Breech delivery, where a baby is positioned feet or buttocks first rather than head first, has been studied extensively to understand its relationship with cerebral palsy (CP), a neurological disorder affecting movement and posture. The connection between breech presentation at birth and cerebral palsy is complex and involves multiple factors related to fetal position, delivery method, and potential birth complications.
**Breech Presentation and Its Causes**
Breech presentation occurs in about 3–4% of full-term births, with a higher incidence in preterm deliveries. The fetus normally moves into a head-down (cephalic) position by the 36th week of gestation, but in some cases, the fetus remains in a breech position due to endogenous factors (such as fetal inability to move adequately) or exogenous factors (such as insufficient space in the uterus). Maternal and fetal medical conditions can increase the likelihood of breech presentation, with probabilities ranging from 4% to as high as 50% in certain cases[1].
**How Breech Delivery May Relate to Cerebral Palsy**
Cerebral palsy is often caused by brain injury or abnormal brain development occurring before, during, or shortly after birth. One of the key mechanisms leading to CP is hypoxic-ischemic encephalopathy (HIE), which is brain damage caused by reduced oxygen and blood flow to the brain during childbirth. Other causes include periventricular leukomalacia (PVL), intracranial hemorrhage, and cerebral dysgenesis[2].
Breech delivery can increase the risk of birth complications that may lead to cerebral palsy, primarily due to the following:
– **Increased risk of oxygen deprivation:** Breech births can be more complicated and prolonged, increasing the chance of hypoxia (oxygen deprivation). Prolonged oxygen deprivation can cause permanent neurological damage, including cerebral palsy[1][2].
– **Trauma during delivery:** The unusual position of the baby in breech presentation can lead to mechanical trauma during delivery, such as head entrapment or cord compression, which may contribute to brain injury[1].
– **Higher likelihood of emergency cesarean or complicated vaginal delivery:** Breech presentation often necessitates cesarean delivery to reduce risks, but emergency situations or attempts at vaginal breech delivery can increase the risk of birth injury[1].
**Evidence and Research Findings**
Studies have shown that babies born in breech presentation have a higher incidence of cerebral palsy compared to those born head first, but this association is influenced by multiple factors:
– The risk of CP is not solely due to breech presentation itself but also related to the complications that can arise during delivery, such as hypoxia or trauma.
– Planned cesarean delivery for breech presentation has been shown to reduce some risks associated with vaginal breech birth, including birth trauma and oxygen deprivation, potentially lowering the risk of cerebral palsy[1].
– Some research suggests that underlying fetal conditions that cause breech presentation (such as fetal neuromuscular abnormalities) may themselves increase the risk of cerebral palsy, independent of delivery method[1][2].
– The overall incidence of cerebral palsy remains low, even among breech deliveries, but the relative risk is elevated compared to cephalic presentations.
**Medical Recommendations and Precautions**
Given the potential risks, medical guidelines often recommend cesarean delivery for term breech presentations to minimize complications. Careful monitoring during labor and delivery is essential to detect signs of fetal distress early and intervene appropriately to prevent hypoxic injury.
Preventive measures include:
– Ultrasound assessment to confirm fetal position before labor.
– External cephalic version (ECV), a procedure to turn the fetus to a head-down position before labor begins.
– Planned cesarean delivery when breech presentation persists at term.
– Skilled obstetric care during vaginal breech delivery when it is attempte
