Rupture of membranes in case of internal podalic version: a risk for cesarean section on the second twin
Objectives To evaluate if internal version with ruptured membranes is a risk factor of cesarean section for the second twin. Patients and methods Two hundred and fifty-nine twins vaginal deliveries after 33 weeks of gestation from 1997 to 2009 in a level 3 maternity. A retrospective case-control study comparing two groups: cases of cesarean section on second twin and five twins vaginal deliveries following the case. Active management of the second twin delivery was performed with a short intertwin delivery. Results Eleven cesarean sections on the second twin were performed (4.2%). The main indication was failure of internal version. The risk of cesarean section was significantly greater when the internal version was performed with ruptured membranes (OR: 25.4 IC 95% [2.3-275.7] P < 0.003) and when intertwin time delivery interval was increased (8.1 ± 5.1 vs 16.7 ± 6.3, P < 0.001). Discussion and conclusion The rupture of amniotic membranes before or during the internal podalic version is associated with a risk of failure and cesarean for the second twin. We recommend to perform the internal podalic version with unruptured membranes according to the French recommendations.