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The breech presentation exists when the cephalic pole of the fetus is positioned in a longitudinal lie and is located within the uterine fundus. The incidence of breech presentation is inversely related to the fetal gestational age.1 It is greater than 25 percent if the fetal age is less than 27 weeks of gestation and decreases to 3 to 4 percent at term.

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Knowledge and preparedness facilitate comfort and promote success in approaching any emergent procedure. The breech delivery is no exception to this rule. Breech delivery is a high-risk obstetric complication generally handled by an Obstetrician. There are situations when a pregnant woman will present to the Emergency Department in active labor with a fetus in the breech position. The preferable method of delivery is a cesarean section if available. Vaginal breech delivery may be the only viable option in the absence of surgical assistance or in the presence of an acute situation such as fetal distress or umbilical cord prolapse.

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The breech presentation is associated with abnormal fetal conditions that may decrease fetal movement or mobility. An increased incidence of breech or other abnormal presentations is associated with primary neurologic disorders, neuromuscular disorders (myotonic dystrophy), genetic abnormalities (trisomies 13, 18, and 21), prematurity, fetal malformations such as hydrocephalus or a cystic hygroma, and polar placentation.1 Maternal abnormalities that increase the risk of an abnormal fetal presentation include a small pelvis, small or abnormal pelvic measurements, uterine anomalies, and lower segment leiomyomata.

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There are three main types of breech presentation (Figure 113-1). The most common is the frank breech, accounting for 50 to 73 percent of breech presentations. The fetus is flexed at the hips and extended at the knees (Figure 113-1A). The fetus is in the “pike” position. The complete breech is the least common type and accounts for approximately 5 to 11 percent of breech presentations. The fetus is flexed at both the hips and the knees (Figure 113-1B). The footling or incomplete breech accounts for approximately 12 to 38 percent of breech presentations. The fetus is incompletely deflexed at one or both knees or hips (Figure 113-1C). The risks of umbilical cord prolapse and prematurity associated with the breech presentation are listed in Table 113-1.

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Figure 113-1
Graphic Jump Location

The main types of breech presentations. A. The frank breech. B. The complete breech. C. The incomplete breech.

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Table Graphic Jump Location
Table 113-1. Breech Presentations and Associated Complications1
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Breech delivery is divided into three categories. These include unassisted or spontaneous expulsion, ...

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