Objective The ideal mode of delivery of twins remains controversial. Common practice is to deliver twins vaginally if the leading twin is cephalic. This study analyzed the outcome of planned vaginal delivery for twins.

Methods Outcomes of planned vaginal twin birth over a 2 year period at St Thomas' Hospital London were recorded. Data was collected from patient records and statistically analyzed.

Results 151 sets of twins were studied. 51% of the women had successful vaginal births, while 49% required emergency caesarean section (ECS) including 7% for the second twin. 65% of vertex-vertex twins were delivered vaginally. Presentation of twins: both vertex in 54%; second twin was non-vertex in 30%; first twin was non-vertex in17%. The main indication for ESC was a non-vertex twin (36%) regardless of birth order (although 81% of first twins were non-vertex). 67% of breech twins underwent ESC; remaining had breech extraction. There was a 3 fold increased risk of a twin with a 5 min Apgar score <7 in the vaginal group versus those delivered via caesarean (p<0.07). Nulliparous women were more likely to deliver babies with lower Apgar scores (p<0.05).

Conclusion There were no statistically significant differences in neonatal outcome between the two modes of delivery. This study showed 67% of breech twins were delivery via emergency CS, a higher rate than that expressed in other studies.1,2 A larger randomized study is necessary to justify a policy of routine elective CS delivery of twins.