[Breech extraction of the second twin. 56 cases and review of the literature]

Abstract

The best indication for breech extraction, and undoubtedly the last, is for delivery of the second twin with a non-cephalic presentation. At the Besançon University Hospital, we have used this technique routinely and without delay in case of non-cephalic presentation of the second twin. In order to evaluate the results of this approach, we studied 56 patients files retrospectively in a continuous series of case over a 7-year period. The following data were noted: birthweights, APGAR score at 5 minutes, requirement for paediatric intensive care, hospitalization in paediatric ward, and death. Gestational age and rate of prematurity were calculated. We also recorded the rate and type of antalgisia used, as well as the frequency of episiotomy. Both the obstetrical and neonatal results indicated that breech extraction of the second twin is a reliable effective technique in terms of mortality and morbidity for the second twin. Using this technique should not raise any legal problems since the other techniques for delivering the second twin have not been shown to give better results. When planned and performed under precise conditions by an experimented physician, this route does not give any poorer results than cesarean. Breech extraction should be an exceptional technique all obstetricians can use, together with cesarean, for delivering the second twin.