Vaginal delivery allowed in all except: (AIPG 2009)
|A||Monochorionic monoamniotic twins|
|B||First twin cephalic and second breech|
|D|| Mento anterior|
Monochorionic monoamniotic twins
a. In face presentation the best presentation is mento anterior, especially left mento anterior and delivery
b. is possible.
c. In Twins, the chances of vaginal delivery are high even if the first twin is breech as the twins are relatively smaller than singletons. Also, if the first fetus is breech and the second is cephalic, a theoretical risk of head entrapment is documented but it’s actually lesser than 1 in 850 twin pregnancies.
d. Extended breech is the commonest breech presentation and is also the best possible presentation for a normal vaginal delivery in breech. In Monochorionic Monoamniotic presentations,there is almost a 50% incidence of cord
e. accidents and that is one reason which even prompts to do a preterm cesarean to many practioners to avoid a sudden fetal cord entrapment and fetal death.