Introduction: Spontaneous vaginal delivery of twins beyond 32 weeks of gestation is safe if the
first twin is in cephalic presentation. Aim of this study is to verify that breech
delivery of the second twin can be safe and feasible in all-fours position of the
mother.
Methods: Prospective observational consecutive case series of vaginal breech deliveries of
second twin delivery in all fours in tertiary perinatal center. Comparison of outcome
was performed with a retrospective cohort of vaginal breech second twin births from
2005 – 2014.
Results: Out of 54 vaginal delivered second twins in breech position 12 women (22.2%) attempted
breech delivery in all-fours position. Six of these deliveries (50%) were completed
spontaneously without any intervention of the obstetrician. In n = 3 (25%) interventions
were successful to complete vaginal births in all fours. The last n = 3 (25%) were
converted back to supine position and delivered by standard maneuvers.
The mean age of these multipara women was 33.2 years (± 3.2; 26.8 – 40.6) and gestational
age was 37.7th weeks (± 1.5; 2 × 34th week of gestation). Total duration of delivery was 3.7 ± 1.9h (range 1 – 9h), childrens'
weight 2.675 ± 370 g (range 1.780 – 3.650 g), head circumference 33.3 ± 1.2 cm and
time between both newborns was 21 ± 9 min (range 9 – 45 min). Second stage of labor
of the second twin took 35 ± 10.7 min (19 – 68 min), expulsive efforts took 12 ± 8
min (range 3 – 45 min). Two twin pregnancies were monochorionic.
Postpartally, n = 3 newborns were transferred to the NICU. No severe peripartal morbidity
or acidosis was observed. The direct comparison of the obstetric parameters with the
outcome data of the breech presentation with classic support showed no clinical significant
differences. The twin-twin interval was slightly prolonged (p = 0.01). There were
no differences in the parameter of neonatal outcome.
Conclusion: Vaginal breech delivery of the second twin in all fours is a feasible and safe option.
