Breech presentation at term and external cephalic version

It is a Thursday antenatal clinic. A 37-year-old primigravida is 36 weeks by dates, and the midwife cannot feel a head in the pelvis. You confirm a breech on ultrasound and you have ten minutes to decide what to offer, how to counsel, and what you would say if she asks whether a vaginal birth is possible. This topic is that conversation.^[9][10]

Overview and definition

Breech presentation is a longitudinal lie with the fetal buttocks presenting. Roughly 3-4% of pregnancies are breech at term, and the rate falls steadily through the third trimester as fetuses turn spontaneously — which is why prematurity, polyhydramnios and uterine anomaly all predispose to breech.^[9]

The three types, and the mode-of-birth implications that ride on them: ^[9][10]

• Frank breech — hips flexed, knees extended, feet by the ears. The most common type and, with a flexed head and adequate pelvis, a candidate for planned vaginal birth.
• Complete breech — hips and knees flexed, the baby sitting cross-legged. Also a possible vaginal-birth candidate under strict criteria.
• Incomplete (footling) breech — one or both feet presenting below the buttocks. A higher risk of cord prolapse and head entrapment; planned caesarean is the default.^[9]

RANZCOG C-Obs 11 (Management of breech presentation at term) is the ANZ statement; RCOG Green-top 20a (ECV) and 20b (breech at term) are the UK framework. Both anchor the answer to any station.^[9][10]

References12ShowHide

1. [1]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.PMID 11052579
2. [2]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.PMID 16580289
3. [3]Hofmeyr GJ, Hannah M, Lawrie TA Planned caesarean section for term breech delivery Cochrane Database Syst Rev, 2015.PMID 26196961
4. [4]Hofmeyr GJ, Kulier R, West HM External cephalic version for breech presentation at term Cochrane Database Syst Rev, 2015.PMID 25828903
5. [5]Coyle ME, Smith C, Peat B Cephalic version by moxibustion for breech presentation Cochrane Database Syst Rev, 2023.PMID 37158339
6. [6]Ainsworth A, Sviggum HP, Tolcher MC, et al. Lessons learned from a single institution's retrospective analysis of emergent cesarean delivery following external cephalic version with and without neuraxial anesthesia Int J Obstet Anesth, 2017.PMID 28499551
7. [7]Collaris RJ, Oei SG External cephalic version: a safe procedure? A systematic review of version-related risks Acta Obstet Gynecol Scand, 2004.PMID 15144330
8. [8]Liu S, Chen L, Liao G, et al. Predictors of a successful external cephalic version: a population-based cohort study BMC Pregnancy Childbirth, 2026.PMID 42260397
9. [9]Fiorentini M, Nedu B, Dapoto F, et al. Breech Presentation: Delivery Management and Future Perspectives Matern Fetal Med, 2026.PMID 42051645
10. [10]van Dijk MR, Papatsonis C, Ganzevoort W, et al. Contraindications in national guidelines for vaginal breech delivery at term: Comparison, consensus, and controversy Acta Obstet Gynecol Scand, 2024.PMID 39154352
11. [11]Rietberg CC, Elferink-Stinkens PM, Brand R, et al. Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants BJOG, 2003.PMID 12798480
12. [12]Schmidt J, Hentrich AE, Kämpf AK, et al. Evidence for the benefit of prenatal pelvimetry in breech presentation at term: A low intertuberous distance is associated with assisted head delivery and short-term neonatal morbidity Int J Gynaecol Obstet, 2026.PMID 41479255