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Cesarean section for the second twin

R B Kurzel1, L Claridad, E C Lampley

  • 1Department of Obstetrics and Gynecology, University of California, Los Angeles, USA.

The Journal of Reproductive Medicine
|January 23, 1998
PubMed
Summary
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Cesarean delivery for the second twin is most frequent when the first twin presents vertex. Complications like cord prolapse and inability to perform version are primary reasons for cesarean birth and neonatal deaths.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatology
  • Maternal-Fetal Medicine

Background:

  • Twin gestations present unique challenges in delivery management.
  • Vaginal delivery of twins requires careful consideration of fetal presentations and potential complications.

Purpose of the Study:

  • To investigate the indications for cesarean section (C/S) for the second twin after vaginal delivery of the first twin.
  • To identify the causes of neonatal death (NND) in twin deliveries.

Main Methods:

  • Retrospective analysis of 541 twin deliveries from 1987 to 1995.
  • Fractionation of deliveries by fetal presentation of twin A and twin B.
  • Analysis of C/S rates, indications, and NND causes based on presentation combinations.

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Main Results:

  • Cesarean section rates for the second twin increased significantly with non-vertex presentations of the first twin.
  • Vertex A/Vertex B presentation had the highest C/S rate (26%) due to cord prolapse of the second twin.
  • Inability to perform internal podalic version and extraction was a major indication for C/S, particularly in Vertex A/Transverse lie B presentations.
  • The primary indications for C/S (cord prolapse, inability to perform version) accounted for 81.5% of C/S and all neonatal deaths.

Conclusions:

  • Cesarean delivery for the second twin is most common when the first twin presents vertex, often due to complications arising after the first twin's vaginal birth.
  • The vertex A/vertex B configuration, while seemingly "safest," carries a substantial risk of C/S for the second twin due to cord prolapse.
  • Management strategies for twin deliveries should focus on addressing cord prolapse and difficulties with version/extraction to reduce C/S rates and neonatal mortality.