Breech presentation

Question 1

What is the incidence of breech presentation?

Answer 1

20% at 28 weeks

3-4% at term

Question 2

For the baby, what are the relative risks of LSCS vs vaginal delivery for breech presentation at term?

Answer 2

Planned LSCS carries a reduced perinatal mortality and early neonatal morbidity compared to planned vaginal delivery.

There is no evidence that the long term health of babies with a breech presentation at term is influenced by how the baby is born

Question 3

For the mother, what are the relative risks of LSCS vs vaginal delivery for breech presentation at term?

Answer 3

Planned LSCS carries a small increase in serious immediate complications, compared to planned vaginal birth.

Planned LSCS does not carry any additional risk to long term health outside of pregnancy

Future pregnancy risks include scare dehiscence, increased risk of repeat LSCS and placenta accreta.

Question 4

How should a breech second twin baby be delivered?

Answer 4

The second twin is non-vertex in about 40% of cases Routine LSCS for breech second twin is not indicated.

Planned vaginal birth according to usual twin indications is reasonable.

Question 5

What is the role of External Cephalic Version (ECV)?

Answer 5

All suitable women should be offered ECV as it has been shown to reduce the chance of breech presentation at term, hence the risk of caesarean birth.

Question 6

What is the success rate of ECV?

Answer 6

Approximately 40% for nulliparous and 60% for multiparous women

Question 7

What can increase the success rate of ECV?

Answer 7

Use of tocolysis, e.g. salbutamol, terbutaline.

Question 8

When should ECV be offered?

Answer 8

From 36 weeks for nulliparous women and from 37 weeks for multiparous women

Earlier ECV is more successful, but more babies vert spontaneously and the risk of prematurity is higher if immediate LSCS is needed due to fetal distress during the actual procedure (unlikely)

Question 9

What are the risks of ECV?

Answer 9

ECV is rarely associated with complications

1/200 risk of emergency CS due to fetal distress

Transient fetal heart rate changes (e.g. deccelerations, reduced baseline variability)

Rare case reports have found placental abruption, uterine rupture & fetal haemorrhage

Rhesus negative women should receive Anti-D after ECV attempt

Question 10

What are contraindications to ECV?

Answer 10

APH in the last week

Abnormal CTG

Major uterine abnormality, e.g. bicornuate uterus

Ruptured membranes

Previous LSCS (relative contraindication)

Oligohydramnios, IUGR (relative contraindications)