Delivery of the Second Twin: Revisiting the Age-Old Dilemma

There is general consensus that cesarean delivery is the optimal mode of delivery for women with a nonvertex-presenting twin and that a trial of labor is reasonable in women with vertex–vertex twins. However, the management of twin pregnancies complicated by a nonvertex second twin remains controversial. With the rise in the twin birth rate, obstetricians are faced with this clinical situation with increasing frequency.