Vaginale Geburt bei Zwillingen

The cesarean section rates for twin births vary widely across the world and across Europe. Mothers of twins, however, prefer a vaginal birth following a competent counselling in which they can have a say. The prerequisite is that multiple birth mothers are advised, monitored and delivered by experienced obstetric teams, which should be available and reachable 24 h a day. Regardless of the chorionicity, gestational age and fetal weight discrepancy, a vaginal birth is recommended if the presenting fetus is in a cephalic presentation, regardless of the position of the second twin. In the case of a high position of the nonpresenting fetus either in a cephalic, breech or transverse position, the birth management requires a special set of birth maneuvers and procedures. A timely epidural anesthesia may be helpful in performing these maneuvers. The birth of the second twin should take place quickly when possible by a well-drilled birth maneuver and in cases of a standing amniotic sac, as a short birth interval between the two fetuses (< 10 min) is associated with a better outcome. The vaginal birth in cases of triplets is also possible depending on the experience of the team but involves more logistical challenges. Through regular simulations and exercises, the awareness and acceptance of vaginal birth in multiple pregnancies can be increased within the obstetrical team.