Manual Aid in the Vaginal Delivery of Spontaneous Twin Cephalic-Complete Breech Pregnancy: A Case Report
DOI:
https://doi.org/10.46799/jhs.v6i11.2740Keywords:
Spontaneous Twin Pregnancy, Cephalic-Complete Breech, Manual AidAbstract
Multiple gestation, particularly those involving a combination of breech and cephalic presentations, presents a complex obstetric challenge. This case report describes the successful vaginal delivery of a twin pregnancy with mixed presentation at 36/37 weeks of gestation. A 28-year-old woman, G2P1A0, presented in active labor with a cervical dilation of 4 cm. The first twin was in cephalic presentation, while the second was in breech. Following the NICE guidelines for twin delivery with a cephalic-presenting first twin, a vaginal delivery was planned. The first baby was delivered spontaneously. For the second, breech-presenting twin, an amniotomy was performed, followed by a Manual Aid for Breech Delivery, resulting in a safe vaginal birth. Both infants had satisfactory Apgar scores, and the third stage was managed without significant postpartum haemorrhage. This case demonstrates that with careful monitoring and skilled intervention, vaginal delivery is a viable and safe option for twin pregnancies with a cephalic-breech combination, potentially avoiding the need for cesarean section. The successful outcome underscores the importance of preparedness for breech extraction and holistic management during the intrapartum and postpartum periods.
References
Altay, M. M., Padden, M., & Geissler, K. (2024). Postpartum care and complications. American Family Physician, 109(3), 256–265.
Biswas, A., Chowdhury, M. E., Ronsmans, C., Dalal, K., Kusiako, T., Mabuya, S., ... & Rahman, A. (2018). Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities—A qualitative case study in Bangladesh. F1000Research, 7, 803. https://doi.org/10.12688/f1000research.13605.1
Bogner, G., Strobl, M., Schausberger, C., Fischer, T., Reisenberger, K., & Jacobs, V. R. (2018). Breech delivery in the all fours position: A prospective observational comparative study with classic assistance. Journal of Perinatal Medicine, 46(1), 87–93.
Bogner, G., Wallner, V., Fazelnia, C., Strobl, M., Volgger, B., Fischer, T., & Jacobs, V. R. (2018). Delivery of the second twin: Influence of presentation on neonatal outcome, a case-controlled study. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-018-1815-0
Fitiri, E., Kappou, D., Wright, A., Wright, D., & Nicolaides, K. H. (2024). Routine 36-week scan: Diagnosis and outcome of abnormal fetal presentation. Ultrasound in Obstetrics and Gynecology, 63(1), 89–95.
Gibson, J. L., Macara, L. M., Owen, P., Young, D., Macauley, J., & Mackenzie, F. (2019). Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance, UK: What’s new that may improve perinatal outcomes? Acta Obstetricia et Gynecologica Scandinavica, 98(12), 1505–1511. https://doi.org/10.1111/aogs.13785
Jonsson, M. (2015). Induction of twin pregnancy and the risk of caesarean delivery: A cohort study. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-015-0566-4
Leskelä, A., & Ylilehto, H. (2024). Attachment relationships: How do they affect a child's life? Nordic Journal of Child Development, 15(2), 112–125.
Lindroos, L., Elfvin, A., Ladfors, L., & Wennerholm, U. B. (2018). The effect of twin-to-twin delivery time intervals on neonatal outcome for second twins. BMC Pregnancy and Childbirth, 18(1), 36.
Mok, Y. M., & Lo, T. K. (2022). Vaginal delivery of second twins: Factors predictive of failure and adverse perinatal outcomes. Hong Kong Medical Journal, 28(1), 23–30. https://doi.org/10.12809/hkmj198038
Naz, S. (2015). Etiology and risk factors of breech presentation. Journal of Rawalpindi Medical College, 19(2), 152–155.
Priyanka, A., Dongaonkar, D., Dalal, A., & Kaur, P. (2022). Vaginal birth as compared with cesarean section in preterm twins—Experience from a tertiary center of a middle-income country. International Journal of Gynecology & Obstetrics, 156(3), 512–518.
Reitter, A., Daviss, B., Krimphove, M. J., Johnson, K. C., Schlößer, R., Louwen, F., & Bisits, A. (2018). Mode of birth in twins: Data and reflections. Journal of Obstetrics and Gynaecology. https://doi.org/10.1080/01443615.2017.1393402
Rissanen, A. S., Jernman, R. M., Gissler, M., Nuutila, M. E., & Heikinheimo, O. (2023). Mode of delivery of Finnish dichorionic and monochorionic-diamniotic twins: A retrospective observational study including a risk score for intrapartum cesarean birth. Health Science Reports, 6(5), e1236. https://doi.org/10.1002/hsr2.1236
Santana, D. S., Cecatti, J. G., Surita, F. G., Silveira, C., Costa, M. L., Souza, J. P., Mazhar, S. B., Jayaratne, K., Qureshi, Z., Sousa, M. H., & Vogel, J. P. (2016). Twin pregnancy and severe maternal outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health. Obstetrics and Gynecology. https://doi.org/10.1097/AOG.0000000000001338
Santana, D. S., Silveira, C., Costa, M. L., Souza, R. T., Surita, F. G., Souza, J. P., Mazhar, S. B., Jayaratne, K., Qureshi, Z., Sousa, M. H., Vogel, J. P., & Cecatti, J. G. (2018). Perinatal outcomes in twin pregnancies complicated by maternal morbidity: Evidence from the WHO Multicountry Survey on Maternal and Newborn Health. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-018-2082-9
Shibata, S., Hayata, E., Kondo, Y., Nakamura, M., Sugimoto, M., & Takeda, J. (2025). Risk factors for postpartum hemorrhage in twin pregnancies: A multicenter retrospective study. Journal of Obstetrics and Gynaecology Research, 51(1), 145–153.
Tasnim, N., Mahmud, G., & Akram, S. (2016). Outcome of twin pregnancy in a periurban hospital. Bangladesh Journal of Obstetrics & Gynaecology, 31(1), 27–32.
The Use of Simulation in Midwifery Clinical Education. (2023). International Journal of Nursing Education, 15(3), 234–245.
Wesnes, S. L., Hannestad, Y., Rortveit, G., & Hunskaar, S. (2017). Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: A cohort study. Acta Obstetricia et Gynecologica Scandinavica, 96(10), 1214–1222.
Ylilehto, E., Leskelä, A., Raussi-Lehto, E., & Gissler, M. (2024). Mode of delivery and perinatal outcomes in twin pregnancies: A population-based cohort study. Birth, 51(1), 89–98.
Zhang, Y., Liu, X., Wang, S., Chen, L., & Wu, Y. (2025). Factors affecting the success of labor in twin pregnancies: A retrospective study on maternal and fetal outcomes. International Journal of Gynecology & Obstetrics, 168(1), 245–253. https://doi.org/10.1002/ijgo.70009
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