Twin delivery: how should the second twin be delivered?

Area of Science:

• Obstetrics and Gynecology
• Perinatology
• Maternal-Fetal Medicine

Background:

• Historically, vaginal delivery of twins was common.
• A significant increase in cesarean deliveries for the second twin has been observed.
• This trend suggests a potential decline in obstetric skills and experience.

Purpose of the Study:

• To update intrapartum management protocols for twin gestations.
• To address the rising rates of cesarean delivery in twin births.
• To promote vaginal delivery in selected twin pregnancies.

Main Methods:

• Review and update of intrapartum management routines for twin gestations.
• Exclusion of potentially hazardous twin deliveries from trial of vaginal delivery.
• Utilizing commonly available obstetric techniques.

Main Results:

• The rate of cesarean delivery for the second twin after vaginal delivery of the first twin increased from 0.33% (1973-1982) to 7% in the last year.
• A new program for intrapartum management of twin gestations has been developed.
• The program focuses on safe vaginal delivery in selected cases.

Conclusions:

• The rising cesarean rates for twin deliveries necessitate updated management strategies.
• The developed program aims to support obstetricians in selecting appropriate cases for vaginal twin delivery.
• Emphasis on utilizing standard obstetric techniques for safer twin births.