Breech presentation is defined as the fetal buttocks or legs entering the pelvis before the head. Breech presentation persists in 3%-4% of term singleton deliveries. Risk factors include abnormal amniotic fluid volume, multifetal gestation, hydrocephaly / anencephaly, uterine anomalies, placenta previa, fundal placentation, pelvic tumors, prior breech delivery (recurrence rate is 10% in second pregnancy and 27% in third pregnancy), and prior cesarean delivery.

There are 3 types of breech: the complete breech with flexed hips and knees; the incomplete breech with one or both hips partially or fully extended; and the frank breech with flexed hips and extended knees and feet adjacent to fetal head.

Breech presentation can be diagnosed by Leopold maneuvers or vaginal exam with palpation of presenting part; however, sonographic evaluation is the most accurate.

Neonates who are breech in utero are at risk for mild physical deformities (frontal bossing, prominent occiput, upslanting eyes, and low-set ears), torticollis, and developmental dysplasia of the hip.

Vaginal delivery of babies in the breech position may increase the risk of fetal distress, injury, and trauma, resulting in increased neonatal morbidity and mortality. Serious injuries may include hypoxia from cord prolapse upon membrane rupture or from head entrapment during delivery, resulting in neonatal encephalopathy, multiorgan failure or damage, permanent neurodevelopmental deficits, or neonatal / perinatal death. In 5% of breech fetuses, the head may be in extreme hyperextension, resulting in a 25% chance of injury to the spinal cord during attempted vaginal delivery. Severe but rare birth trauma may also include basal skull fracture, subdural hematoma, and intracranial hemorrhage. Less severe injuries from breech delivery may include temporary or permanent brachial plexus injury resulting from nuchal arm, extremity, or clavicular fractures, or genital injuries.