VAGINAL DELIVERY OF THE NONVERTEX 2ND TWIN

OBJECTIVE: The purpose of our study was to test the hypothesis that there is no increased morbidity or mortality associated with vaginal delivery of the nonvertex second twin. STUDY DESIGN: The medical records of 781 consecutive twin gestations achieving a gestational age greater-than-or-equal-to 20 weeks and delivering between Jan. 1, 1985, and Dec. 31, 1988, were reviewed. All live-born, vaginally delivered second twins were identified, grouped by presentation, and compared with respect to 5-minute Apgar scores, length of neonatal hospital stay, neonatal intensive care unit admissions, and neonatal deaths. RESULTS: Of the 390 live-born, vaginally delivered second twins, 207 were delivered as vertex and 183 were delivered as breech. Ninety-five percent of the breech deliveries were total breech extractions. There were no statistically significant differences between the vaginal breech and vaginal vertex deliveries in any of the neonatal outcome measures studied even when stratified by birth weight. CONCLUSIONS: These results support the null hypothesis and suggest that vaginal delivery of the nonvertex second twin is a safe intrapartum management option, although no conclusion can be reached in infants weighing < 1500 gm. We found no evidence of excessive morbidity or mortality associated with total breech extraction of the second twin.