In 1969 children of a multiple birth in the GDR made up 1.9% of livebirths and 15.3% of early neonatal deaths. The early neonatal mortality rate of children from a multiple birth was 95.7‰, that of all live-births 12.4‰. The cause was the low birth weight of children from a multiple birth (56.2% vs. 5.8% of all livebirths). Their low birth weight is the result of a hypotrophic development caused by malnutrition. The loss of children from a multiple birth (stillbirths, early neonatal and postneonatal deaths) was 143‰. International experience has shown that such heavy losses can be largely prevented by bed rest of the woman with a multiple pregnancy. We therefore strongly recommend early diagnosis and early in-patient care of women with multiple pregnancy.

Premature delivery is 3-4 times higher in multiple pregnancy. About 12% of all premature infants result from twin pregnancies. Multiple pregnancy is therefore considered as a high-risk pregnancy, involving intensive care of the pregnant woman. The occurrence of toxicosis in twin pregnancies has in this way been reduced to almost 10%. The maturity or immaturity of twins seems to be qualified according to the weight of each single twin, irrespective of the twin partner. Small-for-date babies may be frequently found in twin pregnancies.

A total of 669 newborns from multiple pregnancies, including 15 triplets, have been examined. Full-term fetuses were 19.3% premature ones 60.7%, and dystrophic ones 20%. Of these, 58.4% were born in good conditions, 25.1% in average conditions (4-7 Apgar scores), and 16.4% in bad conditions (1-3 Apgar scores). Complications in the neonatal period were reported in 38.7% of cases (respiratory syndrome 21.2%, CNS injury 4.8%, developmental defects 1.3%, other complications 9.3%).

Twin mortality amounted to 10.5%, mainly due to hypoxemia (7.2%), cerebral lesion (2.4%), developmental defects (0.4%), and general edema (0.5%).

Out of 446 twin births in 1946-1971, 177 (19.8%) were stillborn or perinatally dead. The main reason of twin perinatal mortality is prematurity, which is also confirmed by clinical and anatomopathologic findings. The essential role in the reduction of perinatal mortality is being attributed to ambulatory “K” Centres through early diagnosis of multiple pregnancy and pregnant women hospitalization at 30-32 weeks of pregnancy.

The perinatal mortality rate in multiple pregnancies has been examined both in literature data (where it reaches an average value of 17.5%), and on a sample of 619 twin deliveries from the Danzig population.

The analysis of 682 newborns indicated that developmental defects accounted for 0.44% of the overall perinatal mortality of twins. The 3.7% higher mortality rate for second twins is frequently due to abnormal presentation and longer time-interval following the birth of the first twin.

The complications of multiple pregnancy have been studied in a total of 619 cases of multiple pregnancies followed in the Danzig Department of Obstetrics and Gynecology from 1953 to 1972. On the basis of the results obtained, early hospitalization is recommended in cases of multiple pregnancies.

The material covers 332 twin pregnancies (including 5 of triplets) of which 208 (62.7%) were premature deliveries and 124 (37.3%) deliveries at term.

Of the twin pregnancies included in the group examined 15.7% developed complications (gestosis and eclampsia, kidney and heart diseases, anemia, hydramnios). Spontaneous deliveries were 66.7%, operative deliveries 33.3%. A high mortality of the second twin (13.1%) is noticeable and it increases to 21.4% when operative procedures are applied to the first twin.

The author reports on primary diseases and on secondary reactions of adaptation in fetal hearts of twins. Cases of fibroelastosis endocardica, cases of hypertrophy of the heart, and the circulatory reactions following feto-fetal transfusion in twins, are discussed.

Using histochemical methods, several enzymes of the myocardium in deceased twins have been investigated.

The course of hemolytic disease is generally more severe in twin than in single-born infants, because of prematurity prevailing in twin births and resulting prolonged hospitalization.

The course of hemolytic disease in double conflict (ABO and Rh) does not appear to be milder than in single Rh incompatibility. In one case it was even found to cause more extensive damage to one fetus, as compared to the other with simple Rh conflict.

This paper aims at drawing the attention of obstetricians and pediatricians to a peculiar syndrome: a neonatal emergency without any preliminary signs of fetal distress. This emergency can be predicted before birth. The uterine content film obtained, when a twin pregnancy or an abnormal presentation is suspected, shows an extreme and permanent fetal malposition as early as the 6th month of gestation: the head is forcibly overextended, embedded in the spinal abnormal concavity. Its severity and duration entail a cervical elongation and a temporary atonia of inspiratory muscles. Respiratory autonomy is impossible at birth. A prolonged artificial ventilation should be organised and used immediately at birth to prevent death or any risk of transient cerebral anoxia. The acute neonatal neurological syndrome is only due to a purely peripheral motor and transitory impairment, and it will have no consequences.

Pregnancy duration was examined in 389 multiple pregnancies out of 29,656 general deliveries. Mean duration of multiple pregnancy appears to be 258.5 days, i.e., 23.1 days shorter than general pregnancy, which is statistically significant (t = 32.16, P < 0.001).

There is high linear positive correlation between fetal weight and length, and between these and maternal abdominal circumference. A highly significant multiple correlation exists between fetal weight and length and maternal abdominal circumference in multiple pregnancy.

Statistical studies have shown a significant correlation between maternal pregestational weight and duration of pregnancy (i.e., a low weight may cause a shortening of pregnancy). Duration of pregnancy is further correlated to the weight gain (i.e., it is shortened by an insufficient gain). This phenomenon is observed in thin women, but not in women of heavy weight before the pregnancy.

The studies of weight losses obtained through hypocaloric or sodium-free diets or diuretics, show that a sudden weight loss may cause a shortening of pregnancy duration. This is verified in patients with normal or insufficient weight gain and starting with a normal or small weight, but not in overweight patients or with an important weight gain.

This study demonstrates the dangers of excessive measures toward prevention of toxemia. The decision of compulsive weight loss in mothers with multiple pregnancy must be well thought and carefully applied, for excessive measures could reduce the duration of pregnancy and thus increase the risks of perinatal death.

The possibilities of early diagnosis of multiple pregnancy are shown, which helps to prevent and reduce the incidence of premature deliveries.

B-scannings were performed on 86 pregnant women with clinical suspicion of twin pregnancy. In 22 out of 23 twin cases the ultrasonic diagnosis was right. The earliest diagnosis was in 17th week of pregnancy. The possible difficulties of diagnostics and faults are discussed.

The determination of oxytocinasemia is the method of choice in monitoring multiple pregnancy. An increase in the level of the enzyme indicates a normal development of the pregnancy.

Although, as a rule, the oxytocinasemia level is higher in multiple than in single pregnancy, there are cases with a level pointing to intrauterine fetal danger, if, in a gestation beyond the seventh lunar month, it is lower than 4 μmol∣l∣min.

The birth of a newborn with a body weight below 2500 g, when the oxytocinasemia level exceeds 12 I.U., indicates that a multiple pregnancy is involved.

Total estrogens (E/day), pregnanediol (P/day) in diurnal urine, and thermostable alkaline phosphatase (APt) in blood serum were investigated. Simultaneously, amnioscope examinations were carried out during pregnancy and the beginning of labour. A retrospective assessment of placental test values with respect to the state of newborns was also made. The usefulness of these tests in the diagnosis of a fetus at risk in multiple pregnancies appears to be limited.

In a series of 114 twin pregnancies followed in the course of 12 years (1961-1972) we noted the favourable effect of specialised preventive care. More exact diagnostics (ultrasound scanner) shifted the recovery of twins from the 35th to the 30th week of pregnancy. Due to the therapeutic and preventive bed rest and to the systematic use of orciprenalin, the duration of pregnancy has been prolonged from 36 to 38.5 weeks on the average. The perinatal mortality in twin deliveries decreased from 14.4 to 5%.