title: Attempted vaginal versus planned cesarean delivery in 195 breech first twin pregnancies.
abstract: BACKGROUND
  To compare neonatal and maternal outcomes for breech first twins according to whether vaginal or cesarean delivery was planned and to verify that in appropriate selected cases, attempted vaginal delivery is a reasonable choice.
  
  
  METHODS
  A retrospective study of all twin pregnancies with the first twin in breech position and gestational age at least 35 weeks at birth at two French university hospital centers from January 1994 through December 2000. The primary outcome was a combined indicator of neonatal mortality and severe morbidity, as defined by one or more of the following: death before discharge, admission to neonatal intensive care unit, 5-minute Apgar score <7, cord blood pH <7.10, or birth trauma.
  
  
  RESULTS
  Cesarean delivery was planned for 71 (36.4%) patients, and attempted vaginal delivery for 124 (63.6%), 59 (47.6%) of whom were delivered vaginally and 65 (52.4%) by cesarean during labor. Neither the combined negative outcome indicator nor neonatal mortality differed significantly for either twin or either group. There were no significant differences in maternal mortality or morbidity between the two groups. The frequency of deep vein thrombophlebitis or pulmonary embolism requiring anticoagulant therapy was significantly higher in the planned cesarean group [3/71 (4.2%) versus 0/124; p=0.047].
  
  
  CONCLUSIONS
  When appropriate criteria are used to decide mode of delivery, a careful intrapartum protocol is followed, and an experienced obstetrician, midwife, and anesthesiologist are in attendance, attempted vaginal delivery is a reasonable option for first twins in breech position.
authors.affiliation: Department of Obstetrics and Gynaecology, Rouen University Hospital - Charles Nicolle, Rouen, France. loicsentilhes@hotmail.com
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Alain
authors.initials: A
authors.lastname: Talbot
authors.forename: Alain
authors.initials: A
authors.lastname: Diguet
authors.forename: Eric
authors.initials: E
authors.lastname: Verspyck
authors.forename: Dominique
authors.initials: D
authors.lastname: Cabrol
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008499:Medical Records; D006473:Postpartum Hemorrhage; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014427:Twins