Azimirad A. What to do when it is breech? A state-of-the-art review on management of breech presentation. World J Obstet Gynecol 2023; 12(1): 1-10 [DOI: 10.5317/wjog.v12.i1.1]
Corresponding Author of This Article
Afshin Azimirad, MD, Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, United States. aazimirad@mgh.harvard.edu
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Obstet Gynecol. Jan 20, 2023; 12(1): 1-10 Published online Jan 20, 2023. doi: 10.5317/wjog.v12.i1.1
What to do when it is breech? A state-of-the-art review on management of breech presentation
Afshin Azimirad
Afshin Azimirad, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA 02111, United States
Afshin Azimirad, Diabetes Clinical Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: Azimirad A contributed to all stages of production of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Afshin Azimirad, MD, Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, United States. aazimirad@mgh.harvard.edu
Received: June 24, 2022 Peer-review started: June 24, 2022 First decision: September 5, 2022 Revised: September 15, 2022 Accepted: December 13, 2022 Article in press: December 13, 2022 Published online: January 20, 2023 Processing time: 223 Days and 21.4 Hours
Abstract
Any non-cephalic presentation in a fetus is regarded as malpresentation. The most common malpresentation, breech, contributes to 3%-5% of term pregnancies and is a leading indication for cesarean delivery. Identification of risk factors and a proper physical examination are beneficial; however, ultrasound is the gold standard for the diagnosis of malpresentations. External cephalic version (ECV) refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation. This procedure is performed manually through the mother’s abdomen by a trained health care provider, to reduce the likelihood of a cesarean section. Studies have reported a version success rate of above 50% by ECV. The main objective of this review is to present a broad perspective on fetal malpresentation, ECV, and delivery of a breech fetus. The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them. After discussing breech prevalence, risk factors, diagnosis, and management, an updated review of ECV is presented. Moreover, ECV indications/contraindications, alternatives, clinical techniques on how to perform ECV and breech vaginal delivery, and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
Core Tip: Breech presentation is a leading indication for cesarean surgery. However, external cephalic version (ECV), with a success chance of above 50%, can be performed at 36 wk of gestation or at 39 wk of gestation in order to convert a non-cephalic presenting fetus to a cephalic presenting. A trial of labor or cesarean delivery can be planned after an unsuccessful ECV. Fetus breech can be delivered by vaginal breech delivery or cesarean delivery. The main objective of this review is to present a broad perspective on fetal malpresentation, ECV, and delivery of a breech fetus.
