Cesarean delivery of the second twin after vaginal delivery of the first twin

ABSTRACT

To study the effect of cesarean section of the second twin after vaginal delivery of the first twin, and to compare the outcome with twins delivered by cesarean section or vaginally during the same period of time. Data of all women who gave birth to twins at the Armed Forces Hospital, Riyadh, Saudi Arabia, between 1st January 1987 and 31st December 1996 were reviewed. Twin deliveries, where the first twin was delivered vaginally and a cesarean section was carried out for the second twin, were selected. There were 598 sets of twin deliveries during a 10 year study period. Of the 137 emergency cesarean sections for twin pregnancies, 15 [11%] were carried out for the second twin. There were no early neonatal deaths amongst these cases. Following the vaginal delivery of the first twin, every attempt should be made for internal podalic version and breech extraction of the second twin in cases of transverse lie, compound presentation or high cephalic presentation. Forceps or vacuum delivery should be considered for engaged cephalic presentation. Discrepant growth between twins should be identified and the need for cesarean section for the second twin for a very large baby should be eliminated. Elective cesarean section should be considered in these cases. However, whenever indications exist, cesarean section can be performed safely for the delivery of the second twin even after vaginal delivery of the first twin