cephalic–non-cephalic presentation, the optimal delivery route remains controversial. Patient selection and provider expertise with vaginal breech delivery is crucial. As a result, one common option is cesarean delivery of both twins.
Less often, after spontaneous vaginal delivery of first twin, intrapartum external cephalic version of the second twin can be performed. In case series, this practice, compared with internal podalic version, was associated with higher rates of intrapartum cesarean delivery and fetal distress.
With internal podalic version, a hand placed into the uterus grasps fetal feet to deliver the fetus by breech extraction.
Last and least desirable is vaginal delivery of the first but cesarean delivery of the second twin due to intrapartum complications, such as umbilical cord prolapse, placental abruption, contracting cervix, or non-reassuring fetal heart rate.