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Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):901-6.

The effect of presentation and mode of delivery on neonatal outcome in the second twin.

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  • 1Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157.



The purpose of this study was to determine if cesarean delivery of the nonvertex second twin improved neonatal outcome.


We examined the maternal and neonatal records from 457 sets of twins delivered from 1985 to 1990. We compared 1- and 5-minute Apgar scores, umbilical artery and vein blood pH values, duration of neonatal hospitalization, the incidence and length of ventilation, intraventricular hemorrhage, birth trauma, and mortality rate between vertex and nonvertex second twins delivered either vaginally or by cesarean section.


The presentation and mode of delivery of the second twin was not associated with a significant difference in any of the outcome variables except for the 1-minute Apgar score, which was lower in the nonvertex group delivered vaginally.


Our data do not support routine cesarean delivery for twins of any birth weight when the second twin is nonvertex.

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