Intrapartum management of twin gestations.

A trial of labor and vaginal delivery are usually indicated in vertex-vertex twins. For vertex-nonvertex twins, vaginal birth is preferred, with the second twin being delivered by breech extraction, unless it is significantly larger than the first. Cesarean delivery is indicated if the first twin is nonvertex and for all cases of monoamniotic or potentially viable conjoined twins. There is a limited role for trial of labor after cesarean delivery in twin gestations. In my opinion, combined vaginal-cesarean birth is the riskiest method for mother and infants and should be avoided if possible.

Normal fetus with a twin presenting as both a complete hydatidiform mole and placenta previa.

BACKGROUND: A twin gestation comprising a complete hydatidiform mole and a coexisting normal fetus is a rare and high-risk condition. Only a few such gestations have resulted in live infants. We report a case with a very large molar component presenting as a placenta previa. CASE: A live infant was delivered by cesarean at 31 weeks of gestation. The delivery incorporated prophylactic temporary balloon occlusion of the internal iliac arteries. The patient did not develop persistent gestational trophoblastic disease. CONCLUSION: We recommend that intra-arterial balloon catheters be considered before cesarean delivery in cases of complete hydatidiform mole with a coexisting normal fetus if the molar pregnancy presents as a previa. The size of the molar gestation is not an independent risk factor for persistent or metastatic disease.