The incidence of singleton breech presentation is low (∼3%) but increases (> 20%) in preterm infants weighing less than 2 kg. Frank breech is most common in full-term deliveries and presents with both hips flexed and both knees extended. In a complete breech, both hips and knees are flexed. In both of these, the infant’s buttocks are the usual presenting body part at the perineum. A footling breech has one or both legs extended below the buttocks and a foot is the presenting part. Footling presentation is seen in up to half of all preterm deliveries. Breech deliveries carry a much higher neonatal mortality rate than normal deliveries. Complications of breech delivery include umbilical cord prolapse, nuchal arm obstruction, and difficulty in delivery of the head.
Management and Disposition
The specific maneuvers for breech extraction are beyond the scope of this text. If breech delivery appears imminent, prepare for ED delivery as in the previous section and obtain immediate obstetric and pediatric consultation. During delivery, support the infant’s presenting parts and apply gentle traction as they spontaneously pass through the vaginal outlet. Keep in mind that the head diameter is greater than either the hip or shoulder diameter and may become entrapped by the cervix if it is not adequately dilated.
Whenever possible and delivery is not imminent, immediately transfer stable patients with a breech presentation to an appropriate labor and delivery setting.
Breech Delivery. Footling breech vaginal delivery of the following head. (Photo contributor: John O’Boyle, MD.)