Medical Disclaimer: This article is intended for educational and informational purposes only. It does not substitute professional medical advice, diagnosis, or treatment. Pregnant individuals should consult a licensed obstetrician or qualified healthcare professional for personalized care and delivery planning.

Footling Breech Presentation: Causes, Diagnosis, and Management

Evidence-based educational content by Dr Humaira Latif
Registered Medical Practitioner | Gynecology & Obstetrics Specialist (14+ Years Clinical Experience)

Footling breech presentation is a less common type of fetal malpresentation in which one or both fetal feet are positioned to descend into the birth canal first. Although breech presentations can occur during pregnancy, footling breech is considered a higher-risk variant due to its association with labor complications. Early recognition and appropriate clinical planning play an important role in improving maternal and fetal outcomes.

This article provides a clear, compassionate, and educational overview of footling breech presentation, including its causes, methods of diagnosis, possible risks, and commonly recommended management approaches, in line with international obstetric guidance.

1. What Is Footling Breech Presentation?

In normal pregnancy, the fetus usually assumes a head-down (cephalic) position by late third trimester. Breech presentation refers to any fetal position in which the buttocks or lower limbs present first. Footling breech is a specific subtype where:

• One foot (single footling breech) or
• Both feet (double footling breech)

are positioned below the fetal buttocks and may be closest to the cervix.

2. Types of Breech Presentation

Type	Description
Frank Breech	Buttocks present first, legs extended upward
Complete Breech	Buttocks present first, hips and knees flexed
Footling Breech	One or both feet present first (higher clinical risk)

3. Causes and Risk Factors of Footling Breech Presentation

Several maternal, fetal, and placental factors may influence fetal positioning. Commonly recognized associations include:

• Prematurity: Breech positions are more frequent before 37 weeks
• Uterine factors: Fibroids, uterine anomalies, or previous uterine surgery
• Amniotic fluid imbalance: Polyhydramnios or oligohydramnios
• Multiple pregnancy: Twins or higher-order gestations
• Placental location: Low-lying placenta or placenta previa
• Fetal factors: Congenital anomalies or reduced fetal movements

4. Diagnosis of Footling Breech Presentation

Diagnosis is usually made during routine antenatal care. Common diagnostic methods include:

1. Clinical abdominal examination: Irregular presenting part or absence of head in lower abdomen
2. Ultrasound examination: Confirms fetal position, limb placement, and gestational age
3. Late pregnancy monitoring: Especially important in women with known risk factors

Ultrasound remains the most reliable and non-invasive method for confirming footling breech presentation.

5. Possible Risks and Clinical Considerations

Footling breech presentation requires careful obstetric evaluation because it may be associated with:

• Increased risk of umbilical cord prolapse
• Prolonged or obstructed labor
• Higher likelihood of operative delivery
• Potential birth trauma during vaginal delivery

These considerations guide clinical decision-making and delivery planning.

6. Management and Delivery Planning

Management depends on gestational age, maternal health, fetal wellbeing, and available clinical expertise. Common approaches include:

1. Planned Cesarean Delivery: Often recommended due to safety considerations
2. External Cephalic Version (ECV): May be considered before labor in selected cases
3. Specialist-led Care: Delivery planning in a facility with emergency obstetric services
4. Close Monitoring: Continuous fetal assessment when labor begins

Management Option	Purpose
Cesarean Section	Reduces delivery-related complications
ECV	Attempts to turn fetus to head-down position
Antenatal Monitoring	Ensures timely identification of risks

7. Emotional Support and Pregnancy Care

High-risk pregnancy diagnoses can cause emotional stress. Clear communication, culturally sensitive counseling, and access to educational resources help families feel informed and supported.

Supportive educational materials, including multilingual pregnancy guides and compassionate counseling resources, play a valuable role in holistic maternity care.

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References and Further Reading

• American College of Obstetricians and Gynecologists (ACOG) – Breech Presentation Guidelines
• Royal College of Obstetricians and Gynaecologists (RCOG) – Breech Pregnancy Care
• World Health Organization (WHO) – Maternal and Perinatal Health Resources

Author Note: Written by Dr Humaira Latif, Registered Medical Practitioner and Gynecology & Obstetrics Specialist with over 14 years of clinical and practical experience in maternal health care.

Last Updated: January 2026