Breech Presentation

A malpresentation of the FETUS at near term or during OBSTETRIC LABOR with the fetal cephalic pole in the fundus of the UTERUS. There are three types of breech: the complete breech with flexed hips and knees; the incomplete breech with one or both hips partially or fully extended; the frank breech with flexed hips and extended knees.

Also Known As:

Complete Breech; Frank Breech Presentation; Incomplete Breech; Breech Fetal Presentation; Breech Labor Presentation; Breech Presentation, Frank; Breech, Complete; Breech, Incomplete; Presentation, Breech Fetal; Presentation, Breech Labor; Presentation, Frank Breech; Fetal Presentation, Breech; Labor Presentation, Breech; Presentation, Breech

Networked: 1091 relevant articles (34 outcomes, 135 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Birth Weight (Birth Weights)
2.	Wounds and Injuries (Trauma)
3.	Vomiting
4.	Nausea
5.	Premature Obstetric Labor (Premature Labor)

Experts

1.	Hofmeyr, G J: 12 articles (07/2006 - 01/2000)
2.	Kok, Marjolein: 8 articles (09/2018 - 08/2008)
3.	Roberts, Christine L: 8 articles (07/2017 - 08/2003)
4.	Hofmeyr, G Justus: 8 articles (07/2015 - 01/2012)
5.	Nassar, Natasha: 7 articles (12/2016 - 08/2003)
6.	Vlemmix, Floortje: 6 articles (09/2018 - 03/2013)
7.	Peat, Brian: 6 articles (05/2012 - 08/2003)
8.	Subtil, D: 5 articles (06/2022 - 02/2004)
9.	Gissler, Mika: 5 articles (03/2022 - 01/2019)
10.	Ramanah, R: 5 articles (12/2018 - 09/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Breech Presentation:

1.	Bupivacaine (Bupivacaine Hydrochloride)FDA LinkGeneric 06/19/2020 - "The objective of this study is to appraise the efficacy and safety of bupivacaine in pregnant participants with breech presentation (BP) receiving external cephalic version (ECV). " 10/01/2017 - "Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial." 06/19/2020 - "Anesthesia efficacy of bupivacaine in pregnant participants with breech presentation receiving external cephalic version: A protocol of systematic review of randomized controlled trials." 12/01/2007 - "Nulliparous women at term requesting external cephalic version for breech presentation were randomized to receive spinal analgesia (7.5 mg bupivacaine) or no analgesia before the external cephalic version. " 10/01/2017 - "We conducted a randomized, double-blind trial to assess the effect of four intrathecal bupivacaine doses (2.5, 5.0, 7.5, 10.0 mg) combined with fentanyl 15 μg on the success rate of external cephalic version for breech presentation. "
2.	Remifentanil (Ultiva)FDA Link 10/01/2023 - "The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. " 12/01/2016 - "A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation." 03/01/2017 - "Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term: A randomized controlled trial." 03/01/2017 - "The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term. "
3.	Ritodrine (Yutopar)FDA Link 07/01/1984 - "The effect of external version under tocolysis with intravenous ritodrine during the 37th week of gestation was studied in a prospective randomized trial comprising 130 consecutive women with a fetus in breech presentation. " 01/01/2005 - "To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre. " 01/01/2005 - "External cephalic version significantly reduced the rate of cesarean section in breech presentation, and ritodrine tocolysis improved the success of ECV and should be offered to both nulliparous and parous women in the case of term breech presentation." 03/25/2021 - "At 36 weeks of gestation, she went into preterm labor, with premature rupture of the membrane and breech presentation, and received an infusion of ritodrine hydrochloride for a few hours. " 11/19/1988 - "Reasons for exclusion were: refusal, antepartum haemorrhage, cardiac disease, breech presentation, multiple pregnancy, intrauterine death, and, after May 1986, ritodrine given two hours before delivery, anticoagulant treatment, and any condition needing a particular management of third stage. "
4.	Oxytocin (Pitocin)FDA LinkGeneric 03/01/1970 - "[The use of oxytocin in breech presentation]." 09/15/1965 - "OXYTOCIN IN BREECH PRESENTATION." 04/18/2005 - "Moxibustion may be beneficial in reducing the need for ECV, and decreasing the use of ocytocin, however there is a need for well-designed randomised controlled trials to evaluate moxibustion for breech presentation which report on clinically relevant outcomes as well as the safety of the intervention." 04/01/2002 - "On the other hand, Solihull showed more frequent oxytocin administration, fetal blood analysis, epidural anaesthesia, episiotomies, duration of labour > 13 hours, forceps, ventouse and emergency caesarean section deliveries from cephalic presentation, vaginal deliveries or emergency caesarean sections from breech presentation, resuscitation of the newborn using mask and/or drugs, maternal blood loss > 1 000 ml as well as abnormalities of placental separation. " 02/01/1982 - "4) Certain basic safety requirements such as available operating room facilities and adequate personnel for careful observation are mandatory, but other management policies that remain controversial include use of regional anesthesia, oxytocin administration, timing of hospital admission, artificial rupture of membranes, mode of delivery, proper method to evaluate the uterine scar, and delivery of fetuses in breech presentation and twins. "
5.	Anti-Bacterial Agents (Antibiotics)IBA 01/01/2020 - "The patient's condition improved within 24 hours of symptom onset, prior to antibiotic initiation, and a premature, viable male infant at 29 weeks and 6 days of gestation was delivered via caesarean section four days later due to breech presentation in the setting of preterm labor. "
6.	SmokeIBA 07/16/2023 - "This study confirmed breech presentation risk factors maternal age, nulliparity, tobacco smoke, a previous cesarean delivery (CD), neonatal female sex, gestational age, and birth weight. " 10/01/2021 - "Smoke or smokeless moxibustion treatment for breech presentation: A three-arm pilot trial."
7.	salicylhydroxamic acid (SHAM)IBA 09/01/2016 - "Acupuncture version of breech presentation: a randomized sham-controlled single-blinded trial." 03/01/2013 - "This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33-35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. "
8.	Oxygen (Dioxygen)IBA 11/01/2013 - "A prospective comparative cohort study among 300 women with singleton pregnancy in breech presentation at term undergoing an ECV with inhaled N2O in a 50:50 mix with oxygen for analgesia and 150 ECVs with no analgesia. " 10/01/1989 - "Umbilical blood-gas status at elective cesarean section with oxygen inhalation for breech presentation (25 cases) was compared with that for vertex presentation (25 cases), so as to confirm the security of full-term breech fetuses delivered by cesarean section under spinal anesthesia. " 01/01/1980 - "Significant deterioration of oxygen supply, as compared to a control group, was recordable from high-risk births, infants delivered from breech presentation by the vaginal route, and from newborns with neonatal acidosis. " 02/01/2021 - "Our study sought to determine whether or not nitrous oxide analgesia decreases pain compared to oxygen placebo during external cephalic version for breech presentation. " 08/01/2000 - "To determine oxygen free radical activity in breech presentation at birth and relate it to umbilical cord blood acid-base status. "
9.	Thyrotropin (Thyroid-Stimulating Hormone)FDA Link 11/01/2010 - "To study the relationship between maternal thyrotrophin (TSH) and breech presentation at term. " 04/01/2016 - "Increased TSH in pregnancy, defined as thyroid stimulating hormone (TSH) >97.5th percentile (>3.53mIU/L), was associated with a higher risk for breech presentation at term (aOR 2.32, CI 1.1-4.8, p=0.02) compared to euthyroidism (TSH between 2.5th and 97.5th percentile). " 11/01/2010 - "High thyrotrophin levels at end term increase the risk of breech presentation." 01/01/1997 - "Cord blood thyrotrophin (TSH) levels of 134 patients with singleton pregnancies and breech presentation at delivery were compared with those of cephalic-presenting controls matched for mode of delivery, the presence of labour, parity, and the date of delivery. " 10/01/2001 - "To investigate the relationship between breech presentation, external cephalic version and levels of cord blood thyroid stimulating hormone. "
10.	Terbutaline (Brethaire)FDA LinkGeneric 08/01/1995 - "The study spanned the period from 1985 to 1993, enrolling 113 subjects who presented to our OB/GYN Department with any type of breech presentation at 37 weeks' gestation or greater and met the following criteria: (1) absence of labour or ruptured membranes, (2) singleton pregnancy, (3) absence of medical or obstetrical complications and amniotic fluid index of greater than 8 cm. After a reassuring fetal assessment, IV terbutaline was given prior to an attempt at version. " 03/01/2021 - "A dedicated ECV clinic with experienced operators and the use of intravenous terbutaline could improve success rate of ECV and reduce the number of Caesareans for breech presentation." 11/01/1997 - "Four of the 27 (15%) successful versions in the terbutaline group and three of the 14 (21%) successful versions in the placebo group spontaneously reverted to breech presentation. " 10/01/1986 - "Terbutaline (20 micrograms/min) was infused during 30 min in 17 women in whom a manual external manipulation of a breech presentation was going to be attempted. "

Therapies and Procedures

1.	Fetal Version (External Cephalic Version) 03/01/2014 - "external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. " 01/01/2021 - "Determining the efficacy of performance of a second external cephalic version (ECV) following successful first ECV with subsequent spontaneous reinversion to breech presentation in reducing the rate of cesarean delivery (CD). " 01/01/2021 - "Efficacy of a second external cephalic version (ECV) after a successful first external cephalic version with subsequent spontaneous reinversion to breech presentation: a retrospective cohort study." 01/01/2016 - "Overall a low proportion of women with breech presentation undergo successful external cephalic version, and it is associated with significant reduction in the frequency of cesarean delivery and a number of measures of maternal morbidity. " 02/10/2023 - "External cephalic version (ECV) is a cost-effective and safe treatment option for breech presentation at term. "
2.	Cesarean Section (Caesarean Section) 08/01/2011 - "Does caesarean section provide the best outcome for mother and baby in breech presentation? " 08/01/1998 - "The study was conducted because of the still considerable controversies about the variation in obstetric management in breech presentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the assumed improvement in neonatal and maternal morbidity and mortality obtained by increasing section rate in breeches. " 03/01/2021 - "ECV is a safe and effective procedure to reduce Caesarean section rates secondary to breech presentation. " 02/06/2010 - "For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively). " 01/01/1991 - "ECV reduced the frequency of breech presentation during labour from 83% to 17% and that of caesarean section from 33% to 13%. "
3.	Moxibustion 04/01/2004 - "Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. " 11/05/2010 - "Relatively clear evidence emerged to suggest that moxibustion is effective for breech presentation. " 12/01/2012 - "Despite a lack of scientific evidence supporting the use of moxibustion to address breech presentation, pregnant women consider CAMs, in general, to be safe and effective. " 01/01/2001 - "Acupuncture stimulation, especially with moxibustion, is expected to serve as a safe and effective modality in the management of breech presentation in a clinical setting." 11/01/2009 - "To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the cephalic version of fetuses in breech presentation and the acceptability of this method by women. "
4.	Induced Labor 01/01/1976 - "(6) The infusion of PG F2alpha is effective for the induction of labor in older primiparae, cases of breech presentation and suspected cases of CPD. " 01/01/2019 - "Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. " 03/01/2018 - "This study aims to summarize the effect of induction of labor of breech presentation on perinatal morbidity. " 03/01/2018 - "Few studies have assessed the impact of induction of labor on breech presentation. " 01/01/1998 - "We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. "
5.	Tocolysis 04/01/2015 - "Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation. " 10/17/2012 - "Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation. " 03/01/2000 - "Phase 1 was to develop a scoring system from 53 versions with singleton pregnancy in breech presentation at term using a standard protocol with fetal monitoring, ultrasound assessment and tocolysis. " 07/01/1984 - "We advise external version under tocolysis in late pregnancy to reduce the frequency of breech presentation in labour." 02/01/1975 - "It appears that a cause of failur of the external version with tocolysis near term is the breech presentation with extended legs."