Cesarean delivery of the second twin after the vaginal birth of the first twin: misfortune or mismanagement?

The perinatal characteristics of 16 vaginal-abdominal deliveries of twins were evaluated. The primary indication for the cesarean delivery was compound vertex presentation (n = 4), prolapsed umbilical cord (n = 4), transverse lie (n = 7), and mentoposterior face presentation (n = 1). Ther outcome of Twin A was not different from that of Twin B. About 90% of the twins were eventually discharged on time. A significant correlation (R = 0.9722, p less than 0.0003) was found between the reported rates of combined deliveries and cesareans in twins. The data suggest that a higher rate of combined deliveries is expected in practices where abdominal deliveries are performed more often in twin gestations, while in obstetric services with low cesarean rates in twins, combined deliveries seem to be unfortunate occurrences dictated by unexpected intrapartum events.