Abdominal delivery of the second twin

In a series of 220 consecutive twin deliveries, 10 second twins were delivered by caesarean section after vaginal birth of the first, but only six survived. The mean time-interval between the birth of twins was 68 minutes. Because a protracted inter-delivery interval carries risks of placental separation and cervical contraction, prompt trial of version of the second twin followed by vaginal breech extraction under anaesthesia might improve perinatal outcome

An audit of forceps delivery in Trinidad

An audit of 247 consecutive forceps deliveries during a 6-year period was undertaken in order to establish trends in recourse to this instrument, maternal complications and fetal outcome. The chief indications were prolonged second stage of labour and poor maternal effort. Our overall forceps rate of 0.81% betrays a marked divergence from the practice in metropolitan countries. Although birth injuries were a major drawback, assistance with forceps still appears to be a safer alternative than caesarean section when a problem exists which impedes spontaneous delivery in the second stage. In choosing between obstetric options, we voluntarily take one course which we dislike because the alternative is more objectionable still; the unpleasantness of the choice does not destroy its reality