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Intrapartum External Version of the Second Twin

From the Department of Obstetrics and Gynecology, Yale—New Haven Medical Center, New Haven, Connecticut

Abstract

Twenty-five external cephalic versions were attempted on 14 transverse and 11 breech malpositioned second twins. In ten of 14 (71%) transverse presentations and eight of 11 (73%) breech presentations, version was successful and resulted in subsequent vertex vaginal delivery. Successful version was not associated with parity, gestational age, or birth weight but was associated with mode of anesthesia and disparity in twin size. Among the 25 attempted versions, seven (28%) had one-minute and two (8%) had five-minute Apgar scores below 7. Analysis by birth weight and mode of delivery is presented. Time interval between delivery of twins had no association with outcome. One neonatal death occurred in a 28-week, 1100-g infant. The authors believe that external version is useful in the management of the second twin who has an abnormal presentation, and that routine cesarean section is not always necessary. Further investigation, especially at lower birth weights, is necessary to confirm the safety and efficacy of this method of management.