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  • Dr Peter Chew

Breech pregnancy: What is it? What causes it?

Updated: May 29, 2019

Breech pregnancy means the baby is positioned head up. This means the buttocks and feet will come out first, instead of the head during delivery.


During pregnancy, the baby is surrounded by the amniotic fluid in the amniotic sac. It moves freely in a weightless condition inside the womb. At the early stages of pregnancy, the volume of the amniotic fluid is relatively large in relation to the baby and breech position is quite common.


As pregnancy progresses and in the last trimester, about 97 percent of babies turn spontaneously to the head-down position. Thus, only about three to four percent of babies will remain in a breech position.


Types of Breech Pregnancy Positions

A breech baby may be lying in one of the following positions:


Breech with extended legs or frank breech: This is the most common position where the baby’s legs are straight up against the body in a V shape with legs pointing towards the face.


Breech with flexed legs or complete breech: In this position, the baby is in a sitting position with the legs crossed in front of the body and the feet near the bottom


Footling breech: In this position, one or both of the baby’s feet are hanging below its bottom, so the foot or feet are coming out first during vaginal delivery.


Causes

In most cases, there is no obvious reason why the baby remains in a breech position.

But some conditions may make the baby easier to poise in a bottom-down position. These include:


· Premature birth: In this situation, the baby does not have enough time to turn head down.


· Distorted shape of the womb : Normally, the cavity of the womb is shaped like an inverted triangle with a flat top. But some mothers may be born with a womb that has a dip or indentation at the top (arcuate uterus) or the cavity may be divided by a muscular wall (septate uterus) (see fig 1&2)

Fig 1

Fig 2

These conditions will make the baby difficult to turn to a head down position.


· Uterine fibroids: These muscle growths may distort the shape of the womb.


· Low-lying placenta (placenta previa). This condition may prevent the baby from having enough space to position itself correctly.


· Excessive or scanty amniotic fluid: Too much amniotic fluid allows the baby to assume any position it likes; reduced amount of amniotic fluid, on the other hand, makes it difficult for the baby to move around.


· Multiple pregnancies: When there are more than one baby, foetal movements may be limited,


· Short umbilical cord. When the cord wraps around the baby, its movement is limited.


· Birth orders: Some first-time mums with a tight abdomen are more likely to have a breech pregnancy. On the other hand, mothers who have delivered five or more babies may have loose abdominal muscles. They have increased chances of a breech birth.


· Studies have shown that women with previous Caesarean section have a higher chance of breech birth than that of women with previous vaginal deliveries