Is cesarean section necessary for delivery of a breech first twin?

Eighty-two pregnancies involving a breech first twin were retrospectively analyzed over two study periods during which the cesarean section rates were 20.9 and 94.9%, respectively. The neonatal and maternal morbidity in both study periods was compared. There were no neonatal deaths during either study period and no cases of interlocking twins among patients delivered vaginally. Neonatal morbidity was unrelated to the mode of delivery. The incidence of maternal fever was, however, significantly higher in the cesarean section group compared with the vaginal delivery group (p < 0.001). Our study suggests that vaginal delivery of selected twin gestations with a breech first twin should be an alternative to cesarean delivery.