Caesarean delivery for the second twin

The optimal mode of delivery for a second twin in breech position is controversial, with support for both caesarean and vaginal delivery.

The objective of this review was to assess the effects of caesarean delivery compared with vaginal delivery of a second twin not presenting cephalically.

The Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to December 1998.

Randomised trials of Caesarean delivery compared with vaginal delivery in women with a twin pregnancy where the second twin is not presenting cephalically.

All assessments of trial eligibility, quality and data extractions were done by the author without blinding.

One trial involving 60 pairs of twins was included. Maternal febrile morbidity were increased in women allocated to the caesarean group (relative risk (RR) 3.67, 95% confidence interval (CI) 1.15-11.69), and there was a trend to an increased need for use of general anaesthesia (RR 2.40, 95% CI 0. 98-5.88). No differences were detected in neonatal outcome.

caesarean section for delivery of a second twin not presenting cephalically is associated with increased maternal febrile morbidity with, as yet, no identified improvement in neonatal outcome. This policy should not be adopted except within the context of further controlled trials