Schaal Jean-Patrick, Equy Véronique, Thong-Vanh Catherine, Pons Jean-Claude, Hoffmann Pascale
Département de gynécologie obstétrique, CHU de Grenoble, BP 217, 38043 Grenoble.
Rev Prat. 2006 Dec 31;56(20):2249-54.
The number of twin pregnancies is still increasing. This should not be assessed only as therapeutic success but also as complex obstetrical challenges. The main difficulties encountered are dystocic presentations, dystocic labours, and cord prolapses. Specific multiple pregnancy dystocias as chin-to-chin interlocking twins and conjoined twins are very rare. Twin delivery is substantially worse when compared with singleton delivery, with increased morbidity and mortality principally involving the second twin. Labour induction is possible, and should be indicated between the 38th and 39th weeks of gestation. Caesarean section should be done easily, especially in case of prematurity or in case of breech presentation for the first twin. Excepting these cases and the usual caesarean section indications, there is no demonstrated superiority of the caesarean section delivery compared to the vaginal delivery. When needed, internal version and/or breech extraction should be done with intact membranes. Active management of the third stage is necessary, due to uterine surdistension easily leading to uterine atonia.
