Breech Presentation: Delivery Management and Future Perspectives

Breech presentation is a relatively common fetal malposition, affecting 3% to 5% of fetuses at term. Although various clinical conditions are associated with breech presentation, its prevalence decreases as gestational age progresses toward term. Despite ongoing global academic and clinical debates on the management of breech presentation, there is a growing recognition that the decision on the mode of delivery should consider the patient's preferences. Adequate counseling on available options is crucial. For patients with a term singleton fetus in a breech position who prefer a planned vaginal delivery, the external cephalic version (ECV) serves as an alternative to planned cesarean section (CS). ECV involves gently manipulating the fetus on the mother's abdomen to achieve a cephalic presentation, with a reported success rate of 58%. The procedure is typically performed at or after 37 weeks, and a thorough assessment of fetal well-being is mandatory. While short-term benefits of planned CS for term breech presentation have been demonstrated in neonatal and maternal outcomes, a trial of breech vaginal delivery can be considered in the absence of contraindications and based on the patient's preference. It is crucial for an experienced healthcare provider to offer appropriate assistance to ensure maternal and child well-being and minimize complications, whether attempting a vaginal birth or opting for a CS for breech presentation. Ultrasonography plays a crucial role in diagnosing breech presentation, and transabdominal ultrasound can offer valuable information for predicting ECV success, including placental location and amniotic fluid quantity. Emerging techniques in ultrasonography, such as transperineal ultrasound to assess fetal presenting part engagement and transabdominal ultrasound to evaluate fetal head flexion and position, are increasingly employed in labor ward evaluations. The recently introduced breech progression angle, a transperineal sonographic parameter, holds promise as a reliable tool not only for predicting ECV success but also for assessing the risk of cesarean delivery in patients who will undergo a trial of breech vaginal delivery.