[Internal version and breech extraction of the second twin. A series of 35 cases]. / Version par manoeuvres internes et grande extraction de siège chez le deuxième jumeau. A propos de 35 observations.

OBJECTIVES: Identify indications and assess results of internal version followed by breech extraction. Evaluate fetal and maternal prognosis. METHODS: A retrospective study of 35 cases of ionternal versions followed by primary breech extraction of the second twin performed between 1 January 1986 and 31 December 1994, were analysed and compared with data in the literature. RESULTS: There were 2 failures requiring cesarean extraction of the second twin. There were no maternal complications other than minor bleeding at deliver in 3 who did not require transfusion. Obstetrical trauma was observed in 3 cases with no sequelae. Five infants were referred to the prematurity unit and 9 to the infant intensive care unit due to consequences of prematurity. In six cases nitroglycerin used as a uterine relaxing agent was associated with spinal analgesia thus avoiding general anesthesia. CONCLUSION: Internal version is the only alternative (together with external version) to cesarean, allowing rapid delivery of the second twin in breech position. Maternal prognosis is excellent and fetal prognosis is good if contraindications are avoided.