The obstetric performance of 39 vertex-breech twin-pairs was compared with that of 48 vertex-vertex pairs. No difference was found between the two groups in maternal age, parity, gestational age, birth weight, and Apgar scores. The second twin in breech presentation had a higher incidence of very low birth-weight (less than 1500 g), but of borderline significance (P = .05), and a significantly (P less than .03) longer hospitalization period. The cesarean section rate was 7.7 and 10.4% for the breech and vertex second twin, respectively. In our view, breech presentation of the second twin is not an indication for cesarean section.