title: Is routine cesarean section necessary for vertex-breech and vertex-transverse twin gestations?
abstract: Ninety-three vertex-breech and 42 vertex-transverse twin gestations were managed at Yale-New Haven Medical Center during a 5-year period. Antepartum diagnosis of twin gestation occurred in 93% of the cases, and diagnosis was made before delivery of the second twin in 97% of the cases. Seventy-two (78%) of the vertex-breech and 22 (53%) of the vertex-transverse twins were delivered vaginally. Breech extraction was used for delivery of 76 second twins. Below a birth weight of 1,500 gm, there were six neonatal deaths, four cases of documented intraventricular hemorrhage, and a 67% occurrence of depressed 5-minute Apgar scores. Above a birth weight of 1,500 gm, there were no cases of neonatal death or documented intraventricular hemorrhage and a 5% occurrence of moderately depressed 5-minute Apgar scores. Birth trauma occurred in a 3,420 gm second twin delivered by breech extraction. This infant suffered a greenstick fracture of the right clavicle and a nondisplaced fracture of the right humerus that was not associated with permanent residual injury. We think that, for birth weights greater than 1,500 gm, routine cesarean section for vertex-breech or vertex-transverse twin gestation may not be necessary.
mesh_terms: D001034:Apgar Score; D001720:Birth Injuries / Q000209:etiology; D001724:Birth Weight; D001946:Breech Presentation; D002585:Cesarean Section; D005113:Extraction, Obstetrical; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007746:Labor Presentation; D011247:Pregnancy; D012189:Retrospective Studies; D014427:Twins