A prospective study of 200 consecutive twin deliveries

A prospective study of a consecutive series of 200 twin pregnancies has provided some definitive and some tentative conclusions. It has been shown that in any attempt to assess the value of a form of clinical management, cases in which a nuchal cord was present in either twin must be disregarded and that attention must be paid to the techniques of analgesia/anaesthesia provided for delivery. There is a strong suggestion that the provision of an epidural for either Caesarean section or vaginal delivery is markedly beneficial to the second twin. There is also evidence to suggest that when vaginal delivery is conducted under an epidural, the acid-base status of the second twin is very likely to be as good as, or better than, that of its sibling, whereas that is most unlikely to be so among cases delivered without an epidural. Further benefit is conferred upon both twins if the bearing-down reflex is abolished. Attention is drawn to an apparently increasing frequency of abdominal delivery of the second twin following vaginal delivery of the first and to the consequent demand which this must make upon anaesthetic cover.