The effect of mode of delivery and gestational age on neonatal outcome of the non-cephalic-presenting second twin

Objective: Our purpose was to compare the neonatal morbidity of the non-cephalic- and cephalicpresenting second twin in terms of mode of delivery and gestational age. Study Design: A retrospective cohort study of 422 sets of twins with a cephalic-presenting first twin was performed. Results: The non-cephalic-presenting second twin was less likely to be delivered vaginally than the cephalic second twin, odds ratio 0.5 (95% CI 0.3-0.8). There were no significant differences in low Apgar scores at 5 minutes and admission to the neonatal intensive care unit for non-cephalic-presenting compared with cephalic-presenting second twins, adjusted odds ratio 1.1 (95 % CI 0.5-2.2) and 1.4 (0.8-2.6). Delivery by caesarean section was associated with increased admission to the neonatal intensive care unit for cephalic second twins, adjusted odds ratio 3.8 (1.2-12.7). Neonatal morbidity after vaginal delivery was similar for non-cephalic-presenting and cephalic-presenting second twins, particularly at lower gestational ages (24-31 weeks, Apgar score at 5 minutes <7, adjusted odds ratio 0.8 [0.1-11.3]). Conclusion: Vaginal delivery for the non-cephalic-presenting second twin appears to be a reasonable management option, particularly at early gestational ages. (Am J Obstet Gynecol 2002;187:1356-61.)