While all of these techniques can cause injury to the mother and the fetus, available data favor use of the reverse breech extraction
(pull) technique, since it is associated with fewer maternal risks, including lower rates of uterine incision extension, infection, and postpartum hemorrhage and a shorter operative time.
Chaudhury said, "It is safe to deliver a second twin as a breech extraction
as long as there is continuous fetal monitoring, sufficient experience of the physician, and adequate ultrasound equipment available." In addition, the mother must have no contraindications for labor.
If external version fails or membranes rupture, internal podalic version is done under general anaesthesia followed by breech extraction
. After delivery of babies APGAR score was evaluated.
If the hand from below is ineffective, the surgeon should be prepared to perform a reverse breech extraction
or extend the uterine hysterotomy incision to expedite delivery.
Since the 1980s, an increasing number of studies suggest breech extraction
of the nonvertex second twin may not be as risky as previously thought.
This approach is also useful when breech extraction
of a second twin becomes difficult, and in cases involving podalic version of a second twin.
A breech extraction
or a version extraction of a second twin can be performed safely.