Z Geburtshilfe Neonatol 2015; 219 - P02_10
DOI: 10.1055/s-0035-1566582

Breech delivery of the second twin in all fours position of the mother

G Bogner 1, C Fazelnia 1, M Strobl 2, T Fischer 1, V Jacobs 1
  • 1Universitätsklinik Salzburg, Gynäkologie und Geburtshilfe, Salzburg, Austria
  • 2Klinikum Wels Grieskirchen, Gynäkologie und Geburtshilfe, Wels, Austria

Introduction: Spontaneous vaginal delivery of twins beyond 32 weeks of gestation is safe if the first twin is in cephalic presentation. Aim of this study is to verify that breech delivery of the second twin can be safe and feasible in all-fours position of the mother.

Methods: Prospective observational consecutive case series of vaginal breech deliveries of second twin delivery in all fours in tertiary perinatal center. Comparison of outcome was performed with a retrospective cohort of vaginal breech second twin births from 2005 – 2014.

Results: Out of 54 vaginal delivered second twins in breech position 12 women (22.2%) attempted breech delivery in all-fours position. Six of these deliveries (50%) were completed spontaneously without any intervention of the obstetrician. In n = 3 (25%) interventions were successful to complete vaginal births in all fours. The last n = 3 (25%) were converted back to supine position and delivered by standard maneuvers.

The mean age of these multipara women was 33.2 years (± 3.2; 26.8 – 40.6) and gestational age was 37.7th weeks (± 1.5; 2 × 34th week of gestation). Total duration of delivery was 3.7 ± 1.9h (range 1 – 9h), childrens' weight 2.675 ± 370 g (range 1.780 – 3.650 g), head circumference 33.3 ± 1.2 cm and time between both newborns was 21 ± 9 min (range 9 – 45 min). Second stage of labor of the second twin took 35 ± 10.7 min (19 – 68 min), expulsive efforts took 12 ± 8 min (range 3 – 45 min). Two twin pregnancies were monochorionic.

Postpartally, n = 3 newborns were transferred to the NICU. No severe peripartal morbidity or acidosis was observed. The direct comparison of the obstetric parameters with the outcome data of the breech presentation with classic support showed no clinical significant differences. The twin-twin interval was slightly prolonged (p = 0.01). There were no differences in the parameter of neonatal outcome.

Conclusion: Vaginal breech delivery of the second twin in all fours is a feasible and safe option.