Just done some MCQs and came across some questions about delivery of the 2nd twin. My understanding (and clinical practice that I have seen and used myself in the UK) is that internal podalic version is acceptable management, especially with fetal distress to expedite delivery. The MCQ I copied below says this is false. In fact there was a TOG article on this in 2011 (Webster SNE, Loughney AD, Internal podalic version with breech extraction. The Obstetrician & Gynaecologist 2011; 13:7-14.)
Also, textbooks do describe the use of a ventouse with the station in the midpelvis or at the pelvic brim for the 2nd twin if bradycardia. (Munro-Kerr's Operative Obstetrics, 2007, p.198) Again this is something I have been taught in modern UK O&G practice and used myself.
Any thoughts?
Internal podalic version is no longer an acceptable procedure
True
False
Your answer: False
Correct answer: True
TWIN PREGNANCY
1) Conditions for vaginal operative delivery must be met and the head must be engaged
2) ECV should be considered if twin 2 is breech. Internal podalic version for a non-longitudinal lie however carries significant risks and should not be undertaken
3) The fetal heart should be monitored continuously
Posted by Jonathan N.
I agree with many of the comments you have made and I am a junior registrar who is yet to face many bad outcomes / litigation etc,.
I do think it is still 'acceptable' practice though to perform an internal podalic version for a 2nd twin in appropriate circumstances (maybe the example of a bradycardia was not best, but a breech extraction can be used to expidite delivery). There will be a body of consultants who feel it is 'unacceptable' to revert to LSCS of a 2nd twin without trying an internal podalic version.
It is clearly a skill which is rarely performed. There are aspects of it that we do perform more regular though - for example at a breech LSCS or transverse lie we often perform the breech extraction portion of this delivery in order to be prepared for when it might be appropriate in a 2nd twin. There is the morbidity from the delay of going to theatre and the maternal morbidity from a FD LSCS to consider too.
