What are the recommended delivery options for a term breech presentation, and how do they differ based on maternal and fetal factors?

For a term singleton pregnancy with breech presentation confirmed after 36+0 weeks, the recommended delivery options include external cephalic version (ECV), planned vaginal breech birth, and elective caesarean section. Women should be offered detailed discussion about the benefits, risks, and implications of each option to support shared decision making tailored to their preferences and clinical circumstances ¹.

External cephalic version is recommended for women with uncomplicated singleton breech pregnancies after 36+0 weeks unless contraindications exist such as established labour, fetal compromise, ruptured membranes, vaginal bleeding, or significant maternal medical conditions (e.g., severe hypertension) ¹,². ECV aims to turn the fetus to a cephalic presentation to facilitate vaginal birth and reduce the need for caesarean section ¹.

Planned vaginal breech birth may be considered for selected women who understand the increased risks compared to cephalic vaginal birth and who have no contraindications such as fetal compromise or other obstetric complications. In labour, women with breech presentation should be counselled about the risks and benefits of continuing vaginal birth versus caesarean section, including the increased risk of serious neonatal complications with vaginal breech birth and increased maternal risks with caesarean section ¹,²,³. Continuous fetal monitoring and careful labour assessment are essential ³.

Elective caesarean section is often offered to reduce neonatal risks associated with vaginal breech birth, especially when ECV is unsuccessful or contraindicated, or when maternal or fetal factors increase risk. Before planned caesarean for breech, an ultrasound should confirm fetal presentation as close to the procedure as possible ². Maternal choice for caesarean birth without medical indication should be supported after balanced discussion of risks and benefits, including mental health considerations such as tokophobia ².

Maternal and fetal factors influencing delivery options include:

• Maternal medical conditions (e.g., severe hypertension) contraindicating ECV or vaginal birth ¹,²
• Fetal compromise or suspected small-for-gestational-age status, which may increase risks with vaginal breech birth and influence decision towards caesarean ¹,³
• Obstetric complications such as placenta praevia, which necessitate caesarean birth ²
• Labour status: ECV is not offered in established labour; mode of birth decisions in labour depend on progress and fetal condition ¹,³
• Maternal preferences and psychological factors, which should be respected and supported with appropriate information and mental health support ¹,²

In summary, the management of term breech presentation involves offering ECV to reduce breech births, considering planned vaginal breech birth in selected cases with informed consent, and elective caesarean section when indicated or chosen by the woman. Individual maternal and fetal factors guide the safest and most acceptable delivery option ¹,²,³. Recent literature (Sentilhes et al., 2020) supports these approaches, emphasizing individualized care and multidisciplinary decision making to optimize outcomes for mother and baby (Sentilhes et al., 2020).