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Updated: Apr 30, 2026

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Breech Presentation: Delivery Management and Future Perspectives.

Marta Fiorentini1,2, Bianca Nedu1,2, Fabrizio Dapoto1,2

  • 1Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy.

Maternal-Fetal Medicine (Wolters Kluwer Health, Inc.)
|April 29, 2026
PubMed
Summary

External cephalic version (ECV) is an option for breech presentation, aiming for vaginal delivery. Ultrasonography aids in predicting ECV success and assessing vaginal breech birth risks.

Keywords:
Breech cesarean deliveryBreech presentationBreech progression angleBreech vaginal deliveryExternal cephalic versionTransperineal ultrasound

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Diagnostic Imaging

Background:

  • Breech presentation affects 3-5% of term fetuses, with prevalence decreasing near term.
  • Management decisions for breech presentation are increasingly patient-centered.
  • External cephalic version (ECV) is an alternative to cesarean section for planned vaginal delivery.

Purpose of the Study:

  • To explore the role of ECV and vaginal breech delivery.
  • To highlight the utility of ultrasonography in managing breech presentation.
  • To evaluate novel sonographic parameters for predicting outcomes.

Main Methods:

  • Review of clinical management options for term singleton breech presentation.
  • Assessment of external cephalic version (ECV) success rates (reported 58%).
  • Utilization of transabdominal and transperineal ultrasonography for fetal assessment and prediction of ECV success and vaginal breech birth outcomes.

Main Results:

  • ECV is a viable option for breech presentation at term, with a 58% success rate.
  • Ultrasonography, including placental location and amniotic fluid assessment, aids in predicting ECV success.
  • New sonographic parameters like the breech progression angle show promise in predicting ECV success and assessing vaginal breech delivery risks.

Conclusions:

  • Patient preference is key in managing term breech presentation.
  • ECV and a trial of vaginal breech delivery are options when appropriate.
  • Advanced ultrasonography offers valuable tools for predicting outcomes in breech presentation management.