delivered vaginally. The etiology is unknown but may involve hypertonicity of extensor neck muscles, which if long-standing, may produce' shortening of posterior dura and ligaments which are prone to damage when flexion occurs with vaginal delivery. There are 2 sub-groups: ( 1) angle between main thoracic spine and cervical spine is less than 90 degrees (2) angle is greater than 90 degrees. In Ballas' review 51 group I lesion were all normal whether delivered vaginally or by C-Section, but of the 20 group II the 9 delivered by C-Section were all normal, whereas 8 of II delivered vaginally had complete cervical cord lesions . The usual site is lower cervical spine. Diagnosis of this condition can be made by ultrasound. Many feel that group II fetuses should have a CSection (Bhazwanini, 1973; Caterini, 1975 ; Daw, 1976; Lazer, 1959; Arnie! , 1955 ; Taylor, 1948) but some authors take the opposite view Behrman, 1962; Stern, 1959). The majority of the literature favours C-Section if no congenital abnormalities are seen. All Obstetricians are aware of the im:rcased incidence of prolapsed cord in association with breech position. The incidence in whole group is probably just greater than 3% (Fianu, 1976) and if one sub-divides breech into premature and mature incidence is 8% and 2.5 - 3% (Fianu, 1976) respectfully. Subdivision can also be made into different tyupes of breech: ( I) term frank - I. 5% (Rovinsky, 1973 ; Collea, 1977), (2) Complete 4 - 6% (Moore, 1943; Hall , 1965 ; Morley, 1967; Fianu, 1976)(3) footling- 15 - 18% (Johnson, 1970; Morley, 1967; Fianu, 1976). The PNM associated with this is 3050% overall. Conclusions as to selection for labour are obvious. As well some feel that fetal distress other than associated with cord prolapse is increased with breech (Rovinsky, 197 3) and there is an increased incidence of abruption (Brenner, 1974). There are other factors ofs9me importance such as duration of labour. Rovinsky (I 97 3) found an increased PNM after approximately 18 hours of labour, whereas Fianu ( 1976) found in his retrospective analysis that the optional duration of labour was 3 to 20 hours. Having now examined some of the specific risk factors associated with the breech in labour I will present the literature concerned with their application in management of the breech and the results obtained by doing so. Gerald Zatuchni and George Andros in 1965 were first to look at a risk-scoring system for the term sized breech. They examined various parameters (fig. 1) and POINTS FIGURE I 0 Parity Primig. Gestational Age > 39 wks. Estimated fetal weight >8 lbs. (3630 g.) Previous Breech> 2500 g. None •Dilation 2 ems. •stati on Multip. 38 wks. 3 7 wks. or less 7-7 lb. 15 oz. <7 lb. (3629-3 176 g) (3175 g.) One T wo or More 3 ems. 4 ems . o r more -3 or h1gher -2 *YAG . EXAM ON ADMISSION - I or lower found that if the cumulative score was greater than 3 one could expect safe vaginal delivery. If the score was 3 or less than C-Section should be advocated . Several prospective studies (Zatuchni and Andros , 1967; Mark and Roberts, 1968; Bird and McElon , 1975) all confirm the validity of the original retrospective analysis with improved PNM rate and a C-Section percentage of 20 to 30% with greater than two-thirds of these planned following initial assessment. Weston ( 1974) could not verify the results of the above and commented that possible deficiencies include the inability to plan C-Section prior to labour, and nonutilization of pelvimetry for examination of the bony pelvis. Westin (1977) developed a "feto-pelvic scoring system " comprising maternal pelvimetric data, estimated fetal weight, type of breech presentation , previous obstetrical history (fig. 2) to electively select patients for CSection or vaginal delivery. A possible maximum of 20 points is possible and less than 13 points selects patients for C-Section. As well C-Section was performed if: ( I ) one or more pel vic measu rements were 0 ; (2) fetal weight greater than 4000 g. or less than 1500 g. ( 3) double footling presentation. Initially, 224 si ngleton breeches were evaluated and POINTS FIGURE 2 Parameter Sagottal Inlet Tran sve rse ·· InterSpina l Di stance 0 12 < 12.5 12.5- 13 > 13 <10 10 .0- 10 .5 >10.5 > II <10 10- 11 Jntcrtuber ·· 10.5- 11 >II <1 0 .5 Sagottal Outlet <32 .5 32 .5-33 5 > 33 .5 Sum of Outlet <4000 1500-2000 2000-3500 E>t. Fetal W coght < 1500 3500-4000 Double foothngCompletc Frank Pre sen tati On Songle F Prev1ous Vag•nal Del1v.None Uncom Breech Uncom Breech 2- 3 kg. >J kg. Vtr,.X > 3kg. Unco mplica1ed breech < 2 kg.unco mp. vertex