[Delivery in cases of twin pregnancy]

A retrospective analysis of 233 cases of twin pregnancies has demonstrated an increased frequency of prophylactic caesarean sections (27%) due to an increased performance of caesarean sections when the first twin is a breech and when premature babies are delivered before the 34th week of amenorrhea. When the first twin is a head, a natural delivery is possible with the same criteria as a single pregnancy. The vaginal delivery is also possible if the 2nd twin is a head. In deliveries where the 2nd twin is a breech, there is an increased frequency of early neonatal mortality and Apgar tests under 7 at 5 min, in comparison with the 2nd twin when it is a head. The type of delivery does not seem affected for babies over 1,500 grams. If the 2nd twin is a breech and under 1,500 g, a review of the literature and our results prompt us to broaden the indications of caesarean section. A delay before the birth of the 2nd twin, of under 10 min is usually associated with a better Apgar score at 1 min. without any significant differences at 5 min. It is advisable, at 38 weeks, to induce labor by rupturing the membranes and starting a perfusion of Syntocinon. If the conditions are unfavorable, pursuing the pregnancy requires a close supervision until term.