Multiple pregnancy: second twin transverse lie: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Multiple pregnancy: second twin transverse lie

Sample item

A woman with a twin pregnancy has delivered the first twin vaginally. On examination the second twin lies transverse, the membranes are intact, the fetal heart is normal and uterine contractions have paused. Which is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Correct the lie by external cephalic version or breech manipulation, then rupture membranes and augment with oxytocin

After delivery of the first twin the lie of the second can change. If it is transverse and the fetus is well, the lie is corrected, longitudinal by version, membranes are ruptured once the presenting part is engaged, and oxytocin restores contractions. Delay increases the risk of cervical retraction and fetal compromise.

Option by option

  • A. Correct the lie by external cephalic version or breech manipulation, then rupture membranes and augment with oxytocin (correct)

    Correct. Convert to a longitudinal lie, then amniotomy and oxytocin.

  • B. Immediate classical caesarean section

    Caesarean is reserved for failed correction or fetal distress, not the first step.

  • C. Wait for 4 hours with no intervention

    Prolonged waiting risks cord prolapse, cervical closure and fetal hypoxia.

  • D. Apply strong fundal pressure to push the transverse fetus into the pelvis

    Fundal pressure cannot correct a transverse lie and risks uterine injury.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Correct the lie by external cephalic version or breech manipulation, then rupture membranes and augment with oxytocin. After delivery of the first twin the lie of the second can change.

Why is "Immediate classical caesarean section" not the answer?

Caesarean is reserved for failed correction or fetal distress, not the first step.

Why is "Wait for 4 hours with no intervention" not the answer?

Prolonged waiting risks cord prolapse, cervical closure and fetal hypoxia.

Why is "Apply strong fundal pressure to push the transverse fetus into the pe…" not the answer?

Fundal pressure cannot correct a transverse lie and risks uterine injury.

What concept does this question test?

It tests Multiple pregnancy: second twin transverse lie in OBG. If it is transverse and the fetus is well, the lie is corrected, longitudinal by version, membranes are ruptured once the presenting part is engaged, and oxytocin restores contractions. Delay increases the risk of cervical retraction and fetal compromise.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Multiple pregnancy: second twin transverse lie?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.