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2 results

  • Chapter 13 - Twin Delivery

  • Edited by Sir Sabaratnam Arulkumaran, St George's Hospital Medical School, University of London
  • Book:
    Best Practice in Labour and Delivery
    Published online:
    16 October 2025
    Print publication:
    06 November 2025, pp 159-171

  • Summary

    The twin birth rate has increased over the last four decades due to rising maternal age at conception and the use of assisted reproductive technology. Compared to singletons, twins, especially the second twin, are more susceptible to perinatal complications. However, current evidence suggests that in well-selected patients under skilled obstetricians’ care, planned vaginal delivery can be just as safe as planned caesarean delivery. This chapter elaborates on evidence-based information about selection criteria for vaginal twin delivery, timing of delivery and intrapartum management. Techniques for delivering vertex and nonvertex second twins and intertwin delivery intervals will also be discussed, along with addressing the associated controversies. Given the tendency of twin pregnancies to have preterm delivery, this chapter will also delve into the decision-making process for the mode of delivery in preterm twin gestations.

  • Chapter 12 - Breech Presentation

  • from Part II - INTRAPARTUM AND POSTPARTUM
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book:
    Operative Obstetrics
    Published online:
    07 May 2010
    Print publication:
    04 August 2008, pp 297-321

  • Summary

    This chapter reviews the fundamentals of the techniques for breech delivery and the evaluative process required for appropriate management. Also reviewed are external cephalic version (ECV) and internal podalic version (IPV) and the special needs of the premature breech fetus at delivery. These concepts and approaches are applicable in all breech presentations, independent of the route of delivery. Techniques for delivering the breech fetus are assisted breech delivery, delivering the aftercoming head, and breech extraction. Piper forceps (or alternatively, Simpson or Keilland forceps) can be used for delivering the aftercoming head at the clinician's discretion. The risk that the breech fetus might become acidotic during labor and delivery is marginally greater than for its cephalic counterpart. Once a breech presentation has been diagnosed, the patient and her family can be counseled and instructed about the potential problems that might be encountered.