Intrapartum management of twin gestation.

Neonatal mortality and morbidity were analyzed in 362 pairs of twins delivered at Yale-New Haven Medical Center during a five-year period. Of the 154 (42.5%) pairs in vertex-vertex presentations, 125 (81.2%) were delivered vaginally. No difference in the occurrence of low five-minute Apgar scores was found in relation to the length of time interval between delivery of the twins. Of the 139 (38.4%) twins in vertex-nonvertex presentations, 99 (71.2%) were delivered vaginally. In the entire series, there was one case of significant birth trauma related to vaginal delivery of a nonvertex second twin. The one instance of neonatal death clearly related to birth asphyxia resulted after cesarean section. A protocol for the intrapartum management of twin gestations is presented based upon intrapartum fetal presentation and sonographically determined estimated fetal weight.