Key result
Intrapartum management of twin gestations depends on presentation and operator skill, with combined vaginal-cesarean deliveries considered the riskiest method that should be avoided.
The route of delivery for twins depends on presentation, with vaginal delivery generally preferred for vertex-presenting first twins, while combined vaginal-cesarean deliveries should be avoided.
Supports avoiding combined vaginal-cesarean deliveries based on presentation; Level 5 review leaves optimal strategies open for prospective trials.
In Brief A trial of labor and vaginal delivery are usually indicated in vertex-vertex twins. For vertex-nonvertex twins, vaginal birth is preferred, with the second twin being delivered by breech extraction, unless it is significantly larger than the first. Cesarean delivery is indicated if the first twin is nonvertex and for all cases of monoamniotic or potentially viable conjoined twins. There is a limited role for trial of labor after cesarean delivery in twin gestations. In my opinion, combined vaginal-cesarean birth is the riskiest method for mother and infants and should be avoided if possible. The route of delivery of twins is determined by presentation and operator skill, and combined vaginal-cesarean deliveries should be avoided whenever possible.
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D. P. Cruikshank (2007) conducted a review in Twin gestations. Intrapartum management strategies was evaluated. Intrapartum management of twin gestations depends on presentation and operator skill, with combined vaginal-cesarean deliveries considered the riskiest method that should be avoided.
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