[Second twin delivery in cephalic presentation. Apropos of a series of 127 patients].
BACKGROUND
In 2009, the French National College of Obstetricians and Gynaecologists (CNGOF) clinical practice guidelines encouraged the active management of the second twin (T2) in high and mobile cephalic presentation (CP) by performing systematic internal maneuvers. In our department, this type of management is less frequent as whenever T2 is not delivered spontaneously after a short time interval, an instrumental extraction is realized.


METHODS
We analyzed our practice for 5 years upon 127 twin pregnancies with a trial of vaginal delivery for T2 in CP. We compared the results following different modes of delivery which are: spontaneous delivery, instrumental extraction, and total breech extraction after manual internal version.


RESULTS
No significant difference was found among the 3 groups in terms of maternal, fetal and neonatal well-being. Moreover, instrumental delivery was feasible, with a mean time interval for delivery between the 2 twins<15 minutes, even when performed by an obstetrician on training.


CONCLUSIONS
The aim of our study was to evaluate our practice on T2 in CP, because this event can be quite tricky, thus discouraging less experienced obstetricians towards this practice and resulting in an increase in caesarean sections for T2. Instrumental delivery should be considered a possible option for any T2 in CP so as to ensure the continued existence of vaginal births for twin pregnancies.
Hôpital Jean-Minjoz, pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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M
Roesch
Hôpital Jean-Minjoz, pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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A
Bourtembourg
Laboratoire de biostatistique, faculté de médecine, place Saint-Jacques, 25030 Besançon, France.
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M
Panouillères
Hôpital Jean-Minjoz, pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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R
Ramanah
Hôpital Jean-Minjoz, pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France. Electronic address: didier.riethmuller@univ-fcomte.fr.
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D
Riethmuller
D000328:Adult; D001722:Birth Order; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007746:Labor Presentation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D014219:Trial of Labor; D014427:Twins
Accouchement voie basse; Cephalic presentation; Deuxième jumeau; Grossesse gémellaire; Présentation céphalique; Second twin; Twin pregnancy; Vaginal delivery