• Caroline A Crowther.
• ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia, 5006.
• Cochrane Db Syst Rev. 2011 Dec 7; 2011 (12): CD000047CD000047.

BackgroundThe optimal mode of birth for a second twin in breech position is controversial, with support for both caesarean and vaginal birth.ObjectivesThe objective of this review was to assess the effects of caesarean birth compared with vaginal birth of a second twin not presenting cephalically.Search MethodsThe Cochrane Pregnancy and Childbirth Group's Trials Register and bibliographies up to 31 January 2007.Selection CriteriaRandomised trials of caesarean birth compared with vaginal birth in women with a twin pregnancy where the second twin is not presenting cephalically.Data Collection And AnalysisAll assessments of trial eligibility, quality and data extractions were done by the author without blinding.Main ResultsOne trial involving 60 pairs of twins was included. Maternal febrile morbidity were increased in women allocated to the caesarean group (relative risk (RR) 3.67, 95% confidence interval (CI) 1.15-11.69), and there was a trend to an increased need for use of general anaesthesia (RR 2.40, 95% CI 0.98-5.88). No differences were detected in neonatal outcome.Authors' ConclusionsCaesarean section for the birth of a second twin not presenting cephalically is associated with increased maternal febrile morbidity with, as yet, no identified improvement in neonatal outcome. This policy should not be adopted except within the context of further controlled trials.

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