Vaginal delivery can be allowed in all except

Monochorionic, monoamniotic twins [Ref Williams Obstetrics 23/e, Chap. 24 and 39; Danfroth's Obs. and Gynae 10/e Chap 14 & 22; Dutta Obstetrics 6/e, p 209. Mentoanterior face presentation, extended breech and dichorionic twins with first veex and second breech, all of these can be allowed for vagina delivery. Monochorionic monoamniotic twins are best delivered by caeserean section as soon as lung maturity is attained for fear of entanglement and tightening of umbilical cord which may lead to fetal distress and death. Monoamniotic twins are rare, complicating < 1% of monozygotic twins. They have a very high fetal moality rate of -- 40%. Besides cord entanglement these twins are at greater risk of congenital anomalies, conjoining, preterm bih and twin-twin transfusion syndrome (TTTS). Let's have a revision of twinning Mode of delivery of twin pregnancy After the first twin is delivered vaginally, some norms are to be followed for delivery of second twin as depicted in the following flowcha? ECV - External cephalic version, CPD - Cephalopelvic dispropoion. NVD - Normal vaginal delivery, IPV - Internal podalic version Unskilled in WV, breech extraction and assisted breech delivery. Now let's have a look at mode of delivery for malpresentations - *ACOG - American College of Obstetrician and Gynecologists - 2006 guidelines Occipito posterior position is not dealt here as it is a malposition not malpresentation.