Vaginal delivery is allowed in all except

Ans. Is a i.e. Monochorinoic monoamniotic twins In face presentation the best presentation is mento anterior, especially left mento anterior and delivery is possible. In twins, the chances of vaginal delivery are high if the first twin or presenting twin is cephalic. Extended beech is the commonest breech presentation and is also the best possible presentation for a normal vaginal delivery in breech. In Monochorionic monoamniotic presentations the twins share a single amniotic sac and placate so there is almost a 50% incidence of cord accidents and that is one reason which even prompts to do a preterm cesarean to many practioners to avoid a sudden fetal cord entrapment and fetal death. "A situation requiring cesarean delivery in twin pregnancy is a monoamniotic placentation. The fetal moality in these pregnancies is greater than 50% and the overwhelming cause is cord accidents such as cord prolapse or entaglement." Also Know: Indications for elective cesarean section in Twin pregnancy First twin presenting as non veex (breech or transverse) or both the fetuses non veex. Collision of both the heads at brim preventing engagement of either head. Monoamniotic twins. Chronic Twin-Twin Transfusion Syndrome. Conjoined twins at term. Severe IUGR of one or both fetus. Previous cesarean section. In discordant twin - weight of smaller twin < 1500 gm. Obstetric factors necessitating cesarean section like contracted pelvis, placenta pre, severe preeclampsia, cord prolapse of first baby. Note : There is no valid reason to perform LSCS in all cases of second twins for non cephalic presentation.