We attempted to define parental anxiety in a population of parents of high-risk premature twins (mean birth weight 1,493 +/- 227 kg; mean gestational age 33 +/- 3.5 weeks), admitted to III level NICU. We specifically examined the following factors; gestational age of the twins, whether or not the twins had ventilatory support, pulmonary sequelae, major malformations or intra-ventricular hemorrhage, parental gender and highest level of education obtained by the parent. In the immediate pre-discharge period and a month later, a questionnaire (State-Trait Anxiety Inventory) was given to all parents of premature twins presenting for the discharge. The parents of 30 twins entered the study twice, at the discharge of their first twin (mean postnatal age 40 +/- 32 days), and one month later. They included 15 mothers and 11 fathers, aged 33 +/- 5.5 and 33 +/- 4.2 years, and at the second evaluation 11 mothers and 10 fathers, respectively. As case-controls we examined parental anxiety of fifteen consecutive singleton high-risk prematures, with equal gestational age, discharged immediately after. Our results indicate that the parents of high-risk twin and singleton prematures present an elevated, lasting state-trait anxiety level. Pre- and post-discharge parental anxiety is more elevated (not significant) in twinning with respect to the prematurity alone. When assessed separately by parental gender, in both these groups an increased (not significant) anxiety was persistently found in the mothers. We recommend that, although neonatologists generally define the discharge of the high-risk premature based upon the acquired stabilization of vital parameters, they pay special attention to the twin group we have identified which is at increased risk for predischarge parental anxiety.
The study comprises 889 pregnant women between 14 and 21 weeks of gestation. The control group consisted of 862 pregnant women with unburdened obstetric anamnesis with an uneventful singleton pregnancy. The examined group consisted of 27 pregnant women with uncomplicated twin pregnancy. In the sera of pregnant women AFP (Microparticle Enzyme Immunoassay AxSYM Abbott), total beta-hCG (Microparticle Enzyme Immunoassay AxSYM Abbott) and unconjugated estriol (Radioimmunoassay Amerlex-M. 2T Johnson & Johnson Ortho Clinical Diagnostics Ltd.) were determined. The risk of fetal trisomy 21 was calculated with the use of PRISCA 3.0 software, which corrected the MoM values for twin pregnancy. Ulm Index was also calculated. In the majority of twin pregnancies increased concentrations of AFP, total beta-hCG and uE3 in the range over 1.0 MoM was noted. In the group of women below 35 years of age with singleton pregnancies using PRISCA 3.0 software it approximated to 95%. For women older than 35 optimum index for fetal trisomy 21 risk calculation was Ulm Index with the specificity 93.8%. The specificity of AFP determination in the detection of fetal open NTD in singleton pregnancy was 99%. In the group of women with twin pregnancy the obtained specificity of 77.8% for PRISCA 3.0 software is low, a more advantageous way to calculate the risk of fetal trisomy 21 is Ulm Index with the specificity of 85.2%. The specificity of AFP determination as a screening for fetal open NTD in twin pregnancy was 96.3%.
There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. Digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in Cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.
This study was performed to examine the main characteristics of the French Romulus twin population: zygosity, chorionicity, sex, term and birthweight. A sample of 104 pairs of twins was distinguished by zygosity, chorionicity and sex, and divided into concordant and discordant birthweight groups. Fifty-three % (n = 55) of the fetus pairs studied were born at "ideal term" (35-38 weeks), and 25% (n = 26) were delivered at "preterm" (28-34 weeks). The very preterm (< 28 weeks), and "postterm" (> 38 weeks) represented altogether 22% (n = 23) of the sample. Of the 104 twin pairs, 68% (n = 71) differ by less than 15% in birthweight, and 32% (n = 33) have a birthweight difference higher than 15%. In dizygotic (DZ) pairs females had more tendency to be in the discordant group (p = 0.01) while in monochorionic-monozygotic (MC-MZ) pairs males were more discordant (p = 0.07). We found a significant interaction between sex and zygosity type (p = 0.02). Males had a birthweight difference significantly weaker than that of females in dichorionic-monozygotic (DC-MZ) and DZ twins whereas it was higher than that of females in MC-MZ twins. There were no MZ twin pairs with DC placentation over than 15% birthweight difference. Log linear analysis demonstrated a three-way interaction (p < 0.05) between term type, zygosity type and hypotrophy. Our data indicate that in the group of twins born between 35 and 38 weeks' gestation the crucial question still remains unsettled on how term and birthweight are related to zygotism and/or chorionicity.
The purpose of this study was to evaluate the relationship between the yolk sacs separated or not separated by septum and chorionicity twin pregnancies scanned early in the first trimester. Moreover, to determine the relation between size and morphologic features of the yolk sac and outcome twin pregnancy. Twenty four of 38 spontaneous twin pregnancies were dichorionic, eight--monochorionic diamniotic, five monochorionic twin gestations with discordant sizes and views of yolk sacs, and one a twin ectopic pregnancy (underwent salpingectomy). In all 38 sets of twin two yolk sacs were identified. During the first trimester of dichorionic twin pregnancy, the yolk sacs were always separated by a septum and not separated ("Eight" sign) in monochorionic twin pregnancy. In five cases, one of yolk sacs was abnormally large (> 8 mm) and had thinner wall. Three (all MC) of the five mothers spontaneously aborted during the next 2-3 weeks. In one case of monochorionic twin ectopic pregnancy two yolk sacs were seen normally. The sonographic identification of yolk sacs allows a reliable and simple determination chorionicity twin pregnancy. Moreover, visualization of large size (> 8 mm) of yolk sac can be used as a predictor of abnormal outcome pregnancy.
