Breech presentation

Breech presentation is a significant obstetric event associated with dramatic increases in perinatal morbidity and mortality. Despite a decision to submit all breeches to cesarean delivery, some instances of vaginal breech delivery can be avoided, owing to unforeseen events such as undiagnosed breech presentation, breech presentation diagnosed too late in labor. Collea and coworkers conducted a prospective randomized study that compared elective cesarean section with protocol-managed labor for fetuses with frank breech presentation at term. Because there is controversy surrounding the decision to recommend a trial of labor with breech presentation, as opposed to proceeding immediately to cesarean, the obstetrician is well advised to make a balanced presentation of both views. Continuous fetal surveillance is essential in intrapartum management of breech labor, as umbilical cord prolapse is a potential hazard in all breech presentations. A program of antepartum external cephalic version offers the advantage of decreasing the incidence of breech presentation in labor, thus avoiding the dilemmas for the clinician.