Leading twin in breech presentation, is routine caesarean section necessary?

Background: Multiple gestations and Caesarean delivery are both showing a rising trend worldwide. One major cause for Caesarean section in twin gestations is leading twin in breech presentation. This study is to find out whether vaginal delivery is an option in such cases.Methods: Out of 66 twin deliveries, 27 cases were studied with one twin in breech presentation after excluding the previous LSCS cases. Maternal parameter studied was section rates in primi and multi gravida respectively. Neonatal parameters studied were birth weight and Apgar scores of breech twins and after weight wise distribution of babies into 4 groups the morbidity of those born vaginally were compared to those delivered by Caesarean section.Results: Twin deliveries constituted 2.7 % of total deliveries in one year and combinations of breech with 2nd foetus in breech, cephalic and transverse presentations were 16.8, 9 and 3% respectively. Out of 19 first breech twins, 11 were in primigravida who underwent LSCS and 5 in multigravida of which 60 % underwent LSCS. So 40.6% of primary LSCS were due to first twin in breech. Out of 19 2nd breech twins, 6 delivered vaginally. Irrespective of mode of delivery, morbidity was influenced by birth weight, where babies < 1.5 kg, 1.5-2 kg, 2.1-2.5kg and >2.5kg required NICU care in 100, 64, 20 and 0 % cases in the LSCS group compared to 100, 66.7,0 and0% cases in the vaginal delivery group.Conclusions: Vaginal delivery can be considered as an option for first twin breech specially in multigravida.