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Frank Breech

Last Updated: June 8, 2019

Definition - What does Frank Breech mean?

A frank breech is when the baby’s bottom is down, but the legs are straight up next to its tummy with the feet towards its head. Therefore, the part that presents or appears first is the buttocks rather than the head as in a normal presentation. Frank breech is the most common type of breech presentation. Of the 3% to 4% of term breech deliveries, the frank breech position represents about 50-70% of these deliveries. Breech presentations are not considered normal and can pose serious risks.

A frank breech is also called an extended breech.

FertilitySmarts explains Frank Breech

In most pregnancies, the baby’s head is the presenting part, known as the vertex presentation. But sometimes, the baby’s bottom becomes the presenting part. Factors predisposing to a breech presentation include:

  • Premature delivery (delivery before the normal 37 to 42 weeks of pregnancy)
  • Abnormal-shaped uterus
  • Uterine fibroids
  • Too much fluid in the bag of waters (a condition called polyhydramnios)
  • Too little amniotic fluid (may hinder the baby from turning to the head down-position when delivery is near)
  • Low-lying placenta called placenta previa
  • Abnormalities in the baby (such as chromosomal abnormalities, brain defects, abnormal neck masses)
  • A woman pregnant with more than one baby

As the pregnancy progresses, the chances of most of the breech babies turning to a head down position are high. If the baby doesn't move until term, the labor and delivery process with this type of presentation may be challenging.

While the risk of complications with a frank breech is relatively low, some of the noticeable complications especially those associated with vaginal delivery include:

  1. Umbilical cord compression: When the baby’s body comes out before the cervix fully opens up during vaginal delivery, the baby’s head can get stuck. This is a life-threatening complication because the head can "press against the umbilical cord" and cut off the blood and oxygen supply to the baby, risking its life. This situation is more common in premature babies because they have a larger head that makes it difficult to pass through the cervix.
  2. Increased birth trauma: Certain maneuvers that are not very accurate may be carried out to facilitate a breech vaginal delivery, increasing the risk of traumatic injury. Besides, a vaginal delivery that lasts longer tends to increase the risk of umbilical cord compression in the breech baby. The doctor may thus rush to deliver the baby more rapidly than recommended, putting the baby at risk of serious injuries.
  3. Umbilical cord prolapse: It is a condition in which the umbilical cord prolapses (descends) through the cervix before the baby is delivered. While the risk of this complication with a frank breech is very low, if it occurs, the blood and oxygen delivery to the baby will be cut off.

After the diagnosis of a frank breech by clinical examination and ultrasound, the doctor may make an attempt to turn the baby to a head-down position between the 32nd to 37th weeks of pregnancy. External version is a non-surgical technique that involves gently pushing on the mother’s lower abdomen to move the baby into the head-down position.

The decision about the mode of delivery with a frank breech varies from one case to another. The delivery of a baby in a breech position is a controversial topic. Most doctors are not in favor of attempting a vaginal delivery for a breech position because of the associated risks. A frank breech may be delivered vaginally if the following criteria are met:

  • The baby is not in distress as determined by continuous heart rate monitoring
  • The size of the mother’s pelvis (as determined on ultrasound) is adequate to facilitate a safe vaginal birth
  • The physician is adept at performing an emergency C-section if fetal distress occurs

Most doctors recommend a cesarean section for all babies in a breech position, especially if the baby is premature. Premature babies are small and delicate. Moreover, a premature baby’s head is also relatively bigger than the rest of the body. The head may get stuck during delivery, compressing the umbilical cord.

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