Fetal Presentation, Position, and Lie (Including Breech Presentation)
- Key Points |
Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .
Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are
Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)
Fetal position: Relation of the presenting part to an anatomic axis; for transverse presentation, occiput anterior, occiput posterior, occiput transverse
Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse
Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.
Abnormal fetal lie, presentation, or position may occur with
Fetopelvic disproportion (fetus too large for the pelvic inlet)
Fetal congenital anomalies
Uterine structural abnormalities (eg, fibroids, synechiae)
Multiple gestation
Several common types of abnormal lie or presentation are discussed here.
Transverse lie
Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.
Breech presentation
There are several types of breech presentation.
Frank breech: The fetal hips are flexed, and the knees extended (pike position).
Complete breech: The fetus seems to be sitting with hips and knees flexed.
Single or double footling presentation: One or both legs are completely extended and present before the buttocks.
Types of breech presentations
Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.
Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.
Predisposing factors for breech presentation include
Preterm labor
Uterine abnormalities
Fetal anomalies
If delivery is vaginal, breech presentation may increase risk of
Umbilical cord prolapse
Birth trauma
Perinatal death
Face or brow presentation
In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.
Brow presentation usually converts spontaneously to vertex or face presentation.
Occiput posterior position
The most common abnormal position is occiput posterior.
The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.
Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.
Position and Presentation of the Fetus
If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.
In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.
For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.
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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 ...
The main types of breech presentation are: Frank breech - Both hips are flexed and both knees are extended so that the feet are adjacent to the head ( figure 1 ); accounts for 50 to 70 percent of breech fetuses at term. Complete breech - Both hips and both knees are flexed ( figure 2 ); accounts for 5 to 10 percent of breech fetuses at term.
Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.
Breech presentation refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency cesarean section and placenta previa; and for the baby in terms of preterm birth, small fetal size, congenital anomalies, and perinatal mortality.
At full term, around 3%-4% of births are breech. The different types of breech presentations include: Complete: The fetus's knees are bent, and the buttocks are presenting first. Frank: The fetus's legs are stretched upward toward the head, and the buttocks are presenting first. Footling: The fetus's foot is showing first.
In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.. In brow presentation, the neck is moderately arched so that the brow presents first.. Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor.
Breech presentation occurs in 3-4% of term deliveries and is more common in preterm deliveries and nulliparous women. Breech presentation is associated with uterine and congenital abnormalities, and has a significant recurrence risk. Term babies presenting by the breech have worse outcomes than cephalic presenting babies, irrespective of the ...
Breech presentation: clinical practice guideline from the French College of Gynaecologists and Obstetricians [2020] ... The lack of a standard definition of a footling breech is problematic because the term is open to interpretation and will invariably lead to a higher rate of C/S for breech in this setting, further limiting birth mode options ...
Overview. Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of ...
Introduction. Breech presentation of the fetus in late pregnancy may result in prolonged or obstructed labour with resulting risks to both woman and fetus. Interventions to correct breech presentation (to cephalic) before labour and birth are important for the woman's and the baby's health. The aim of this review is to determine the most ...
Breech presentation is a type of malpresentation and occurs when the fetal head lies over the uterine fundus and fetal buttocks or feet present over the maternal pelvis (instead of cephalic/head presentation). The incidence in the United Kingdom of breech presentation is 3-4% of all fetuses. 1.
Presentation of the feet or buttocks of the foetus. 6.1.1 The different breech presentations. In a complete breech presentation, the legs are tucked, and the foetus is in a crouching position (Figure 6.1a).; In a frank breech presentation, the legs are extended, raised in front of the torso, with the feet near the head (Figure 6.1b).; In a footling breech presentation (rare), one or both feet ...
Complex (Compound) Presentation Breech Presentation. Definition. It is the presence of a limb alongside the presenting part usually the arm presents with the head. Incidence. About 1:800 labours. Aetiology. Interference of adaptation of the presenting part to the pelvic brim which may be: Foetal causes: Malpresentations.
1. Background. The management of breech presentation continues to cause academic and clinical contention globally [[1], [2], [3]].In recent years, research has shown that if certain criteria are met, and appropriately experienced and skilled clinicians are available, Vaginal Breech Birth (VBB) is a safe option [[4], [5], [6]].However, with Caesarean Section (C/S) rates for breech presentation ...
Move the towel up to cover the arms and rotate the body to make the back anterior. To deliver the head, place your index and middle fingers of one hand over the fetal maxilla to flex the head, while the body rests on your palm and forearm, as shown here. With your other hand, hook 2 fingers over the neck, grasp the shoulder, and apply gentle ...
breech presentation occurs when a fetus is positioned logitudinally with the buttocks or feet closest to the mother's cervix. complete breech. flexion of the hips and knees. incomplete (footling) breech. some deflexion of one hip and knee. frank breech. flexion of both hips with extension of both knees. Epidemiology.
Introduction. Breech presentation means the baby is lying longitudinally with its bottom and/or feet presenting first to the lower part of the mother's uterus. (RANZCOG, 2016). Breech occurs in 3-4% of term deliveries and is more common in preterm.
This chapter presents an easy-to-follow algorithm for obstetric management of the risks associated with breech presentation. The diagnosis of breech presentation can be made by physical examination vaginal examination or ultrasound. Ultrasound will also determine the type of breech: frank, complete or incomplete/footling breech. Fetal ...
Types of breech presentations Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) — dedicated to using leading-edge science to save and improve lives around the world.
A breech presentation is difficult, even for a veterinarian (to push the foal deeper into the uterus and try to get each hind leg up over the pelvis), and the foal may have to be delivered by Caesarean section. Any malpresentation is best handled by an equine veterinarian, but time is crucial.
Breech births also occur in many other mammals such as dogs and horses, see veterinary obstetrics. ... Complete breech presentation is the next most favorable position, but these babies sometimes shift and become footling breeches during labour. Footling and kneeling breeches have a higher risk of cord prolapse and head entrapment.
The meaning of BREECH PRESENTATION is presentation of the fetus in which the breech is the first part to appear at the uterine cervix. ... Share the Definition of breech presentation on Twitter Twitter. Medical Definition. breech presentation. noun: ...
The fetus whose presenting part is the buttocks and/or feet. What is the epidemiology of breech presentation? Occurs in 3-5% of fetuses at term (37-40 weeks). -Spontaneous version may occur at any time prior to delivery. Risks of breech presentation include developmental dysplasia of the hip, torticollis and mild deformations.