Management of the nonvertex second twin.

We reviewed twin deliveries during a five year period at North Carolina Memorial Hospital and Wake County Medical Center in which Twin B presented as nonvertex. We compared three delivery routes: primary abdominal delivery, breech extraction of the second twin and external version of the second twin. There was no difference in neonatal outcome between the delivery routes. Mothers in the external version group were more likely than those in the breech extraction group to undergo abdominal delivery of the second twin. These women also required more emergency anesthesia, had a higher blood loss and stayed in the hospital longer after delivery.