In footling breech presentation, which part of the fetus presents first?

BTSC Staff Nurse 31 July-2025

Obstetrics & Gynaecology

Easy

Appeared in: BTSC Staff Nurse 31 July-2025

Explanation

A footling breech is a specific type of breech malpresentation where the fetus's lower extremities are positioned to enter the birth canal first.
By definition, in a footling presentation, one or both of the fetus's feet are the presenting part.
This occurs when one or both of the fetal hips and knees are extended, allowing the foot or feet to descend below the buttocks.
The image provided clearly illustrates the footling breech, showing the feet pointing downwards into the cervix, in contrast to frank and complete breech presentations.

Option A: The buttocks are the presenting part in a frank breech presentation, where the hips are flexed and the knees are extended.
Option B: The head is the presenting part in a normal cephalic or vertex presentation, which is the most common and desired presentation for vaginal delivery.
Option D: The shoulder is the presenting part in a transverse lie, where the fetus is positioned horizontally across the uterus. This is a different type of malpresentation that requires intervention, usually a Cesarean section.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of presenting part in footling breech presentation as background academic context rather than a clinical decision trigger.
Footling breech presentation has the highest risk of umbilical cord prolapse among all breech types. The presenting feet do not fill the cervix well, creating space for the cord to descend and become compressed, which is a medical emergency.
Due to the high risk of cord prolapse and other complications like head entrapment, a planned Cesarean section is the most common and often the safest mode of delivery for a footling breech presentation.
Nursing care involves vigilant monitoring of the fetal heart rate for signs of distress (e.g., variable or prolonged decelerations) that could indicate cord compression, and preparing the patient for a potential emergency Cesarean section.

How to Approach the Question

First, identify the key terms in the question: 'footling breech presentation' and 'presents first'.
Recall the definition of different fetal presentations. 'Breech' indicates the lower part of the fetus (buttocks or feet) is presenting.
Differentiate between the specific types of breech presentations: frank, complete, and footling.
The term 'footling' itself is the main clue, directly referring to the feet.
Evaluate the options. 'One or both feet' is the direct definition of a footling presentation.
Eliminate the other options by associating them with their correct presentations: 'Buttocks' with frank breech, 'Head' with cephalic presentation, and 'Shoulders' with a transverse lie.

Concept Tested & Keywords

Concept Tested: Identification of presenting part in footling breech presentation.
Stem keywords: footling breech presentation, fetus, presents first
Lead-in keywords: which part

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 46-54

E6 Obstetrics Williams p. 21-40