Question:medium
A woman with DCDA twins at 38 weeks, with the first twin in breech presentation, has BP 140/96 mmHg and 1+ proteinuria. What is the management?
A woman with DCDA twins at 38 weeks, with the first twin in breech presentation, has BP 140/96 mmHg and 1+ proteinuria. What is the management?
Show Hint
Delivery is due now, and a breech leading twin means abdominal route.
Updated On: Jun 23, 2026
- Immediate LSCS
- Induction at 40 weeks
- Immediate induction and vaginal delivery
- Induction if signs of preeclampsia develop
Show Solution
The Correct Option is A
Solution and Explanation
Two decisions stacked together: when to deliver, and by what route.
When: BP 140/96 with 1+ proteinuria is preeclampsia, and twin pregnancies are already delivered around 37-38 weeks. At 38 weeks with preeclampsia, continuing to 40 weeks (option 2) or merely watching for preeclampsia to appear (option 4) is unsafe, because it is already here and the gestational target is reached. So delivery now is mandatory.
How: the leading first twin is breech. A non-cephalic presenting twin is a recognised indication for caesarean section, so attempting immediate vaginal delivery (option 3) is hazardous due to the risk of interlocking and a difficult breech.
Combine the two and the safe plan is immediate caesarean section. Hence option 1, immediate LSCS. Ref: Dutta Obstetrics.
When: BP 140/96 with 1+ proteinuria is preeclampsia, and twin pregnancies are already delivered around 37-38 weeks. At 38 weeks with preeclampsia, continuing to 40 weeks (option 2) or merely watching for preeclampsia to appear (option 4) is unsafe, because it is already here and the gestational target is reached. So delivery now is mandatory.
How: the leading first twin is breech. A non-cephalic presenting twin is a recognised indication for caesarean section, so attempting immediate vaginal delivery (option 3) is hazardous due to the risk of interlocking and a difficult breech.
Combine the two and the safe plan is immediate caesarean section. Hence option 1, immediate LSCS. Ref: Dutta Obstetrics.
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