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Is routine caesarean section necessary for breech-breech and breechtransverse twin gestations?


JK Essel
ET Opai-Tetleh

Abstract

Objective: To determine if perinatal outcome is affected by the route of delivery in breech-breech and breech-transverse twin gestations. Design: Prospective observational study. Setting: Umtala General Hospital, a referral hospital for approximately 32 rural hospitals throughout the former Transkei. Subjects: Twin gestations with breech-breech and breech-transverse presentations. Main outcome measures: Birth weights, 5-minute Apgar scores and neonatal mortality rates among 41 women who underwent vaginal delivery were compared with those of 27 who underwent transverse lower-segment caesarean sections. Results: A total of 68 women were involved in the study. Forty-one were delivered vaginally and 27 underwent transverse lower-segment caesarean sections. The vaginal delivery group consisted of 35 breech-breech and 6 breech-transverse twin gestations, while the caesarean section group comprised 25 breech-breech and 2 breech-transverse presentations. Both twin I and twin 11 in the caesarean section group were bigger than their respective counterparts delivered vaginally (P < 0.02 for twin I and P < 0.01 for twin 11). There were no statistically significant differences in either 5-minute Apgar scores or neonatal mortality rates between the two groups. Conclusion: Vaginal delivery of breech-breech and breech-transverse twin gestations appears a reasonable option provided criteria for vaginal breech delivery are adhered to.

S Afr Med J 1996; 86: 1196-1200

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eISSN: 2078-5135
print ISSN: 0256-9574