Is routine caesarean section necessary for breech-breech and breech-transverse twin gestations?

OBJECTIVE

To determine if perinatal outcome is affected by the route of delivery in breech-breech and breech-transverse twin gestations.

DESIGN

Prospective observational study.

SETTING

Umtata General Hospital, a referral hospital for approximately 32 rural hospitals throughout the former transkei.

SUBJECTS

Twin gestations with breech-breech and breech-transverse presentations.

MAIN OUTCOME MEASURES

Birth weights, 5-minute Apgar scores and neonatal mortality rates among 41 women who underwent vaginal delivery were compared with those of 27 who underwent transverse lower-segment caesarean sections.

RESULTS

A total of 68 women were involved in the study. Forty-one were delivered vaginally and 27 underwent transverse lower-segment caesarean sections. The vaginal delivery group consisted of 35 breech-breech and 6 breech-transverse twin gestations, while the caesarean section group comprised 25 breech-breech and 2 breech-transverse presentations. Both twin I and twin II in the caesarean section group were bigger than their respective counterparts delivered vaginally (P < 0.02 for twin I and P < 0.01 for twin II). There were no statistically significant differences in either 5-minute Apgar scores or neonatal mortality rates between the two groups.

CONCLUSION

Vaginal delivery of breech-breech and breech-transverse twin gestations appears a reasonable option provided criteria for vaginal breech delivery are adhered to.