External cephalic version can safely be performed with most breech presentations.

(BJOG. 2019;126:493–499) Breech presentation has been managed in part by planned cesarean section, contributing to rising cesarean section rates. External cephalic version (ECV) has been used to avoid noncephalic birth and cesarean delivery and reduce complications, including uterine scarring. Although there have been large studies documenting successful and safe ECV, these studies have left out information regarding patients with a breech presentation who did not receive ECV. This study documented the outcomes of pregnancies, both low-risk and high-risk, with a breech presentation who were referred for ECV.

ObjectivesTo investigate the effectiveness of a structured questionnaire completed at 36 weeks gestation in predicting breech presentation.DesignQuestionnaire‐based study.SettingTertiary NHS Foundation Trust.ParticipantsWomen attending for a universally offered 36‐week fetal growth scan.InterventionCompletion of a previously designed maternal questionnaire detailing sensation of fetal movements during the past week, immediately before a routine growth scan.ResultsBetween September 01, 2018 and September 30, 2019, 2341 questionnaires were handed out and 2053 were returned. Analysis was performed in 1938 (94.4%) completed questionnaires. Recorded presentation was breech in 109 (5.6%), transverse/oblique in 15 (0.8%), and cephalic in 1814 (93.6%). Women “thinking their baby was breech” had a high positive likelihood ratio, at 11.8 (95% CI 7.4–19.1), but poor sensitivity (27.3%). “Feeling kicks low down or near the bladder” was sensitive for non‐cephalic presentation (76.3%) but with poor specificity (48.9%). The questions “kicks low” (“no”) (P = 0.013, aOR 2.18 [1.18–4.04]) and ‘thinks cephalic (“no”)’ (P = 0.001, aOR 0.12 (0.04–0.43) were independent risk factors for a non‐cephalic presentation.ConclusionsThe questions posed in this questionnaire could aid the detection of breech presentation, but do not perform better than published data on palpation. Missing a breech presentation near term through palpation alone is well reported. Combining the concept of palpation to exclude breech presentation and these questions may help focus a clinician and improve both palpation skills and breech detection. As a minimum, a woman who believes her baby is breech should be taken seriously.