Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower

extremity entering the pelvis first. The three types of breech presentation include frank breech,
complete breech, and incomplete breech. In a frank breech, the fetus has flexion of both hips, and
the legs are straight with the feet near the fetal face, in a pike position. The complete breech has
the fetus sitting with flexion of both hips and both legs in a tuck position. Finally, the incomplete
breech can have any combination of one or both hips extended, also known as footling (one leg
extended) breech, or double footling breech (both legs extended).

Base on NCBI bookshelf (article by:Caron J. Gray; Meaghan M. Shanahan) it is a

conditions associated with breech presentation include those that may increase or decrease fetal
motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations,
aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental
polarity as in placenta previa are most commonly associated with a breech presentation. Also,
a previous history of breech presentation at term increases the risk of repeat breech presentation
at term in subsequent pregnancies.

During the physical exam, using the Leopold maneuvers, palpation of a hard, round,
mobile structure at the fundus and the inability to palpate a presenting part in the lower abdomen
superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a
breech presentation. And, during a cervical exam, findings may include the lack of a palpable
presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech,
palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring,
caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal
vertex.
Any of these findings should raise suspicion and ultrasound should be performed.As mentioned
previously, the most common clinical conditions or disease processes that result in the breech
presentation are those that affect fetal motility or the vertical polarity of the uterine cavity.
Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of
the fetus to turn into the vertex presentation in the third trimester include:
 Mullerian anomalies: Septate uterus, bicornuate uterus, and didelphys uterus
 Placentation: Placenta previa as the placenta is occupying the inferior portion of the
uterine cavity. Therefore, the presenting part cannot engage
 Uterine leiomyoma: Mainly larger myomas located in the lower uterine segment, often
intramural or submucosal, that prevent engagement of the presenting part.
 Prematurity
 Aneuploidies and fetal neuromuscular disorders commonly cause hypotonia of the fetus,
inability to move effectively
 Congenital anomalies: Fetal sacrococcygeal teratoma, fetal thyroid goiter
 Polyhydramnios: Fetus is often in unstable lie, unable to engage
  Oligohydramnios: Fetus is unable to turn to vertex due to lack of fluid
 Laxity of the maternal abdominal wall: Uterus falls forward, the fetus is unable to engage
in the pelvis.
The risk of cord prolapse varies depending on the type of breech. Incomplete or footling
breech carries the highest risk of cord prolapse at 15% to 18%, while complete breech is lower at
4% to 6%, and frank breech is uncommon at 0.5%.

Epidemiology

Breech presentation occurs in 3% to 4% of all term pregnancies. A higher percentage of

breech presentations occurs with less advanced gestational age. At 32 weeks, 7% of fetuses are
breech, and 28 weeks or less, 25% are breech.

Specifically, following one breech delivery, the recurrence rate for the second pregnancy
was nearly 10%, and for a subsequent third pregnancy, it was 27%. Prior cesarean delivery has
also been described by some to increase the incidence of breech presentation two-fold.

https://www.ncbi.nlm.nih.gov/books/NBK448063/

https://emedicine.medscape.com/article/262159-overview