Best Pract Res Clin Obstet Gynaecol. 2002 Feb;16(1):43-56.
Twin delivery.
Barrett JF, Ritchie WK.
Sunnybrook and Women's College Hospital, University of Toronto, 60 Grosvenor
Street, Toronto, Ontario, M5S 1B6, Canada.
The incidence of twin pregnancy has increased worldwide over the past 10
years largely as a consequence of the assisted reproductive technologies.
Issues such as intrapartum monitoring and operative interventions,
especially with regard to the second twin, provide a unique challenge in
labour and delivery. Epidemiological data suggest that the term twin has a
threefold higher mortality rate than the singleton. It is the authors' view
that many aspects of twin delivery deserve as much import as those features
of twin gestations such as pre-term birth and intrauterine growth
restriction that, to date, have received much of the research and clinical
interest in this area.Indications for elective Caesarean section are
presented, incorporating new data derived from the delivery of the term
singleton breech, and implications on the timing thereof are
discussed.Vaginal delivery of both twins presenting by the vertex is
recommended as safe as long as guidelines for the conduct of such delivery
are followed. The recommended time interval between twins as well as the use
of epidural, fetal monitoring and ultrasound in the delivery room are
discussed.The second twin presenting as a non-vertex presents an urgent
dilemma for accoucheurs. Data suggest that internal version and breech
extractions are safer than external cephalic version provided that the
appropriate techniques are applied. It is revealed, however, that the use of
elective Caesarean section in this group of babies has not been subject to
randomized controlled studies of sufficient power to determine the best
method of delivery of the second twin - particularly in the low-birth-weight
baby.
