DELIVERY OF THE NONVERTEX 2ND TWIN - BREECH EXTRACTION VERSUS EXTERNAL CEPHALIC VERSION

OBJECTIVE: Our purpose was to compare the maternal and perinatal outco mes of twin gestations in which the nonvertex second twin was delivere d by total breech extraction versus those delivered by external cephal ic version. STUDY DESIGN: The intrapartum courses of 284 consecutive t win gestations were analyzed retrospectively. Once those with actual b irth weight < 600 gm, unrecognized multifetal pregnancy, multiple cong enital anomalies, cesarean delivery, and/or antepartum intrauterine fe tal death were excluded, 23 mothers were delivered by total breech ext raction and 21 underwent external cephalic version. RESULTS: The two g roups were similar for mean (+/-SD) maternal age, gravidity, parity, g estational age at delivery, ultrasonographic estimate of birth weight for twin B, incidence of breech or transverse presentation for the sec ond fetus, and actual birth weight of the first or second newborn. Sus pected fetal distress that led to cesarean delivery occurred significa ntly more often in parturients who underwent attempted external versio n (4/21) than total breech extraction (0/23, p = 0.04). The incidence of eventual abdominal delivery was also significantly higher in patien ts who underwent attempted external cephalic Version (10/21) rather th an breech extraction (1/23, p = 0.001). For twin B the occurrence of l ow Apgar scores at 1 minute was significantly higher for infants sifte r attempted external version (7/21) rather than breech extraction (1/2 3, p = 0.02), but the mean pH, number with Apgar scores < 7 at 5 minut es, and number of neonatal intensive care unit admissions were similar . No perinatal traumatic injury occurred in either group. CONCLUSION: On the basis of our experience, total breech extraction of the nonvert ex second twin is preferable to external cephalic version because it a ppears to be associated with a significantly lower incidence of fetal distress and abdominal delivery with comparable neonatal outcome.