Failure To Perform C-Section Causes Fatal Twin Birth

This case involves the death of one baby after a twin vaginal delivery. Prior to her labor, the mother was never consulted regarding the possibility of a C-section delivery. Twin A was born via traditional vaginal delivery without any complications. Twin B was born 26 minutes later with a variety of complications, including low umbilical cord pH and Apgar scores the started at 1 and never rose above 2. The baby was noted to have abnormal neurological function and subsequently died from anoxic brain injury. An obstetrics and gynecology nurse was sought to opine on whether the patient’s condition warranted a C-section and/or a different method of delivery for Twin B.

Question(s) For Expert Witness

1. What are some common indications for twins to be delivered via C-section?

Expert Witness Response E-206355

I have participated in many twin births. Generally, most twin births are C-sections because of all the variables involved. In most cases, especially when the presentations are complicated, the risk of C-Section complications is far less than the risk of birth injuries possible to twin fetuses. Even if both twins are vertex, an attending cannot be certain that Twin B will be able to accommodate to the pelvis. Problems can also occur if one or both twins are breech, or if one is transverse. Prior to the onset of labor, pts gravida and para, and gestational age must be considered through normal assessments, including non-stress tests, biophysical profile, etc. External fetal monitoring is not always a reliable assessment of fetal well being because the lie and presentation of Twin B make good tracings hard to achieve. Internal monitoring is best, of course, but hard to achieve due to limited access to Twin B.