title: [Twin delivery with the first twin in breech position. A study of 137 continuous cases].
abstract: OBJECTIVE
  The first twin (T1) in breech position is at risk of complications during vaginal delivery, making the choice of the appropriate delivery route highly important. Although British and American practice guidelines recommend the cesarean section, the French National College of Obstetricians and Gynecologists concluded that there was not enough data to choose one delivery route or the other. In this context, we set out to describe practices in our centre.
  
  
  METHODS
  Our retrospective study was conducted at a level III labor ward between January 1st, 1995 and December 31st, 2006. One hundred and thirty-seven twin pregnancies at more than 26 gestational weeks (GW), with T1 in breech and T2 in any position, were included.
  
  
  RESULTS
  A cesarean section was performed before labor in 60.6 % cases. Among the 54 (39.4 %) cases where a trial of labor was accepted, 29 patients (53.7 % success rate) delivered vaginally and 25 (46.3 %) had a cesarean section during labor. No statistical difference was observed between the neonatal outcomes after cesarean section as compared to vaginal birth. However, a significant relationship was found between delivery route and parity. Less than one-third of nulliparas versus two-third of patients with a history of at least one delivery, having trials of labor, ultimately gave birth vaginally. Thus, we observed a high rate of cesarean section during labor in nulliparas (68 % of the initially accepted trials of labor).
  
  
  CONCLUSIONS
  Our study is the first one that clearly shows that the success rate of the trial of labor is closely related to a history of vaginal birth. Following these results and because of more than two-third of cesarean section during labor in nulliparas, we subsequently plan an elective cesarean section at the 38th GW for nulliparas with twin pregnancies and T1 in breech position. Nevertheless, if any of these patients go in labor before the cesearean section, a careful trial of labor is offered.
authors: Service de gynécologie-obstétrique, CHU Saint-Jacques, 2, place Saint-Jacques, 25000 Besançon, France.
authors: A
authors: A
authors: Bourtembourg
authors: R
authors: R
authors: Ramanah
authors: M
authors: M
authors: Jolly
authors: E
authors: E
authors: Gannard-Pechin
authors: P
authors: P
authors: Becher
authors: S
authors: S
authors: Cossa
authors: B
authors: B
authors: Mulin
authors: R
authors: R
authors: Maillet
authors: D
authors: D
authors: Riethmuller
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D004200:Diseases in Twins / Q000628:therapy*; D005260:Female; D005602:France; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010298:Parity; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D014219:Trial of Labor