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Caesarean delivery for the second twin.

C A Crowther1

  • 1Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, South Australia, Australia, SA 5006. ccrowthe@medicine.adelaide.edu.au

The Cochrane Database of Systematic Reviews
|May 5, 2000
PubMed
Summary
This summary is machine-generated.

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Caesarean delivery for a second breech twin increases maternal febrile morbidity without improving neonatal outcomes. Further trials are needed to determine optimal delivery methods for non-cephalic second twins.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Twin Pregnancy Management

Background:

  • The optimal delivery method for a second twin presenting in breech position remains debated, with both cesarean and vaginal delivery options supported.
  • Managing non-cephalic second twins presents unique challenges in twin pregnancies.

Purpose of the Study:

  • To compare the effects of cesarean delivery versus vaginal delivery for the second twin when it is not presenting cephalically.
  • To evaluate maternal and neonatal outcomes associated with different delivery modes for non-cephalic second twins.

Main Methods:

  • Systematic review of randomized controlled trials up to December 1998, searching the Cochrane Pregnancy and Childbirth Group trials register and Cochrane Controlled Trials Register.
  • Inclusion criteria focused on twin pregnancies where the second twin was not cephalic, comparing cesarean versus vaginal delivery. Trial eligibility, quality assessment, and data extraction were performed by a single author without blinding.

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Main Results:

  • One trial with 60 twin pairs was included in the analysis.
  • Women allocated to cesarean delivery experienced significantly increased maternal febrile morbidity (RR 3.67, 95% CI 1.15-11.69).
  • A trend towards increased general anesthesia use was observed in the cesarean group (RR 2.40, 95% CI 0.98-5.88), with no significant differences in neonatal outcomes.

Conclusions:

  • Cesarean section for non-cephalic second twins is linked to higher maternal febrile morbidity.
  • Currently, there is no evidence of improved neonatal outcomes with cesarean delivery for non-cephalic second twins.
  • Cesarean delivery for non-cephalic second twins should only be considered within the framework of further controlled trials.