Selected Intrapartum External Cephalic Version of the Second Twin

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Abstract
After delivery of twin A, external cephalic version was attempted on 30 malpositioned second twins (12 transverse and 18 breech). Version was successful and resulted in subsequent vertex vaginal delivery for 11 of the 12 transverse presentations and 16 of 18 breech presentations. Successful version was not associated with parity or with birth weight. Among the 30 attempted versions, only one infant had a 1-minute Apgar score below 7. There were not enough cases to determine an association of delivery interval between twins and poor neonatal outcome. External cephalic version in selected twin gestations is useful for management of the second twin with abnormal presentation. Technique refinement and greater experience may improve the overall success rate with external version of the second twin. Although external cephalic version cannot yet be recommended as the method of choice, the procedure seems safe, and routine cesarean delivery may not always be indicated.

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