Breech presenting twin A: is vaginal delivery safe?

Area of Science:

• Obstetrics and Gynecology
• Neonatal Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• Breech presentation in twins complicates delivery, necessitating careful consideration of maternal and neonatal outcomes.
• Existing data on vaginal delivery of breech-presenting twins versus cesarean delivery requires further investigation, particularly regarding neonatal safety.

Purpose of the Study:

• To compare the neonatal outcomes of vaginally delivered breech-presenting twins versus those delivered via cesarean section.
• To evaluate the safety and efficacy of different delivery modes for breech-presenting twins.

Main Methods:

• Retrospective review of maternal and neonatal charts for live, non-anomalous twins delivered at >= 25 weeks gestation over 11 years.
• Analysis focused on 130 breech-presenting twins, comparing outcomes between vaginal delivery (VD) and cesarean delivery (CS) groups.
• Key neonatal outcomes assessed included respiratory distress syndrome, intraventricular hemorrhage, need for mechanical ventilation, nursery stay, and mortality.

Main Results:

• No significant differences were observed in respiratory distress syndrome, intraventricular hemorrhage, mechanical ventilation, nursery stay, or mortality rates between twin A in the VD and CS groups.
• Patients in the VD group were more likely to present in labor with advanced cervical dilation.
• One case of traumatic vaginal delivery in a breech-presenting twin resulted in spine fracture and immediate neonatal death, highlighting a critical risk.

Conclusions:

• While immediate neonatal outcomes appear comparable, the potential for severe complications like head entrapment in vaginal breech twin deliveries is concerning.
• Cesarean delivery may represent a safer route for breech-presenting twins when twin A is in a non-vertex presentation.
• Further research and careful case selection are warranted for managing breech-presenting twin deliveries.