Outcome of 306 twin deliveries according to first twin presentation and method of delivery

The objective of this manuscript is to examine the effect of presentation o f the first twin and mode of delivery on perintal outcome in twin deliverie s. We reviewed all records of twin deliveries at a gestational age of 32 we eks and more from January 1, 1989 to December 31, 1995. Study cases were di vided according to the first twin presentation (vertex = group A, nonvertex = group B) and then subdivided according to the planned mode of delivery, vaginal trial of labor (VTOL), and cesarean section (CS). The protocol for group A facilitated an attempt at vaginal delivery and for group B, vaginal delivery was considered as for a singleton fetus in breech presentation. O f 306 pairs of twins, 235 were in group A and 71 in group B. In group A, 21 9 women (93.2%) were eligible for VTOL, and the remaining 16 underwent CS. Thirty-three group B women were eligible for VTOL (46.5%; p < 0.001) and 38 had CS. In group A, of the 219 candidates for VTOL, 199 (90.9%) delivered vaginally and 20 underwent a CS. In group B, of the 33 VTOL candidates 18 ( 54.5%) delivered vaginally and 15 underwent CS. Neonatal outcome did not di ffer in relation to the presentation of the first twin or the planned/actua l mode of delivery. There were no cases of birth trauma, neurological compl ications, or perinatal mortality. Trial of vaginal labor is safe in twin de liveries with the first twin in vertex presentation. Provided criteria for vaginal breech delivery are adhered to, this also appears to be a reasonabl e option in twin deliveries with the first twin in nonvertex presentation.