ABSTRACT
Providing the presenting part of twin 2 is engaged in the pelvis, any adverse feature suggesting fetal hypoxia can be managed by rapid assisted vaginal delivery; this is usually straightforward, as the maternal tissues have been dilated by the passage of twin 1 and an episiotomy has often already been performed. Ventouse or forceps may be used in a cephalic presentation and this is the only situation where a breech extraction may be appropriate. In mid-cavity, with a cephalic presentation, the ventouse is safer than the forceps.
