Objective. The aim was to determine the chorionic and amniotic types in multifetal pregnancies with transvaginal ultrasonography at very early stage of gestation.

Study design. Twenty-one spontaneous multifetal pregnancies were scanned transvaginally before 8 weeks' gestation (four of them from 4th week). The chorionic and amniotic type was determined ultrasonographically. All twin gestations had postpartum pathologic evaluation of the placenta and histologic determination of the chorionic and amniotic type.

Results. Ultrasonographic evaluation of the 21 pregnancies demonstrated 20 twin and 1 triplet gestation. Four of the twin pregnancies were monochorionic-diamniotic. Triplet was monochorionic-triamniotic (spontaneously aborted in 8th week of gestation). In all 20 twin pregnancies, transvaginal ultrasonography correctly predicted the chorionic and amniotic type before 8 weeks of gestation.

Conclusion. Transvaginal ultrasonography allows a reliable, simple and rapid determination; the dichorionic twin pregnancy in 4 weeks, monochorionic in 5 weeks, and differentiation of mono-or diamniotic in 7 weeks of gestation.

I gemelli sono i rappresentanti di un'eccezione biologica della specie umana, di un avvenimento fuori dal consueto, per cui il parto della donna non dà origine ad un nuovo essere, ma a due o più rappresentanti della specie. Questa eccezione è così evidente e caratteristica che non ha mancato, come non manca, di impressionare l'intelligenza e la fantasia dell'uomo presso ogni popolo e in ogni epoca della storia.

Anche il sapere medico, prima ancora che si organizzasse in scienza, ha fermato la sua attenzione sul fenomeno della gemellanza cercandone la causa e le applicazioni.

Secondo la scienza Talmudica la nascita dei gemelli è dovuta al fatto che una goccia di sperma si è divisa in due parti. Del pari Ippocrate ritiene che il concepimento gemellare avvenga per la bipartizione dello sperma e ciascuna parte penetri in una delle due corna dell'utero. Nell'antichità classica il fenomeno della gemellarità fu riportato al caso delle formazioni doppie dovuto, secondo Empedocle, ad un eccesso dello sperma emesso in una sola volta, dovuto invece, secondo Democrito, allo sperma emesso in più volte, ad ognuna delle quali corrisponderebbe un embrione.

Secondo Aristotele invece, le mostruosità doppie «sarebbero originate da un fenomeno di concrescenza per il quale due embrioni, dapprima separati, vengono a fondersi parzialmente, in modo da costituire una sola formazione, nella quale però sono riconoscibili le due componenti».

Galeno sembra accettare l'ipotesi di Empedocle, aggiungendo tuttavia che il calore eccessivo dell'utero possa dividere il seme in più parti, donde originerebbe formazioni doppie, triple, ecc… Plinio non aggiunge nulla di nuovo alle idee dominanti e si limita a fornire descrizioni più o meno esaurienti di gravidanze multiple.

Sanghvi's hypothesis on long term effects of inbreeding was tested in Kotas. Kota is a numerically small tribal population in the Nilgiri district, Tamil Nadu State, India. Consanguineous marriages are common in this tribe. A total of 95 couples were taken for this study and necessary data were collected on a set proforma. Of the 95 couples, 28 (29.5%) were consanguineously related. The inbreeding coefficient for autosomal genes is 0.022 and for sex-linked genes is 0.03. Inbreeding effects on reproductive losses were examined through an exponential regression model. Although the regression coefficient B values are positive, they are insignificant, suggesting no consistent relationship between degree of consanguinity and the reproductive losses. The estimates of genetic load is 1.8 lethal equivalents per gamete and the average B/A ratio is 5. These findings empirically support the Sanghvi's contention.

The computerized version of the Wisconsin Card Sorting Test (WCST) was administered to a sample of 96 subjects (Ss), constituted in equal parts by monozygotic twins (MZ), dizygotic twins (DZ), unique children and couples of “almost contemporary” brothers. The statistic tests (Analysis of principal components, ANOVA) underline, as far as the rapidity to define a category is concerned, a statistically significant difference between DZ and singletons, independently from the fact that the latter may be unique children. A significant difference emerged neither between MZ and singletons, nor between MZ and DZ.

Aim. To evaluate the association between the incidence of leave of absence from work and perinatal outcome for the twin-pregnant woman.

Material and methods. A 20.2% sample of all twin-pregnant women between 1982 and 1988 (1,331/6,602) was taken at random from the entire material of twin deliveries in Sweden, archived at the Medical Birth Registry (MBR), National Board of Health and Welfare. For each woman in the sample, information on period(s) and reasons for leave of absence from work during pregnancy was obtained by inquiry to all Regional Health Insurance Offices throughout Sweden. A comparison of perinatal outcome was also made with information from the Danish Fertility Database and the Norwegian Medical Birth Registry.

Results. Duration of leave from work increased from 58 days in 1982 to 97 days in 1988 (trend analysis; t = 7.9, p <0.001). No association was seen between perinatal mortality for twins weighing. < 1,500 g and changes in the incidence of leave of absence. The incidence of twins with a birthweight < 1,500 g varied among the three countries, increasing significantly only in Sweden (trend analysis χ2 = 20.3, p <0.0001).

Conclusion. Although the number of days of leave of absence increased by 60%, there was no obvious association with perinatal mortality for twins weighing < 1,500 g. The incidence of Swedish twins with a birthweight < 1,500 g increased significantly, indicating that the effect of leave of absence from work on perinatal outcome may be less effective than previously thought.

A case of balanced X; autosome translocation 46, X, t (X; 22) (q 24; q 13) in a 25-year-old female with secondary amenorrhea and premature ovarian failure (POF) is described. The relationship between balanced X; autosome translocation [t (X; A)] and varied phenotypic expression observed in these women is discussed. This case highlights the importance of early recognition of these women in order to give them the best chance of conception in their oligohypomenorrhic phase before complete loss of gonadal function.

Twin gestation is associated with higher rate of neonatal hypoglycemia than do singletons. We examined the role of specific risk factors associated with neonatal hypoglycemia of 216 premature twins and 1284 premature singletons, consecutively born in the years 1994-1996 in the Department of Pediatrics of Padua University, Italy. Significantly higher risk of hypoglycemia (Dextrostix <40 and <20 mg%) was found in twins vs singletons (54% vs 32%, OR 2.49, CI 1.77-3.56; 19% vs 8%, OR 2.65, CI 1.59-4.19, respectively). Gestational age of 34-37 weeks increased hypoglycemia risk for the premature twins (77% vs 51%, OR 3.20 CI 1.49-6.88). Twin deliveries statistically differed from those of singletons in several perinatal characteristics. More twins were born by cesarean section (85% vs 55%, OR 4.15, CI 2.48-6.95), and the birth weight of twins was much lower related to prematures with BW < 1.0 kg (12% vs 6%, OR 2.06, CI 1.11-3.82) and SGA (20% vs 10%, OR 2.41, CI 1.46-3.98). The risk of twin deliveries was increased at 30-33 weeks gestational age (25% vs 15%, OR 1.84; CI 1.17-2.90). Twins were found to have higher rates of hospitalization (50% vs 40%, OR 1.52, CI 1.04-2.23) and showed an increased risk of cardiorespiratory resuscitation (51% vs 31%, OR 2.36, CI 1.61-3.47), hypothermia (11% vs 4%, OR 3.02, CI 2.333.91), BPD (25% vs 19%, OR 2.55, CI 1.10-5.91), and PVL (4% vs 1%, OR 4.08, CI 1.23-13.5). Mortality was found more often (not significant) in premature twins. The risk for intrapartum and early neonatal morbidity was however, mostly reduced in hypoglycemic twins, while it was comparable between smaller or smaller weight discordant twins and larger twins. Similarly, SGA twins, and smaller or smaller weight-discordant twins did not show increased hypoglycemia risk. In conclusion, our findings suggest that the multiple gestation per se is the single most important relative risk factor of hypoglycemia in premature twins.