10.1. BACKGROUND
The incidence rate of breech presentation decreases from 40% at 24 weeks gestation to 3% at 40 weeks as most fetuses (over 90%) change their presentation to cephalic spontaneously by the end of pregnancy. This apparently reflects a congenital ability of a mature active fetus to assume the most convenient position that is congruent to the uterine cavity whose shape is like that of pear turned upside down. Breech presentation can be associated with anomaly of the fetus itself, pathological volume of amniotic fluid, specific localization of the placenta, relative shortness of the umbilical cord due to its entanglement. The higher rates of neonatal mortality and morbidity in breech presentation are associated, first of all, with fetal immaturity, congenital anomalies of development (predominantly of the CNS), as well as with asphyxiation or trauma during labor.
The main method of decreasing the rate of adverse neonatal outcomes in breech presentation is cesarean section. Over the recent decade in most countries of Western Europe, USA and Canada elective cesarean section has become almost the only acceptable method of delivery in breech presentation. In 1970 about 14% of fetuses in breech presentation were delivered via cesarean section. According to the National Center for Health Statistics in the USA, in 2005 the incidence rate of cesarean section in breech presentation amounted to 87.2%.
10.2. DEFINITION
Breech presentation is a situation when the fetus is in longitudinal lie, and the presenting part is the pelvic pole (the buttocks, buttocks and feet, feet, knees).
10.3. ICD-10 CODE
O32.1. Maternal care for breech presentation
10.4. TERMINOLOGY
Terms
Breech presentation (Middle English breeches, from Old English brec, plural of broc leg).