A patient with dichorionic diamniotic (DCDA) twins at 38+2 weeks is in active labor. Twin A is vertex presentation. Twin B is transverse lie. Twin A delivers vaginally. After delivery of Twin A, CTG of Twin B shows a variable deceleration pattern. Estimated weight of Twin B is 2.8 kg. What is the MOST appropriate next management step?
- A Emergency cesarean section for Twin B due to abnormal CTG
- B Internal podalic version (IPV) and breech extraction of Twin B ✓
- C Expectant management and oxytocin augmentation to allow spontaneous rotation to vertex
- D External cephalic version (ECV) of Twin B under tocolysis
Explanation
After delivery of Twin A in a twin pregnancy, when Twin B is in transverse lie with CTG concerns, internal podalic version (IPV) followed by breech extraction is the most appropriate and rapid intervention. IPV involves inserting a hand into the uterus, grasping the fetal feet, and converting to a longitudinal lie for breech extraction — this can be performed quickly and avoids the delay of cesarean section. It is particularly appropriate when: the cervix is fully dilated (from Twin A's delivery), the uterus is still relaxed, and there is urgency (CTG deterioration). ECV (D) is performed transabdominally and is slower and less reliable in this setting. Expectant management (C) with a CTG concern and transverse lie risks cord prolapse or increasing hypoxia. Emergency cesarean (A) is appropriate only if IPV fails or the clinical situation deteriorates rapidly.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.