Question:
A woman with DCDA twins at 38 weeks, with the first twin in breech presentation, has BP 140/96 mmHg and 1+ proteinuria. What is the management?
A woman with DCDA twins at 38 weeks, with the first twin in breech presentation, has BP 140/96 mmHg and 1+ proteinuria. What is the management?
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Delivery is due now, and a breech leading twin means abdominal route.
Updated On: Jun 23, 2026
- Immediate LSCS
- Induction at 40 weeks
- Immediate induction and vaginal delivery
- Induction if signs of preeclampsia develop
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The Correct Option is A
Solution and Explanation
Step 1: BP 140/96 with 1+ proteinuria is preeclampsia. In a twin pregnancy the recommended time of delivery is about 37-38 weeks, so at 38 weeks delivery is already due, and preeclampsia is an added reason to deliver now.
Step 2: The first (presenting) twin is breech. A non-cephalic first twin is an accepted indication for caesarean section in twin pregnancy.
Step 3: Because delivery is indicated AND the leading twin is breech, vaginal delivery and waiting until 40 weeks are both unsafe, ruling out options 2, 3 and 4.
So the management is immediate LSCS.
Ref: Dutta Obstetrics, 8th ed, p. 244
Step 2: The first (presenting) twin is breech. A non-cephalic first twin is an accepted indication for caesarean section in twin pregnancy.
Step 3: Because delivery is indicated AND the leading twin is breech, vaginal delivery and waiting until 40 weeks are both unsafe, ruling out options 2, 3 and 4.
So the management is immediate LSCS.
Ref: Dutta Obstetrics, 8th ed, p. 244
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