title: The effect of mode of delivery and gestational age on neonatal outcome of the non-cephalic- presenting second twin.
abstract: OBJECTIVE
  Our purpose was to compare the neonatal morbidity of the non-cephalic- and cephalicpresenting second twin in terms of mode of delivery and gestational age.
  
  
  METHODS
  A retrospective cohort study of 422 sets of twins with a cephalic-presenting first twin was performed.
  
  
  RESULTS
  The non-cephalic-presenting second twin was less likely to be delivered vaginally than the cephalic second twin, odds ratio 0.5 (95% CI 0.3-0.8). There were no significant differences in low Apgar scores at 5 minutes and admission to the neonatal intensive care unit for non-cephalic-presenting compared with cephalic-presenting second twins, adjusted odds ratio 1.1 (95 % CI 0.5-2.2) and 1.4 (0.8-2.6). Delivery by caesarean section was associated with increased admission to the neonatal intensive care unit for cephalic second twins, adjusted odds ratio 3.8 (1.2-12.7). Neonatal morbidity after vaginal delivery was similar for non-cephalic-presenting and cephalic-presenting second twins, particularly at lower gestational ages (24-31 weeks, Apgar score at 5 minutes <7, adjusted odds ratio 0.8 [0.1-11.3]).
  
  
  CONCLUSIONS
  Vaginal delivery for the non-cephalic-presenting second twin appears to be a reasonable management option, particularly at early gestational ages.
authors.affiliation: Royal United Hospital, the Division of Obstetrics and Gynecology, St Michael's Hospital, Bath, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Caukwell
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Murphy
mesh_terms: D001034:Apgar Score; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007746:Labor Presentation; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D014427:Twins