TWINS

  • Twins per se is not an indication for C/S
  • Typically twins are smaller with lower bodyweight
  • Vaginal delivery is usually possible

When presenting twin (twin A) is in breech and second twin (twin B) in a cephalic presentation there is a risk of “locked twins”. In this case deliver by C/S

VAGINAL DELIVERY – both twins in breech

RETAINED TWIN B

Cervix is fully dilated

  • Deliver by internal version and extraction using a foot or both feet.

Cervix is not fully dilated

  • Deliver by C/S

LOCKED TWINS

Head of second twin (twin B) in cephalic presentation locks head of presenting twin (twin A) in breech. Chin against chin.

Both twins alive

  • Deliver the second twin (twin B) by C/S
  • Cover the incision with sterile towels
  • Position the patient’s legs in stirrups
  • Deliver the head of first twin (twin A) by Mauriceau-Levret’s maneuver
  • Change gown and glows
  • Return to the abdominal incision
  • Proceed as usual

First twin (twin A) is dead / Second twin (twin B) is alive

  • Give appropriate anesthesia
    • Spinal
    • Ketamine
    • General intubation
  • Place patient’s legs in stirrups
  • Decapitate the first twin (twin A)
    • Heavy scissors
    • Scalpel
  • Remove the body
  • Push the decapitated head up inside the uterus
  • Grasp a foot or both feet of the second twin (twin B)
  • Perform internal version
  • Deliver twin B by extraction on the foot/the feet
  • Continue as usual for a breech delivery
  • Introduce one hand into the uterus
  • Extract the decapitated head
    • One finger in the mouth
    • The severed neck in the palm of the hand
    • To protect vagina from injuries
  • Apply fundal pressure with the other hand
  • Remove placenta
  • Check for uterine rupture

Both twins dead

Same procedure as with “First twin dead / Second twin alive”

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