Expert offers advice on the management of breeches. (Questions not Addressed by Guidelines).

SAN FRANCISCO -- The American College of Obstetricians and Gynecologists' 2001 committee opinion affirming cesarean section as the preferred method of breech delivery left. some questions unanswered, Dr. E.J. Quilligan said.

Dr. Quilligan, emeritus professor in the department of obstetrics and gynecology at the University of California, Irvine, answered some of these questions at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

One issue is the management of premature breeches.

"There are arguments on both sides of the fence when it comes to premature breeches," he said.

His search of the literature reveals that although most studies on premature breeches are not prospective or randomized, they do lean toward C-section as the preferable, safer method.

Turning to twin pregnancies in which the first twin is vertex but the second is breech, Dr. Quilligan noted that breech delivery of the second twin is achievable. "In these cases, the cervix is often completely dilated, and in many cases, the second twin is smaller than the first," he added.

A breech extraction or a version extraction of a second twin can be performed safely.