anomalies and fibroids, placenta praevia, multiple pregnancy, fetal anomalies. Often none.
External cephalic version
- Offered at 36 to 37 weeks (37 for multiparous); success 50 to 60 percent, higher with tocolysis and in multiparous patients.
- Contraindications: an indication for caesarean anyway, antepartum haemorrhage in the last week, abnormal fetal monitoring, ruptured membranes, multiple pregnancy, major uterine anomaly.
- Done with ultrasound, monitoring before and after, and anti-D if Rh negative; a small risk of needing emergency delivery, so it is done where theatre is available.
Mode of birth
- Planned caesarean at 39 weeks reduces short-term perinatal morbidity (the Term Breech Trial); planned vaginal breech birth is an option in selected cases (frank or complete breech, estimated weight 2500 to 4000 g, flexed head, no previous caesarean, an experienced attendant, and the patient's informed choice), and skill in vaginal breech delivery must be maintained for the breech that arrives unplanned.
- Transverse or oblique lie at term: caesarean, after excluding praevia; external version may be attempted.
Watch it done
Lie, presentation and position on a model, the vocabulary the board and the partogram use.
Inspection, fundal height, lie, presentation, engagement and the fetal heart, in the order a clinician examines.
On the modelFundus and cornuaIsthmus and lower segmentBony pelvis