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Twin A BreechFrom: ainsron@msn.comFri May 5 10:53:49 2000
There was an article from Israel in the January Green journal that discussed their experience with vaginal delivery of twins when Twin A was breech. The conclusion was that the outcome was the same, morbidity and mortality, if A was over 1500 gms. There were ~600 patients in the study. I've always felt and was taught that it was verbotten primarily because of the risk of interlocking heads. That wasn't a problem in the study. Have any of the listers had experience with this scenario, and if not, would you consider it an option for a motivated patient? The day before I read the article (I'm a few months behind on my reading, too much time on the computer.), I was seeing a patient in consultation who had planned a home birth before the twins were diagnosed and she is requesting a vaginal delivery in the hospital,with Twin A breech. I told her in no uncertain terms that it was no an option in my hands. I don't mind delivering selected breeches vaginally, but this thought puts my coronaries into spasm. Now that I have this article supporting the idea, do I need to rethink my position and discuss the article's "new information" with the patient, or let sleeping dogs lie?
-- Ronald E. Ainsworth, MD
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