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NICE suggest that (1):
- if breech presentation at term
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:
auscultation: position of the foetal heart
- vaginal examination
ultrasound - able to determine type of breech
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.
(2008). Antenatal care.
- 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.
Last reviewed 01/2018