The incidence of vertex vaginal delivery was 32.4%, assisted breech delivery in 22.7% cases, caesarean section in 39.6% and internal podalic version
was done in 4 cases for second baby.
After 32 weeks, the mode of delivery may be vaginal if the presenting twin is vertex and the delivery provider can perform breech extraction or internal podalic version
, if necessary.
The second twin delivered by spontaneous vaginal delivery in 29(58%), vacuum delivery 3(6%), spontaneous breech delivery in 5(10%), assisted breech delivery in 7(14%), breech extraction in 3(6%), internal podalic version
and breech extraction in 3 (6%).
Though scarred uterus secondary to previous caesarean delivery is one of the commonly recognized risk factors for rupture of uterus, other risk factors are prolonged / obstructed labor, grand multiparity, macrosomic / hydrocephalic fetus, trauma, injudicious use of uterotonic drugs, labor dystocia, intrauterine manipulations such as internal podalic version
and breech extraction, mishandling by trained / untrained TBA, malpresentations and instrumental delivery4.
There are several risk factors for rupture uterus like multi parity (5) uterotonic drugs, placenta percreta (6), CPD, mal position, mal presentation, internal podalic version
, perforation of uterus during MTP, instrumental delivery, and scarred uterus following operations on uterus like caesarean section, myomectomy, utericuloplasty.