[First breech twin pregnancy: Can we still accept a vaginal delivery? Comparative study of perinatal outcome with attempt of vaginal delivery versus planned cesarean: 166 cases].

Objectives: To evaluate practices and perinatal outcome in planned routes of delivery for first breech twins.

Materials And Methods: A retrospective study in first breech twin pregnancies with a gestational age of at least 35 weeks at onset of labor. Maternofetal pathologies known to be associated with a poor neonatal outcome were excluded. A low neonatal outcome was defined by at least one of the following criteria: neonatal death, 5-minute Agar Score < 7, cord blood pH < 7.10, traumatic neurological injuries, admission in neonatal intensive unit care. Neonatal and maternal outcomes were compared between attempt of vaginal delivery (AVD) and planned cesarean section (PCS).

Results: Among 166 included patients, an AVD has been performed in 105 cases (63.3%) and a PCS in 61 (36.8%). In AVD group, 46 women (43.8%) delivered vaginally. Low neonatal outcome was not significantly different in AVD group compared with PCS group (9 (8.6%) versus 6 (9.8%); p = 0.78 for the first twin and 7 (6.7%) versus 2 (3.3%); p = 0.49 for the second twin). There was no significant difference in maternal morbidity between the two groups. As a general rule, established practices for deciding route of delivery and labor have been applied in our department.

Conclusion: No excess of neonatal risk in AVD group compared with PCS was observed. These results could be extrapolated to centers applying a careful protocol to decide the route of delivery and labor practices.