Diagnosis and management

NICE suggest that (1):

• if breech presentation at term
  • all women who have an uncomplicated singleton breech pregnancy at 36 weeks should be offered external cephalic version. Exceptions include women in labour and women with a uterine scar or abnormality, fetal compromise, ruptured membranes, vaginal bleeding and medical conditions
  • where it is not possible to schedule an appointment for external cephalic version at 37 weeks, it should be scheduled at 36 weeks.

Diagnosis is by:

• palpation
• auscultation: position of the foetal heart
• vaginal examination
• ultrasound - able to determine type of breech

Treatment:

• caesarean or vaginal delivery decision is based on the type of breech, any causative factors, and the results of pelvimetry etc
• external cephalic version is possible, but this carries the risk of abruption
• vaginal delivery must be carefully monitored and supervised by an obstetrician
• often the decision is heavily influenced by maternal preference

Note that planned caesarean section had a lower risk for perinatal mortality and serious morbidity than planned vaginal birth in breech presentation (2) in a randomised trial comparing the two forms of delivery.

Reference:

1. NICE. Antenatal care. NICE guideline NG201. Published August 2021
2. Hannah ME et al, for the Term Breech Trial Collaborative Group (2000). Planned caesarian section versus planned vaginal birth for breech presentation at term: a randomised trial. Lancet, 356, 1375-83.