Category: 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”