Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of issues related to breech presentation

G Justus Hofmeyr, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Breech presentation describes the fetus whose buttocks are adjacent to the birth canal. This topic will provide an overview of major issues related to breech presentation, including the best approach for delivery. Techniques for breech delivery are discussed separately. (See "Delivery of the fetus in breech presentation".)


The main types of breech presentation are:

Frank breech – In the frank breech position, both hips are flexed and both knees are extended so that the feet are adjacent to the fetal head (figure 1). At term, 50 to 70 percent of breech fetuses are in this position.

Complete breech – In the complete breech position, both hips and both knees are flexed (figure 2). At term, 5 to 10 percent of breech fetuses are in this position.

Incomplete breech – In the incomplete breech position, one or both hips are not completely flexed (figure 3). At term, 10 to 40 percent of breech fetuses are incomplete.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 15, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Scheer K, Nubar J. Variation of fetal presentation with gestational age. Am J Obstet Gynecol 1976; 125:269.
  2. Hickok DE, Gordon DC, Milberg JA, et al. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol 1992; 166:851.
  3. Ben-Rafael Z, Seidman DS, Recabi K, et al. Uterine anomalies. A retrospective, matched-control study. J Reprod Med 1991; 36:723.
  4. Michalas SP. Outcome of pregnancy in women with uterine malformation: evaluation of 62 cases. Int J Gynaecol Obstet 1991; 35:215.
  5. Fianu S, Václavínková V. The site of placental attachment as a factor in the aetiology of breech presentation. Acta Obstet Gynecol Scand 1978; 57:371.
  6. Sekulić S, Ilinčić M, Radeka G, et al. Breech presentation and the cornual-fundal location of the placenta. Croat Med J 2013; 54:198.
  7. Ranney B. The gentle art of external cephalic version. Am J Obstet Gynecol 1973; 116:239.
  8. Mostello D, Chang JJ, Bai F, et al. Breech presentation at delivery: a marker for congenital anomaly? J Perinatol 2014; 34:11.
  9. Westgren M, Edvall H, Nordström L, et al. Spontaneous cephalic version of breech presentation in the last trimester. Br J Obstet Gynaecol 1985; 92:19.
  10. Soernes T, Bakke T. The length of the human umbilical cord in vertex and breech presentations. Am J Obstet Gynecol 1986; 154:1086.
  11. Moessinger AC, Blanc WA, Marone PA, Polsen DC. Umbilical cord length as an index of fetal activity: experimental study and clinical implications. Pediatr Res 1982; 16:109.
  12. Fruscalzo A, Londero AP, Salvador S, et al. New and old predictive factors for breech presentation: our experience in 14 433 singleton pregnancies and a literature review. J Matern Fetal Neonatal Med 2014; 27:167.
  13. Hall MH, Carr-Hill R. Impact of sex ratio on onset and management of labour. Br Med J (Clin Res Ed) 1982; 285:401.
  14. Robertson IS. Breech presentation associated with anticonvulsant drugs. Am J Obstet Gynecol 1984; 4:174.
  15. Albrechtsen S, Rasmussen S, Dalaker K, Irgens LM. Reproductive career after breech presentation: subsequent pregnancy rates, interpregnancy interval, and recurrence. Obstet Gynecol 1998; 92:345.
  16. Ford JB, Roberts CL, Nassar N, et al. Recurrence of breech presentation in consecutive pregnancies. BJOG 2010; 117:830.
  17. Nordtveit TI, Melve KK, Albrechtsen S, Skjaerven R. Maternal and paternal contribution to intergenerational recurrence of breech delivery: population based cohort study. BMJ 2008; 336:872.
  18. Hofmeyr GJ. Abnormal fetal presentation and position. In: Chapter 34, Turnbull's Obstetrics, 2000.
  19. Thorp JM Jr, Jenkins T, Watson W. Utility of Leopold maneuvers in screening for malpresentation. Obstet Gynecol 1991; 78:394.
  20. Powell R, Walker S, Barrett A. Informed consent to breech birth in New Zealand. N Z Med J 2015; 128:85.
  21. Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol 2006; 194:20.
  22. Lockwood CJ. The term, singleton, vaginal breech delivery controversy. J Matern Fetal Neonatal Med 2002; 12:75.
  23. Kotaska A. Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery. BMJ 2004; 329:1039.
  24. Hauth JC, Cunningham FG. Vaginal breech delivery is still justified. Obstet Gynecol 2002; 99:1115.
  25. van Roosmalen J, Rosendaal F. There is still room for disagreement about vaginal delivery of breech infants at term. BJOG 2002; 109:967.
  26. Menticoglou SM. Why vaginal breech delivery should still be offered. J Obstet Gynaecol Can 2006; 28:380.
  27. Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015; :CD000083.
  28. Whyte H, Hannah ME, Saigal S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol 2004; 191:864.
  29. Negele K, Heinrich J, Borte M, et al. Mode of delivery and development of atopic disease during the first 2 years of life. Pediatr Allergy Immunol 2004; 15:48.
  30. Laubereau B, Filipiak-Pittroff B, von Berg A, et al. Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life. Arch Dis Child 2004; 89:993.
  31. Hull AD, Moore TR. Multiple repeat cesareans and the threat of placenta accreta: incidence, diagnosis, management. Clin Perinatol 2011; 38:285.
  32. Schutte JM, Steegers EA, Santema JG, et al. Maternal deaths after elective cesarean section for breech presentation in the Netherlands. Acta Obstet Gynecol Scand 2007; 86:240.
  33. Lawson GW. Report of a breech cesarean section maternal death. Birth 2011; 38:159.
  34. Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev 2015; :CD000166.
  35. Collea JV, Chein C, Quilligan EJ. The randomized management of term frank breech presentation: a study of 208 cases. Am J Obstet Gynecol 1980; 137:235.
  36. Gimovsky ML, Wallace RL, Schifrin BS, Paul RH. Randomized management of the nonfrank breech presentation at term: a preliminary report. Am J Obstet Gynecol 1983; 146:34.
  37. Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356:1375.
  38. Ekéus C, Norman M, Åberg K, et al. Vaginal breech delivery at term and neonatal morbidity and mortality - a population-based cohort study in Sweden. J Matern Fetal Neonatal Med 2017; :1.
  39. Macharey G, Väisänen-Tommiska M, Gissler M, et al. Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study. J Perinat Med 2017.
  40. Hartnack Tharin JE, Rasmussen S, Krebs L. Consequences of the Term Breech Trial in Denmark. Acta Obstet Gynecol Scand 2011; 90:767.
  41. Vistad I, Klungsøyr K, Albrechtsen S, Skjeldestad FE. Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011. Acta Obstet Gynecol Scand 2015; 94:997.
  42. Pasupathy D, Wood AM, Pell JP, et al. Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term. Int J Epidemiol 2009; 38:490.
  43. Lansac J, Crenn-Hebert C, Rivière O, Vendittelli F. How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network. Eur J Obstet Gynecol Reprod Biol 2015; 188:79.
  44. Hehir MP. Trends in vaginal breech delivery. J Epidemiol Community Health 2015; 69:1237.
  45. Weiniger CF, Lyell DJ, Tsen LC, et al. Maternal outcomes of term breech presentation delivery: impact of successful external cephalic version in a nationwide sample of delivery admissions in the United States. BMC Pregnancy Childbirth 2016; 16:150.
  46. Vlemmix F, Bergenhenegouwen L, Schaaf JM, et al. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand 2014; 93:888.
  47. Lyons J, Pressey T, Bartholomew S, et al. Delivery of breech presentation at term gestation in Canada, 2003-2011. Obstet Gynecol 2015; 125:1153.
  48. Goffinet F, Carayol M, Foidart JM, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006; 194:1002.
  49. Maier B, Georgoulopoulos A, Zajc M, et al. Fetal outcome for infants in breech by method of delivery: experiences with a stand-by service system of senior obstetricians and women's choices of mode of delivery. J Perinat Med 2011; 39:385.
  50. Michel S, Drain A, Closset E, et al. Evaluation of a decision protocol for type of delivery of infants in breech presentation at term. Eur J Obstet Gynecol Reprod Biol 2011; 158:194.
  51. Vistad I, Cvancarova M, Hustad BL, Henriksen T. Vaginal breech delivery: results of a prospective registration study. BMC Pregnancy Childbirth 2013; 13:153.
  52. Fonseca A, Silva R, Rato I, et al. Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes? Acta Med Port 2017; 30:479.
  53. Azria E, Le Meaux JP, Khoshnood B, et al. Factors associated with adverse perinatal outcomes for term breech fetuses with planned vaginal delivery. Am J Obstet Gynecol 2012; 207:285.e1.
  54. Robilio PA, Boe NM, Danielsen B, Gilbert WM. Vaginal vs. cesarean delivery for preterm breech presentation of singleton infants in California: a population-based study. J Reprod Med 2007; 52:473.
  55. Kayem G, Baumann R, Goffinet F, et al. Early preterm breech delivery: is a policy of planned vaginal delivery associated with increased risk of neonatal death? Am J Obstet Gynecol 2008; 198:289.e1.
  56. Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2013; :CD000078.
  57. Bergenhenegouwen LA, Meertens LJ, Schaaf J, et al. Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review. Eur J Obstet Gynecol Reprod Biol 2014; 172:1.
  58. Bergenhenegouwen L, Vlemmix F, Ensing S, et al. Preterm Breech Presentation: A Comparison of Intended Vaginal and Intended Cesarean Delivery. Obstet Gynecol 2015; 126:1223.
  59. Hsieh YY, Tsai FJ, Lin CC, et al. Breech deformation complex in neonates. J Reprod Med 2000; 45:933.
  60. Fox AE, Paton RW. The relationship between mode of delivery and developmental dysplasia of the hip in breech infants: a four-year prospective cohort study. J Bone Joint Surg Br 2010; 92:1695.
  61. Azria E, Kayem G, Langer B, et al. Neonatal Mortality and Long-Term Outcome of Infants Born between 27 and 32 Weeks of Gestational Age in Breech Presentation: The EPIPAGE Cohort Study. PLoS One 2016; 11:e0145768.
  62. Macharey G, Gissler M, Rahkonen L, et al. Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study. Arch Gynecol Obstet 2017; 295:833.