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Obstetrician-gynecologist, reproductive specialist

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Indications for cesarean section for breech presentation

Alexey Kryvenko, medical expert
Last reviewed: 08.07.2025

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A planned caesarean section for breech presentation of the fetus should be performed if the following indications are present:

pelvic stenosis of I-II degree with a fetal weight over 3500 g;
first-time mothers over 35 years of age;
complicated obstetric history (habitual miscarriage, stillbirth);
lack of biological readiness for childbirth during treatment with estrogens, antispasmodics and other drugs for 7-10 days in combination with a large fetus, long-term infertility;
presentation or prolapse of the umbilical cord loops in breech presentation of the fetus;
incomplete placenta previa;
large fetus, post-term pregnancy, toxicosis of the second half of pregnancy;
symptoms of threatened or incipient fetal asphyxia;
cicatricial changes in the cervix and vagina;
scar on the uterus;
some types of extragenital pathology - obesity grades II-III, congenital heart defects, high degree of narrowing of the left venous opening, active rheumatic process, decompensated and acquired heart defects, diabetes mellitus;
tumors of the pelvic organs;
truly post-term pregnancy with symptoms of fetal dysfunction;
fetal malnutrition of various etiologies;
multiple pregnancy, with breech presentation of one of the fetuses;
excessive extension of the head in breech presentation with a fetal weight of 2000-3500 g;
mixed breech and foot presentation of the fetus (risk of prolapse of the umbilical cord loops);
prematurity (fetal weight 1500-2500 g).

Indications for surgery during childbirth are:

lack of readiness of the pregnant woman's body for childbirth during her treatment for 6-8 hours and untimely rupture of amniotic fluid;
lack of effect from labor induction with oxytotic agents during the 6-10 hour anhydrous period;
weakness of labor activity that does not respond to drug therapy in primiparous women for up to 10 hours and in multiparous women for up to 8 hours, especially in combination with untimely rupture of amniotic fluid;
late labor with symptoms of threatened or incipient fetal asphyxia;
prolapse of the umbilical cord loops when the cervix is dilated to 4-5 cm and the fetus is in breech presentation;
lack of effect from tucking in the umbilical cord loops in breech presentation;
weakness of labor with the location of the placenta in the bottom of the uterus;
any deviation from the normal course of the first stage of labor with a large fetus;
lack of effect from a single labor stimulation in primiparous women over 30 years of age, with untimely rupture of amniotic fluid, the presence of concomitant extragenital pathology, toxicosis of the second half of pregnancy;
disproportion between the sizes of the pelvis and the fetus, especially in combination with uncoordinated labor;
any deviation from the normal course of the first stage of labor or damage to the fetus that occurs during breech presentation.

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