Management of Breech Presentation and Delivery Techniques
Summary
Breech presentation, in which the fetus lies buttocks or feet first, occurs in approximately 3–5 per cent of term pregnancies and poses unique challenges for safe delivery. Management strategies centre upon anticipating and correcting malpresentation when possible, selecting an appropriate mode of birth, and ensuring skilled attendance. External cephalic version (ECV) remains the first-line intervention to rotate the fetus into a head-first position, reducing the need for operative delivery. When ECV is contraindicated or unsuccessful, clinicians and families must weigh the risks and benefits of planned vaginal breech birth against elective caesarean section. Recent advances have refined selection criteria for vaginal breech birth, incorporated imaging modalities such as ultrasound and MRI pelvimetry, and emphasised maternal positioning and physiological birth techniques. Multidisciplinary breech clinics and structured training programmes are emerging to standardise care, support informed decision-making and maintain clinical expertise. Globally, a flexible, patient-centred approach informed by local resources, clinician skill and parental preference is underpinning efforts to optimise perinatal outcomes while preserving maternal autonomy.
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Management of Breech Presentation and Delivery Techniques publication trend
The graph below shows the total number of articles in management of breech presentation and delivery techniques across all publications each year (not limited to Nature Index journals).
Technical terms
Breech presentation: Fetal position in which the buttocks or feet, rather than the head, enter the maternal pelvis first.
External cephalic version (ECV): A manual technique performed through the maternal abdomen to turn the fetus from breech to head-first presentation.
Planned vaginal breech birth: A managed labour and delivery approach in which a qualified professional conducts a vaginal delivery despite persistent breech presentation, following strict selection criteria.
Frank breech: A subtype of breech presentation where the fetal hips are flexed and the knees extended, positioning the feet near the head.
Manual assistance: Specific hands-on manoeuvres used by the attendant to facilitate safe descent and delivery of fetal parts during vaginal breech birth.
References
- Evaluation of postural therapy using lateral position according to fetal back orientation on breech presentation and breech recurrence (BRLT study): An open-label randomized controlled trial.. PLOS Medicine (2025).
- Impact of implementation of a breech clinic in a tertiary hospital. BMC Pregnancy and Childbirth (2020).
- Practical insight into upright breech birth from birth videos: A structured analysis. Birth (2020).
- New MRI Criteria for Successful Vaginal Breech Delivery in Primiparae. PLOS ONE (2016).
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