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:

• caesarian 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 caesarian 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 (2008). Antenatal care.
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.