title: [Active management of the second twin for vaginal delivery: ruptured versus intact membranes. Apropos a series of 182 patients].
abstract: OBJECTIVE
  The vaginal management of the second twin (T2) differs throughout our country. In 2009, the French National College of Gynecologists and Obstetricians released practice guidelines, with low-level evidence, encouraging active management of the second twin, using maneuvers with intact membrane.
  
  
  METHODS
  In our level III labour ward, these maneuvers are systematically performed when the second twin is in a breech or transverse presentation and after ruptured membranes in most cases. We studied 182 twin pregnancies with active management of the T2 at more than 28 weeks of gestation, from 1st January 1996 to 31st December 2010, by comparing the membrane status during delivery of T2.
  
  
  RESULTS
  The results did not show any significant differences between the two groups of patients concerning the neonatal or maternal results. The technique is feasible, even by residents. Our results show that total breech extraction of the second twin with ruptured membranes is feasible, which allows for reappraisal of the national recommendations.
  
  
  CONCLUSIONS
  In our practice, it is possible to actively deliver the T2 with ruptured membranes without altering maternal and fetal prognosis and thus simplifying learning for young doctors.
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
authors: M
authors: M
authors: Roesch
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
authors: M
authors: M
authors: Mangin
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
authors: A
authors: A
authors: Bourtembourg
authors: Laboratoire de biostatistique, faculté de médecine, place Saint-Jacques, 25000 Besançon, France.
authors: M
authors: M
authors: Desmaret
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
authors: R
authors: R
authors: Maillet
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
authors: R
authors: R
authors: Ramanah
authors: Pôle mère-femme, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France. Electronic address: didier.riethmuller@univ-fcomte.fr.
authors: D
authors: D
authors: Riethmuller
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D059285:Pregnancy, Twin
keywords: Deuxième jumeau; Grande extraction; Intact membrane; Membranes intactes; Membranes rompues; Ruptured membrane; Second twin; Total breech extraction