Cesarean delivery for the second twin in the vertex-vertex presentation: Operative indications and predictability

Background. The incidence of second twin delivery by cesarean section and whether obstetric parameters are predictive should be studied. Methods. In this retrospective study, all vertex-vertex twin deliveries during a 48-month period were reviewed. Results. During the study period, 106 sets of vertex-vertex twins were identified. In 68 pairs, both were delivered vaginally (group 1), and 21 pairs were born via cesarean section. In the 17 pairs in group 2, the first infant was delivered vaginally and the second by cesarean section because of fetal distress in 6 cases (35%), cord prolapse in 6 (35%), abnormal/unstable lie in 4 (23%), and abruptio placenta in 1 case (6%). The only maternal factor associated with abdominal delivery for twin B was greater maternal age. When cesarean delivery was required for twin B, a longer interval between deliveries and a lower Apgar score were noted. Conclusion. Cesarean birth of twin B is a more common clinical event than previously reported but is not easily predicted by obstetric parameters.