Our data show that oxytocic perfusion should be liberally given during twin pregnancy labor, since its use is correlated with lower fetal mortality, especially of the second premature twin. This therapy might act, namely, by reducing the number of second-twin abnormal presentations. In our series, the higher mortality rate associated with lengthening of time interval between both births could be attributed to second-twin abnormal presentations. However, mortality rate versus time interval in spontaneous twin deliveries warrants obstetrical management providing second-twin birth within 15 minutes.

Investigations were carried out on 68 labors in twin pregnancies. It was observed that, upon stimulation of uterine contractions by means of oxytocic agents, mainly oxytocin (90%), the mean duration of labor was significantly reduced to about 7 hours, and prolonged labors (over 20 hours) were completely eliminated. The time between delivery of the first and the second baby is now below 30 minutes in all cases, and this is regarded as the optimum time. No neonatal deaths were observed in labors taking place at term. The condition of the newborns at birth was estimated in accordance with the Apgar score and it was found that the second newborn scored worse than the first one; a fact definitely related to the higher proportion of operative procedures during delivery of the second twin (48%) as compared to the first one (10%).

The authors stress that, owing to the introduction of the method of conducting twin labors, maternal mortality has been completely eliminated and twin perinatal mortality has been markedly reduced: from about 28% in 1923-1962 to about 10% in recent years.

An analysis of the conditions of delivery in multiple pregnancy, with special respect to the parity of the woman, has been carried out on a sample of 619 deliveries from multiple pregnancy in the Danzig population.

The analysis concerns 16 cases of births of conjoined twins reported in the Polish literature. Cesarean section was applied in 2 cases, while 13 cases were spontaneously delivered without destructive operations. Embryotomy was necessary in 1 case. Liveborn fetuses were 7, while 9 were stillborn; 6 were male and 10 female. The heaviest body weight amounted to 5810 g, and the lowest to 1200 g. When the diagnosis of live conjoined twins is possible before the second stage of labor, Cesarean section should be performed. Treatment during vaginal delivery depends on the ensuing conditions.

Seventy-six cases of puerperium following twin pregnancy were studied. The most frequent complication occurring during puerperium was represented by febrile states, the etiology of which was difficult to explain and which required administration of antibiotics. They were observed on 28% of cases. The most important causes of frequent infections in puerperium seem to be a high frequency of obstetric procedures during twin delivery and much slower involution of the uterus after labor. This was reported for fetuses delivered at term as well as for premature labors.

Complication in the form of puerperal anemia requiring blood transfusions were observed in 10% of cases. Puerperal eclampsia, bleedings, thrombophlebitis, mastitis, accounted jointly for 7% of puerperal complications. The total percentage of puerperal complications following twin delivery was 45%. This fact indicates the need for careful observation of women in puerperium, broad prophylactic measures, and effective management of possible complications of puerperium in women for whom twin pregnancy and twin delivery per se are a considerable biological stress.

An analysis of the neonatal period of 277 twins was carried out and the results were compared with those of a control group. The conditions of the twins are significantly worse than those of singletons. This is due to the increased possibility of hazards of pregnancy and labor, as well as to prematurity and intrauterine malnutrition of the babies.

A total of 26 healthy full-term infants from multiple pregnancies and a control group of 96 infants from single pregnancies, all from the Rzeszow district, were tested. Blood was taken from cranial veins at the first, third, and sixth day of life, always at the same time. All infants were kept under the same conditions. The results of the investigation show that (a) twin infants have lower values of peripheral blood than singleton infants in their first six days after delivery, and (b) the second twin has higher values of peripheral blood as compared with the first one.

HbF, number of erythrocytes, Hb level, and hematocrits, were determined in mature twins, in immature twins, and in the control group. No essential differences were found in the parameters of these groups. However, in the comparison of absolute differences of values found in both MZ and DZ twins, there was a statistical significance for all the tested parameters.

This work presents the results of clinical observations and ECG examinations in 45 newborns from multiple pregnancies, including 27 full-term and 13 premature newborns. In both groups cyanosis was observed, the second twin born prematurely being most often affected. Changes in ECG include bradycardia, which occurs in the first 24 hours of life and chiefly in children born with asphyxia. The same newborns showed a delayed evolution of T wave. The similarity of ECG was noticed in 5 MZ pairs.

Vectorcardiographs and electrocardiographic examinations were made inMZ and DZ twins, triplets and quadruplets. The similarity of the cardiac electrogenesis in the twins was studied using the correlation calculation after the affinic transformation of the vectorcardiograms and the multipolar description of cardioelectric field. The similarity of electrocardiograms and vectorcardiograms in MZ twins depends on heart electrogenesis.

The differences appearing during the neonatal period result from a nonuniform course of circulation organ adaptation and the establishment of conduction pathways in the newborn heart.

In 1970 Hungary has joined in the WHO twin research program, and the medical file of twins has thus become compulsory.

A total of 269 twin pairs could thus be examined at the age of 6 months, 157 at the age of 12 months, and 44 at the age of 24 months. They all came from the same population and included 54 pairs diagnosed as MZ and 109 diagnosed as DZ. Extensive dental examination is planned to take place yearly till the age of 14 years.

Infants born from multiple pregnancies were observed for three years, 1969-71. Twin births were 1.88% {full-term 1.23%, premature 0,66%) and perinatal twin mortality was 7.94%. The Apgar scale assessment, acid-base balance, physical and psychomotor development equilibration rate, and morbidity, were determined. Great differences were found beween first and second twins, sometimes differing 1000 g in weight. In postnatal disorders the equilibration period was shorter than in single-born children. Examinations after three years did not show much deviation from the norm, although twin pregnancies and deliveries are dangerous and the children are included in the “high-risk” group.

This study has aimed at assessing the psychomotor development of children from multiple pregnancy after full-term and premature births. A total of 166 children aged 6 months to 12 years were examined, including 70 pairs of twins, 2 sets of triplets, and 20 more children from multiple pregnancies of which only one child had survived.

A body weight below 10 percentiles was in 17%, and stature deficiency in 23% of children. The psychomotor development was arrested in 13%. Most of the children (18 out of 23) with arrested psychomotor development had a low body weight at birth and a complicated course of the neonatal period, as well as serious general illnesses in the infantile period.

The psychomotor development of 130, one- to nine-year-old children was followed. Their development was not, as a rule, found to occur abnormally.

The further development of twins was found to be in close correlation:

(1) with the condition after birth (43% of complications in the further development of children having at birth a 1-7 Apgar score);

(2) with the weight at birth (35.2% of complications in a weight group of 1001-1500 g): this is connected with dystrophy and prematurity;

(3) with the order in which the twins were born.

The physical development of 20 premature same-sex twin pairs with dissimilar birth weight was observed, as compared to a control group of 17 pairs of premature same-sex twins born with similar weight.

The comparison showed that greater differences in development occur between twin siblings born with dissimilar weight. The twins poorly grown in utero were at a disadvantage mainly in body weight.

In the preschool or school age, twins poorly grown in utero twice as often had underheight. Underheight was found more frequently in boys.

The degree of intrauterine dystrophy does not seem to be of great importance to the further development. Neither was any relationship found between the physical development of the dystrophic twin and the degree of prematurity, as defined by fetal age and birth weight of the larger twin.

In follow-up psychological examinations of two groups of premature same-sex twins in preschool and school age (18 pairs with dissimilar and 15 pairs with similar birth weight), intelligence, visual and auditory perception, and drive, were evaluated.

The twins with lower birth weight usually attained lower IQs than their cotwins with higher birth weight, and nearly as a rule had poorer IQs of Verbal and Performance Scales. They also more often were hyperactive and had concentration difficulties. There were no differences in visual and auditory perception.

Preliminary investigations on the psychomotor development of infants from multiple pregnancies have been carried out.

The psychomotor development in the first six months of life appears to he more similar in MZ than DZ twin partners. It further appears to be rather connected with birth weight than with birth order. The psychomotor development of twins with a birth weight exceeding 2300 g attains, as early as in the first six months of life, a level concordant with the standards established for singletons.

A total of 59 children from multiple pregnancy, aged from 18 months to 13 years, have all shown a mental development within or above normal limits.

In 18 children there are reasons to suspect the presence of a CNS lesion, although the general mental level is good.

The numerical concordance of intelligence quotients is not typical for MZ and DZ twins. In four cases there were marked qualitative differences despite IQ concordance.

The behavior of twins in their home, preschool, and school environment, is determined by the separate nature of the relationship in which the twins live since birth.

Psychological examinations were made in 56 children from quintuplet, quadruplet, and triplet pregnancies. The psychomotor development of these children from multiple pregnancies did not, as a rule, differ much from the one of singletons, although the multiple pregnancy was more inclined to cause lesions of the central nervous system. Out of the 56 children examined, 25 were found to develop properly.

It is necessary to examine the development of each child separately, taking into consideration its health condition in the neonatal period and its specific environment which effect the individual development and may be the cause of disturbances, as well as of mental differences not only in children from the same pregnancy but even in MZ twins.

The authors have examined 30 children from triplet pregnancies aged 18 months to 16.5 years. The group included 20 girls and 10 boys. Triplet pregnancy was found to be, in the average, the fourth consecutive pregnancy in mothers. Physical and mental development was assessed. It was found that 60% of children showed a physical development below the appropriate norm for their age. In 83% of the children under examination mental age ranged below chronological age.