The purpose of this study was to assess the risk of neonatal death in the second twin.We carried o ut a retrospective cohort study of 128,219live born sec ond twins in the U-nited States for the years 1995throu gh 1997.The study subjects were divided into 3groups:second twins who were delivered by cesarean delivery afte r vaginal delivery of the first twin(group 1),both twins delivered vaginally(group2),and both twins delivered by cesarea n delivery(group3).The risk of asphyxia -related neonatal deaths was in-creased in groups 1and 2;the increased risk in group 1was stronger in term births than in pr eterm births.The risk of neonatal deaths,especially for t erm infants with as-phyxia -related deaths,is increase d for the second twins who are delivered by cesarean delive ry after vaginal deliv-ery of the first twins.
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