PMID: 9437589Jan 23, 1998Paper

Cesarean section for the second twin

The Journal of Reproductive Medicine
R B KurzelE C Lampley

Abstract

To determine the reasons for cesarean section (C/S) for the second twin following vaginal delivery of twin A, and causes of neonatal death (NND). Five hundred forty-one twin deliveries were studied retrospectively from 1987 to 1995. Deliveries were fractionated by fetal presentation for twin A and twin B (i.e., vertex A/vertex B, vertex A/breech B, vertex A/transverse lie B, breech A/vertex B, ... transverse lie A/transverse lie B, yielding nine groups). The variation in C/S rate was noted with respect to fetal presentation for twin A and twin B. The indications for C/S of twin B following successful delivery of twin A were noted, as were sources of NND. The C/S rate rose as the presentation of twin A changed from vertex to breech to transverse lie (13.8%, 67.4% and 100%, respectively, for twin B vertex). A similar trend was found for twin B as breech or transverse lie. The overall C/S rate was 34.6%, and of these, 27 were solely to deliver twin B, for 5.0% of all twins and 14.4% of all C/S. The risk for C/S for the second twin was increased 7.6x if twin A was vertex rather than breech. The prime reasons for C/S of twin B varied with the presentation of twin B. Cord prolapse of twin B was most common for vertex A/vertex B (7/8)...Continue Reading

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