Breech presentation – An overview

Abstract

Introduction
Breech presentation is a form of mal-presentation in which the fetal buttocks or lower extremities occupy or is in direct relationship with the maternal pelvic inlet. It is the commonest form of mal-presentation of the fetus. Its incidence decreases with advancing age from 25% at 28 Weeks, through 15% at 32 Weeks to 2-4% at term[1-3].

It accounts for 3-4% of infants born at term or at least 20,000 babies per year in the United Kingdom[3-5].  It is commoner in preterm babies and may be associated with both fetal and maternal anomalies. There has been intense debate about the safest mode of delivery for breech babies[5,6].
Depending on the attitude of the fetus, breech presentation has been classified as:
(a) Frank or Extended breech presentation when the fetal hips are flexed and the knees extended. It is also called 'pike'. This accounts for 50-70% of breech presentations and is commoner in Primigravidae;
(b) Complete or Flexed breech presentation when both the hips and the knees are flexed. It is also described as 'cannon ball' and accounts for 5-10% of breech presentations. It is commoner in Multiparous women.
(c) Footling or Incomplete breech presentation when one or both hips are extended. Here the foot (or feet) lies below the fetal buttock and either it or the knee(s) may be presenting[3,5,7].