• informationallife_threateningbreech_cord_prolapse_emergency

  Cord prolapse after rupture of membranes with breech presentation → IMMEDIATE knee-chest position + manual elevation of presenting part + emergent cesarean (target time-to-delivery < 30 min).

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmoderatebreech_planned_cesarean_default

  Persistent breech after failed/declined/contraindicated ECV in patient not a vaginal breech candidate → planned cesarean at 39+0 wk per Term Breech Trial Hannah 2000 Lancet PMID 11052579 (planned cesarean superior for perinatal mortality/serious morbidity).

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmoderatebreech_trial_of_vaginal_breech

  Eligible for trial of vaginal breech per ACOG CO 745 (PMID 30045211) — frank or complete breech, EFW 2500-4000 g, experienced provider, hospital-specific protocol, no fetal anomaly, pelvic adequacy, favorable cervical exam, detailed informed consent including Term Breech Trial findings.

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmildbreech_ECV_candidate_at_37_wk

  Persistent breech at ≥ 37 wk in patient without ECV contraindications → offer ECV at L&D with OR backup; terbutaline 0.25 mg SC tocolytic ×1; success ~ 50-60% (ACOG CO 745 PMID 30045211).

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmildbreech_failed_ECV_or_contraindication

  Failed ECV (no version) or contraindication (placenta previa, non-reassuring FHR, hyperextended head, severe FGR, prior classical cesarean) → planned cesarean at 39+0 wk; ECV may be re-attempted in subsequent pregnancy if breech recurs.

  Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

This dossier does not reference any calculators.

• external cephalic version (ECV) at gestational age ≥ 37 weeks

  first line
  obstetric_procedure_conversion
  triggers: breech_presentation_at_term_no_contraindications
  PregCat: N/A — procedure. | Lactation: N/A — procedure. | ACOG CO 745 (PMID 30045211) endorses ECV as alternative to planned cesarean; performed at L&D with OR backup; continuous EFM; success ~ 50-60% (higher in multiparas, polyhydramnios, posterior placenta, normal BMI); contraindications include placenta previa, non-reassuring FHR, hyperextended fetal head, severe FGR, recent vaginal bleeding; relative contraindications include prior classical cesarean and multifetal gestation.
• terbutaline

  first line
  beta_2_agonist_tocolytic
  0.25 mg SC ×1 15 min before ECV • SC • single dose
  triggers: ecv_procedure_tocolytic_facilitation
  PregCat: former B — long obstetric experience for short-term tocolysis; FDA black box for chronic tocolysis (cardiac death risk with prolonged use) but single-dose ECV use is acceptable. | Lactation: compatible with caution per LactMed — small amounts in milk; transient infant tachycardia possible; single-dose ECV use does not constrain lactation. | Facilitates ECV by relaxing uterine smooth muscle; nifedipine 20 mg PO is acceptable alternative; salbutamol IV / nitroglycerin IV are alternatives; monitor maternal HR + BP.
  rxcui 10368
• Rho(D) immune globulin

  first line
  rh_d_immunoglobulin_alloimmunisation_prophylaxis
  300 µg IM ×1 within 72 h of ECV • IM • single dose within 72 h
  triggers: rh_negative_maternal_blood_type_post_ecv
  PregCat: former C — labeling categorises but routinely used in Rh-negative pregnancy without harm signal. | Lactation: compatible per LactMed — IgG isotype with negligible milk transfer; routine postpartum use. | Small fetomaternal hemorrhage risk from ECV can sensitise Rh-negative mothers; Rho(D) IG within 72 h prevents alloimmunisation that would affect future pregnancies; ACOG CO 745 standard practice.
  rxcui 35465
• planned cesarean delivery at 39 weeks for persistent breech

  first line
  obstetric_definitive_delivery_mode
  triggers: persistent_breech_at_term_failed_or_declined_ECV_not_vaginal_breech_candidate
  PregCat: N/A — obstetric mode of delivery. | Lactation: N/A — delivery event. | Hannah 2000 Term Breech Trial Lancet (PMID 11052579) showed planned cesarean superior to planned vaginal breech for perinatal mortality / serious neonatal morbidity (1.6% vs 5.0%, RR 0.33); default for persistent breech when ECV fails/declined/contraindicated and patient not a candidate for trial of vaginal breech; schedule at 39+0 wk if elective; spinal or epidural anesthesia preferred.
• selective trial of vaginal breech delivery per strict criteria

  add on
  obstetric_alternative_delivery_mode
  triggers: eligible_for_vaginal_breech_per_ACOG_CO_745_criteria
  PregCat: N/A — obstetric mode of delivery. | Lactation: N/A — delivery event. | ACOG CO 745 (PMID 30045211) — may be reasonable under hospital-specific protocol with detailed informed consent including Term Breech Trial findings (Hannah 2000 PMID 11052579) AND Goffinet 2006 PREMODA AJOG (PMID 16580289) safe-in-select-units findings; criteria: frank or complete breech (NOT footling), EFW 2500-4000 g, experienced provider, hospital-specific protocol, no fetal anomaly, pelvic adequacy, favorable cervical exam; readiness for emergent cesarean throughout labor.
• emergent cesarean for cord prolapse

  rescue
  obstetric_emergency_delivery
  triggers: cord_prolapse_after_rupture_membranes_with_breech
  PregCat: N/A — obstetric emergency intervention. | Lactation: N/A. | Cord prolapse after rupture of membranes with breech presentation → IMMEDIATE knee-chest position + manual elevation of presenting part + emergent cesarean (target time-to-delivery < 30 min); preserves fetal blood flow until OR available.