title: Management of nonvertex second twin.
abstract: OBJECTIVE
  The objective of the current study is to compare outcomes of twin pregnancies with attempted labor and active second-stage management with twin pregnancies delivered by planned cesarean delivery.
  
  
  METHODS
  Two hundred and eighty-three patients with twin pregnancy meeting the inclusion criteria were reviewed. They were followed for success of ECV and/or IPV in planned vaginal group and abdominal mode of delivery. Fetal outcome was assessed by APGAR score of both twins as well as NICU admission, if needed.
  
  
  RESULTS
  Out of 283 patients, 116 patients (40.9 %) had planned cesarean section, and 167 patients (59.01 %) had planned vaginal delivery. Out of 167 patients, 148 patients (88.6 %) had a vagi nal delivery of both twins. ECV was successful in 36 patients (25.3 %), and IPV was successful in 102 (95.3 %). IPV failed in five patients (4.6 %), and hence resorted to emergency cesarean section. There was no significant difference in the rates of twin B having a 5-min Apgar score lower than 7 or an arterial cord pH below 7.20 in both the groups. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 8.3 %, out of which combined vaginal-cesarean delivery rate was 4.6 %.
  
  
  CONCLUSIONS
  Active second-stage management is associated with neonatal outcomes similar to those with planned cesarean delivery and a low risk of combined vaginal-cesarean delivery.
authors.affiliation: Gynae Unit II, Fatima memorial hospital, Lahore, Pakistan ; House 32-B, street-1, cavalry ground, Shadman, Lahore, Pakistan.
authors.forename: Farhatulain
authors.initials: F
authors.lastname: Ahmed
authors.affiliation: Gynae Unit II, Fatima memorial hospital, Lahore, Pakistan.
authors.forename: Noorikiran
authors.initials: N
authors.lastname: Naeem
authors.affiliation: Gynae Unit II, Fatima memorial hospital, Lahore, Pakistan.
authors.forename: Shamila
authors.initials: S
authors.lastname: Yasir
keywords: Cesarean section; ECV; IPV; Second twin delivery; Twin pregnancy