Breech Presentationand

External Cephalic Version

Professor Steve Robson

ANU Medical School

Breech Presentation at Term

• Breech presentation complicated 3.8% of term births in Australia in 2012

• More than 90% of those were delivered by caesarean section

• 78% of those were performed before labour commenced.

Breech

• 14% at 29-32 weeks, 2.2-3.2% at term

• Aetiology• Extended legs, Uterine anomalies, Substance abuse/anticonvulsant use,

Contracted pelvis/placenta praevia, Variations in liquor, previous breech

• Fetal anomaly • Short cord, Congenital anomaly (up to 5% at term), IUGR, multiple pregnancy

Outcomes

• Term breech known to have increased PNMR/ severe morbidity even if delivered by LUSCS• True even if correction for gest age and congenital anomaly

• 0.31/1000 vs 0.89/1000

• Most trials have looked at ante and intrapartum care in comparison with vertex presentation• Outcomes do not indicate best mode of management of the breech therefore

145 vaginal breech deliveries in 11 years

1 vaginal breech per month between

multiple consultants

Chatila, Lim, Robson 2016

stephen.robson@anu.edu.au