Breech presentation and external version

Information to the patient / i / Hospital District of Southwest Finland Department of Obstetrics and Gynaecology

Foetal breech presentation

The occurrence of breech presentation in mature pregnancies is about 3,5 %. In most cases there is no clear reason behind the breech presentation. The foetus strives to conform itself to the space in the womb. Malformations in the womb, such as a binary womb, add to the likelihood of breech presentation. Breech presentations are the most common also when it comes to certain diseases or foetal malformations, and the foetus is also often in breech presentation during the early pregnancy weeks. Also a great amount of amniotic fluid, a short umbilical cord and a placenta that reaches over the orifice of the uterus increase the likelihood of breech presentation.

If it is detected during pregnancy week 35-36 at the child health clinic that the foetus is in breech presentation, the mother is directed to the Maternity Outpatient Ward. At the Maternity Outpatient Ward the foetal presentation is verified with ultrasound.

An external version can be attempted if the foetal breech is still mobile, i.e. if the foetus has not yet attached itself to the pelvis. The womb must not be so sensitive to contractions and the foetus must not be too big. There needs to be enough amniotic fluid and it must be possible to get a good hold of the foetus, this means that the mother cannot be remarkably overweight. The placenta must not cover the entire anterior wall of the womb. After the ultrasound the physician assesses if an external version can be attempted.

If a vaginal delivery is planned with breech representation, a measurement imaging of the pregnant woman’s pelvis is carried out and an external version is not considered.

External version

If needed, the mother can receive a contraction preventing medicine as a spray under the tongue while the external version is being carried out. The foetal condition is checked with ultrasound and before and after the measure the foetal electrocardiogram is taken.

An obstetrician carries out the external version after the ultrasound scan. A nurse follows up the foetal condition with ultrasound; the foetal electrocardiogram, during the length of the external version. The physician tries with his hands to get the foetus to turn by pressing the abdominal wall. The measure can and will be brought to a halt if the mother experiences pain, if changes in the foetal condition are detected or if the external version does not seem to succeed. If it is detected that the foetal heart rate becomes slower during the external version, the aim is to get the foetus back into breech presentation. Short of half of the external versions succeed.

After the version, or the attempt for external version, the foetal electrocardiogram is recorded for about half an hour. It is also important to follow up on the mother’s condition. Pregnant women who to their blood types are Rh-negative are given an anti-D-immunoglobulin protection as an injection in the muscle. The foetal presentation is checked also when the woman comes to deliver.