[Rupture of membranes in case of internal podalic version: a risk for cesarean section on the second twin].
OBJECTIVE
To evaluate if internal version with ruptured membranes is a risk factor of cesarean section for the second twin.


METHODS
Two hundred and fifty-nine twins vaginal deliveries after 33 weeks of gestation from 1997 to 2009 in a level 3 maternity. A retrospective case-control study comparing two groups: cases of cesarean section on second twin and five twins vaginal deliveries following the case. Active management of the second twin delivery was performed with a short intertwin delivery.


RESULTS
Eleven cesarean sections on the second twin were performed (4.2%). The main indication was failure of internal version. The risk of cesarean section was significantly greater when the internal version was performed with ruptured membranes (OR: 25.4 IC 95% [2.3-275.7] P<0.003) and when intertwin time delivery interval was increased (8.1±5.1 vs 16.7±6.3, P<0.001).


CONCLUSIONS
The rupture of amniotic membranes before or during the internal podalic version is associated with a risk of failure and cesarean for the second twin. We recommend to perform the internal podalic version with unruptured membranes according to the French recommendations.
Département de gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371 avenue Doyen-Gaston-Giraud, Montpellier, France. elsarebufa@hotmail.com
E
E
Rebufa-Dhenin
A
A
Flandrin
L
L
Reyftmann
H
H
Dechaud
G
G
Burlet
P
P
Boulot
D000328:Adult; D000650:Amnion / Q000601:surgery; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D014710:Version, Fetal / Q000706:statistics & numerical data*