Physiotherapeutic Techniques as Supportive Interventions in Breech Presentation: An Extended Clinical Case Report and Comprehensive Literature Review

Author: Massimo Morandini, Abdulazeez Alao

Abstract

Breech presentation occurs in approximately 3– 4% of pregnancies at term and represents a major challenge in obstetric practice. While external cephalic version (ECV) is the standard intervention, it is associated with variable success rates and potential risks. Physiotherapeutic manipulative treatment (PMT) may represent a safe, non-invasive adjunct to conventional care by optimizing maternal biomechanics and creating conditions favorable to spontaneous cephalic version (SCV). Objective: To present a detailed case report of PMT applied to a primigravida with breech presentation at 34 weeks, accompanied by an extensive literature review. Methods: A 34-year-old primigravida at 34 weeks with breech presentation underwent three physiotherapy sessions in 10 days. Interventions included fascial release, diaphragmatic mobilization, pelvic diaphragm techniques, muscle energy techniques, quadratus lumborum release, sacroiliac joint and rib cage mobilization, and a fetal disengagement maneuver in quadruped position. Pain was assessed using VAS, disability with the Oswestry Disability Index (ODI), and quality of life with the SF-36. Fetal position was monitored by ultrasound. A narrative literature review was conducted focusing on physiotherapy, manipulative therapy, and complementary approaches to breech management. Results: Maternal outcomes included reduced pain (VAS 6→3), improved posture, and enhanced mobility. ODI improved from 36% to 16%, and SF-36 scores indicated better physical functioning and vitality. Ultrasound confirmed SCV at 37 weeks. The patient was delivered vaginally at 39 weeks without complications. Literature review suggests growing evidence supporting manipulative and physiotherapeutic interventions as adjuncts in breech management. Conclusion: Physiotherapy may provide a safe and promising complementary approach in breech presentation. Rigorous clinical trials are necessary to validate efficacy, standardize protocols, and integrate physiotherapy into obstetric guidelines.