In one patient alone, first twin was delivered vaginally while second twin was delivered by caesarean section because of transverse lie of second twin with failed internal podalic
After 32 weeks, the mode of delivery may be vaginal if the presenting twin is vertex and the delivery provider can perform breech extraction or internal podalic
version, if necessary.
The second twin delivered by spontaneous vaginal delivery in 29(58%), vacuum delivery 3(6%), spontaneous breech delivery in 5(10%), assisted breech delivery in 7(14%), breech extraction in 3(6%), internal podalic
version and breech extraction in 3 (6%).
2,4 The predisposing factors of UR in developing countries have been demonstrated as: age 31-35, para (greater than)3, and poor antenatal care, grandmultiparity, obstetric trauma from prolonged or neglected labour, malpresentation, external and internal podalic
version, breech extraction, manual cervical dilatation, and injudicious use of oxytocin, prostaglandins by untrained paramedics and previous unknown corporeal scar.
Though scarred uterus secondary to previous caesarean delivery is one of the commonly recognized risk factors for rupture of uterus, other risk factors are prolonged / obstructed labor, grand multiparity, macrosomic / hydrocephalic fetus, trauma, injudicious use of uterotonic drugs, labor dystocia, intrauterine manipulations such as internal podalic
version and breech extraction, mishandling by trained / untrained TBA, malpresentations and instrumental delivery4.
As Tatlock tells us, Siegemund became "the next best thing to an expert in obstructed labor and had perfected the techniques of cephalic and podalic