ABSTRACT
In a review of the literature in 1989, Petrikovsky and Vintzileos11 evaluated the route of delivery of higherorder gestations. Although malpresentations were common, a broad spectrum of complications were seen such as placental abruption, intrauterine oxygen deprivation, umbilical cord prolapse and vaginal bleeding. An elective cesarean section avoided the majority of these complications and allowed for the antepartum organization of the obstetric and neonatology personnel. The importance of this interdisciplinary cooperation and the availability of neonatal beds should not be underestimated. When the decision has been made to proceed with a vaginal trial of labor, the attending obstetrician should plan to have the assistance of another well-trained obstetrician who is capable of diagnosing an anomalous fetal presentation with ultrasound, and who is able to be a competent operative assistant if a malpresentation is seen. Furthermore, during the second stage of labor, there must be adequate obstetric personnel at hand, who are able to monitor the fetal movement ultrasonographically.
