Breech extraction versus cesarean section for the remaining second twin.

All second twins delivered by cesarean section (CS) after vaginal birth of the first twin (n = 38) and all breech-extracted second twins (n = 282) in Sweden during 1973-81 were identified. Data from the medical records of all CS second twins were extracted and compared with breech-extracted second twins from the same departments born within 2 years of the CS twin (n = 25). Second twins delivered after maternal general anesthesia had lower 5-min Apgar scores, irrespective of mode of delivery. Maternal morbidity was substantial in the CS group. The results encourage the use of breech extraction under local anesthesia rather than CS when there is a need for a quick delivery of the second twin and when both alternatives are available.