ABSTRACT
The objective of this manuscript is to examine the effect of presentation of the first
twin and mode of delivery on perintal outcome in twin deliveries. We reviewed all
records of twin deliveries at a gestational age of 32 weeks and more from January
1, 1989 to December 31, 1995. Study cases were divided according to the first twin
presentation (vertex = group A, nonvertex = group B) and then subdivided according
to the planned mode of delivery, vaginal trial of labor (VTOL), and cesarean section
(CS). The protocol for group A facilitated an attempt at vaginal delivery and for
group B, vaginal delivery was considered as for a singleton fetus in breech presentation.
Of 306 pairs of twins, 235 were in group A and 71 in group B. In group A, 219 women
(93.2%) were eligible for VTOL, and the remaining 16 underwent CS. Thirty-three group
B women were eligible for VTOL (46.5%; p < 0.001) and 38 had CS. In group A, of the 219 candidates for VTOL, 199 (90.9%) delivered
vaginally and 20 underwent a CS. In group B, of the 33 VTOL candidates 18 (54.5%)
delivered vaginally and 15 underwent CS. Neonatal outcome did not differ in relation
to the presentation of the first twin or the planned/actual mode of delivery. There
were no cases of birth trauma, neurological complications, or perinatal mortality.
Trial of vaginal labor is safe in twin deliveries with the first twin in vertex presentation.
Provided criteria for vaginal breech delivery are adhered to, this also appears to
be a reasonable option in twin deliveries with the first twin in nonvertex presentation.
KEYWORD
Twin delivery - presentation - mode of delivery
