A rare indication for Caesarean section: the second twin. (Discussion of the paper by G. Scholtes: Geburtsh. u. Frauenheilk. 34 (1974) 448) (Author's transl)
Schnell, K.H.
Geburtshilfe und Frauenheilkunde 35(2): 146-148
1975
ISSN/ISBN: 0016-5751 PMID: 1140551 Document Number: 91310
The discussion raises objections to this indication for Caesarean section. The indication for Caesarean section should become apparent prior to an attempt of vaginal delivery. A combined version of the second twin with intact membranes should eliminate some of the problems of internal podalic version with ruptured membranes. From 1971 to 1974, 43 twin deliveries (0.96 percent) occurred in 4,695 deliveries. There were two primary Caesarean sections. Four second twins were manually extracted. Five second twins were delivered by the Veit-Smellie Maneuver. One second twin was delivered by forceps and internal podalic version was used in 6 cases (13.9 percent). Three second twins died, one due to spontaneous antepartum umbilical cord complication, one due to fetal anomaly and one due to virus infection. The perinatal mortality for the second twin was therefore 6.9 percent. The author concedes that a combined version with intact membranes prior to an attempt of vaginal delivery may have been desirable in his cases but he reiterates that a Caesarean section for the second twin was the only way to obtain healthy live infants in his three exceptional cases.