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Breech/vtx twins ( was What would ya'll do, new case )From: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk)Tue Jan 21 15:35:30 1997
In message <32D677F7.4E19@waonline.com>, Cheri Van Hoover <cherivh@waonline.com> writes >David A. Nagey, MD, PhD, FACOG wrote: >> >> I would be interested in a discussion >> > on what is and is not an appropriate presentation to deliver vaginally in >> > twins. >> > >> > J.G.M.Robertson MD >> > >> >> What I would do and what I would suggest sometimes differ. I would consider >> delivering these twins vaginally (breech/vtx) if A practically fell out >> once the stitch was removed - but (while I've done it before), I'm getting >> old and am no longer up to inducing a breech. > >What about all the cautions I've read in various texts about not doing >breech/vertex twins vaginally because of the risk of the fetal heads >locking? Is this not truly the contraindication to vaginal birth that >I've been led to believe? Physicians I've worked with who were willing >to do vaginal breech deliveries have scheduled sections for women with >twins who were breech/vtx because of this stated risk. > I have a fairly elderly UK text from early 1980's but with references going back to last century ( Munro-Kerr's Operative Obstetrics ). It says incidecne of locked twins is 1:90,000 of all twins. Many of these locked twins can be corrected and proceed to vaginal delivery ! Though he admits that locking of aftercoming head of breech with forecoming head is more difficult. Even in this situation he is positive and describes manouvres. In my practice twin deliveries of breech/vertex, breech/breech and breech trans, have all been permitted. Personally I have never experienced locked twins as above ( I have met twins impacted where presenting part of twin II refuses to descend ), nor have I ever met anyone who has ever experienced such a complication. This suggests to me that those who section all breech twins are doing so unnecessarily. "Common as Rocking-Horse manure!"
--
Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
Tel: 01582-497459 (office) Fax: 01582-497424
01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk
http://www.obgyn.net/board/griffith.htm
"It is dangerous to be right on a subject on which the established authorities
are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths)
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