Management of the breech second twin.

The risk of vaginal delivery of breech infants is well documented and reflected in a high cesarean section rate for those infants. We also found that, among sets of twins delivered between 1970 and 1977, breech first twins were significantly more likely to be delivered by cesarean sections than were vertex first twins. Breech second twins, however, did not have a cesarean section rate significantly higher than that of vertex second twins. The data did not justify a less frequent use of cesarean section for breech second twins. There was no significant difference in perinatal mortality rates or Apgar scores between breech first and second twins, and cesarean sections improved the outcome equally for breech first and second twins. Breech infants, whether first or second, fare worse than vertex infants. Therefore, appropriate management of twins in labor should include determination of the presentation of the second twin and use of the same indications for cesarean section for both first and second twins in breech presentation.