Approach to women considering vaginal delivery of the singleton pregnancy with persistent breech presentation

* The optimum estimated fetal weight thresholds to minimize risk of morbidity with vaginal breech birth vary among guidelines. For example, some use a minimum threshold of 2500 grams or a maximum threshold of 3500 or 3800 grams.
¶ Hyperextension is usually defined as a cervical spine extension angle ≥90 degrees. On ultrasound, the axis of the face is a perpendicular line with the axis of the fetal body.
Δ The operator uses his/her fingers to exert pressure on the back of the knee and guide the thigh away from the trunk as the trunk is rotated in the opposite direction. This causes the knee to flex and allows extraction of the foot and the leg.
◊ Refer to UpToDate topic on Delivery of the fetus in breech presentation.
§ The middle finger of one hand is placed on the maxilla, and the second and fourth fingers are placed on the malar eminences to promote flexion and descent while counterpressure is applied to the occiput with the middle finger of the other hand.