title: Cesarean delivery for the second twin in the vertex-vertex presentation: operative indications and predictability.
abstract: BACKGROUND
  The incidence of second twin delivery by cesarean section and whether obstetric parameters are predictive should be studied.
  
  
  METHODS
  In this retrospective study, all vertex-vertex twin deliveries during a 48-month period were reviewed.
  
  
  RESULTS
  During the study period, 106 sets of vertex-vertex twins were identified. In 68 pairs, both were delivered vaginally (group 1), and 21 pairs were born via cesarean section. In the 17 pairs in group 2, the first infant was delivered vaginally and the second by cesarean section because of fetal distress in 6 cases (35%), cord prolapse in 6 (35%), abnormal/unstable lie in 4 (23%), and abruptio placenta in 1 case (6%). The only maternal factor associated with abdominal delivery for twin B was greater maternal age. When cesarean delivery was required for twin B, a longer interval between deliveries and a lower Apgar score were noted.
  
  
  CONCLUSIONS
  Cesarean birth of twin B is a more common clinical event than previously reported but is not easily predicted by obstetric parameters.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Sullivan
authors.forename: D
authors.initials: D
authors.lastname: Harkins
authors.forename: D P
authors.initials: DP
authors.lastname: Seago
authors.forename: W E
authors.initials: WE
authors.lastname: Roberts
authors.forename: J C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D001034:Apgar Score; D001724:Birth Weight; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins