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The aim of this study was to determine the safety of vaginal delivery with a non-vertex second twin when the first twin is in the vertex presentation. A retrospective analysis was undertaken, utilizing a cohort of twin gestations in which the presenting twin was vertex and the second twin was either vertex (group A) or non-vertex (group B). We assessed maternal and neonatal outcomes including emergency cesarean delivery, 5-minute Apgar scores, cord arterial pH, NICU admissions, and adverse maternal postpartum outcomes including ICU admissions and the requirement of blood products. Six hundred and eighty-five women with a vertex presenting twin were admitted to labor and delivery. Three hundred and ninety-five women were included in group A (vertex/vertex) and 290 were included in group B (vertex/non-vertex). No statistically significant differences were found in the 5-minute Apgar scores, cord arterial pH, or in the rates of emergency cesarean deliveries, NICU admission, maternal blood transfusion or ICU admissions. In conclusion, vaginal delivery of a breech second twin when the presenting twin is vertex was found as safe as vaginal delivery of twins in the vertex/vertex presentation.

Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins