CuraRN

Breech and Limb Presentations

Student study notes from paramedic coursework (2023 to 2024), not medical advice. Verify clinical values against current references and your local protocols.

EMS etiologies

Setting: OB/GYN

Breech presentation refers to the fetus in the longitudinal orientation with the buttocks or lower extremity entering the maternal pelvis first. The three types of breech presentation:

• frank breech - both hips flexed, and the legs are straight with the feet near the fetal face
• pike position - the fetus sitting with both hips flexed and both legs in a tuck position
• incomplete breech - any combination of one or both hips extended, also known as footling (one leg extended) breech, or double footling breech (both legs extended)

Clinical Presentation

The baby’s buttocks or feet are positioned to come out first during delivery. Ultrasound scan will show the baby’s position in the uterus. The baby’s heartbeat may be difficult to locate using a stethoscope or Doppler device.

Treatment Modalities

External cephalic version (ECV) is a procedure in which pressure is applied to the mother’s abdomen to try to turn the baby into a head-down/ head first position. If the baby remains in the breech position and ECV is unsuccessful or not possible, a cesarean section may be recommended. Some situations dictate a vaginal breech delivery but this requires expertise and is not a recommended course.