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.
In another study--a review of 362 consecutive twin deliveries--only 4 cases of birth trauma occurred, and only 1 of those was associated with vaginal breech extraction
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.
A breech extraction
or a version extraction of a second twin can be performed safely.
This approach is also useful when breech extraction
of a second twin becomes difficult, and in cases involving podalic version of a second twin.
Rupture is more likely following breech extraction
, obstructed labor, abnormal fetal presentation, and midforceps delivery.
This is true for breech extraction
at vaginal delivery, as well as management of a second twin.