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The rate of cesarean delivery for fetuses with intrapartum breech presentation exceeds 90%. Of the remaining 10%, some are delivered vaginally before cesarean delivery can be performed. Only a small percentage of patients elect to undergo a trial vaginal breech delivery. Criteria for vaginal breech delivery at term include an adequate maternal pelvis, frank breech presentation without hyperextension of the fetal head, and an estimated fetal weight between 2.5 and 4.0 kg. The practitioner should be experienced in managing vaginal breech delivery.
The overall neonatal morbidity from trauma is significantly increased with elective vaginal breech, with an odds ratio of 3.86. Planned cesarean delivery should be strongly considered for persistent breech presentation at
External cephalic version at term is an alternative to vaginal breech delivery that can decrease term breech presentation by at
External Cephalic Version
External cephalic version results a reduction in the incidence of both intrapartum breech presentation and cesarean delivery rate. Modern studies confirm a low incidence of perinatal morbidity associated with the procedure; however, uncommon (yet serious) complications of external cephalic version include placental abruption, uterine rupture, fetal-maternal hemorrhage, isoimmunization, fetal distress, and even fetal death. D immune globulin should be administered to D-negative women after the procedure. For the fetus that reverts to breech presentation after successful version, a second attempt may be considered when criteria are
Breech presentation should be diagnosed before labor in order for a patient to be extended the option of external cephalic version. If the diagnosis is in doubt at term after performing Leopold's maneuvers and a pelvic examination, ultrasonography should be used to confirm the