Cesarean section for the second twin

Twin pregnancies delivered after 26 weeks gestation were reviewed. Of 167 twin pregnancies 101 (60.5%) were delivered by cesarean section. There were 8 combined vaginal-abdominal deliveries, including 4.8% of all twins delivered and 7.3% of all twins delivered by cesarean section. The commonest indication for the cesarean birth of the second twin was transverse lie. The data suggest that cesarean section of the second twin is not possible to predict by obstetrics variables including antepartum ultrasound. In order to decrease the rate of combined vaginal-abdominal deliveries the need to reassess the currently protocol of management for twin delivery is indicated.