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Within the “Wrocław Longitudinal Twin Study” in a part of the material the liking level of singletons (SIN) to identical twins (TMZ) and of TMZ to SIN was analysed cross-sectionally, in the period of 11th to 18th year of life. In each of the 76 classes of elementary and high schools in Wrocław (Poland), including the investigated in 1976-7 TMZ (64 pairs), were evaluated the relations between school-mates, using the Korczak's five-degree scale of liking. The declared by TMZ and SIN liking decreased with age between pupils of the same sex, and increased between pupils of opposite sex, however, in TMZ with some delay. The liking declared by TMZ of both sexes to SIN was on average lower than that declared by SIN to TMZ. The degree of liking declared by SIN to TMZ of the same sex was average higher than in relation of SIN to SIN particularly among girls. Thus, there occurred the so-called “prima donna effect”. The liking declared to pupils of opposite sex in relation of SIN to TMZ was on average lower than the analogous one in relation of SIN to SIN and in relation TMZ to SIN even worse. The higher contrast in treating pupils of the same and opposite sex in TMZ than in SIN indicates a lower social maturity in TMZ. A diverse influence of socio-economic conditions on the declared toward then liking by boys and girls was found. The low number of separated twins did not allow to make a generalisation on specificity of their position in class. The sending of TMZ to different classes appeared to be in Wrocław elementary schools sporadic (1 repeater), and in high schools observed in 38%, from that 28% of twins went to equivalent classes, usually in different school, and in 10% of pairs one of the twins repeated the class.
Taking into consideration two facts: that the structure of social life forces twins to part and that the presented roles in a pair are not equal, (one of the twins plays the role of a leader (L) and the other, the subordinate (P.)), one can ask the question — what meaning does the moment of parting have and what are its consequences?
In order to do that, a survey was conducted, (a sample of 31 pairs of twins above the age of 30), in which every pair was asked the question: “Which one of you made the decision about parting?” The answer had two options: A – I, B – brother/sister. Out of 31 pairs of twins, 16 pairs chose the variant different from his brother or sister – that is A, B, admitting that the interpersonal conflict was the result of the parting. In 7 pairs, both twins chose the B variant – they withdrew from the conflict; and in 8 pairs they chose the A variant – looking for a compromise as the means of agreement.
When analyzing the results of the survey, we can state the following:
– in the relationship of twins, there is an interpersonal conflict;
– the decision about parting is difficult with prevalent feelings of sadness and sorrow;
– after parting, at least one of the twins has problems with preserving his identity and integrity of psychological space.
Since the moment of parting is necessary and difficult, specialists and mainly parents are required to consciously change their position towards the relationship of twins. It has to be the result of applied educational methods which aim at creating subjectivity and equality of each of the twins before the moment of parting.
The aim of this preliminary study was the estimation of renal blood flow in 16 premature newborns from twin pregnancies with mean body weight 1270 g and mean gestational age 29 weeks.
In control group we have 16 singleton newborns with mean gestational age 29 weeks and mean birth weight 1240 g. In both intervention and control group we have the similar clinical symptoms. The renal blood flow was carried out in the first day of life with the Acuson 128 XP Colour Doppler using the 6 and 7 MHz linear transducer. The renal blood flow parameters-PI, RI, Vmax, Vmin Vmean were measured in right and left renal arteries in theirs courses from the aorta to the renal hilus, by color sinal. In the investigation group the mean value of RI in right and left renal artery was 0,88. Mean PI in right vessel was 1,67 and in left 1,56. Mean V min in right and in left artery was 0,03 and mean V max in right artery was 0,34 and in left 0,33. Mean value of mean velocity in right vessels was 0,18 and in left 0,19.
In control group we observed in right artery mean value of PI 1,74 and in left 1,6. Mean RI was 0,86 and 0,86 in right vessel in left vessel. Mean V min was 0,05 in right and 0,04 in left artery. Mean V max was 0,37 in right and 0,34 in left artery. Mean value of V mean was 0,19 in right artery and 0,18 in left artery.
Using the student, Mann-Whitney and Shapiro-Wilk tests we have not observed statistically significant difference of Doppler parameters between control and investigation group and between the left and right artery. Although in newborns with broad PDA we noted significant higher value of RI (0,97, 0,98) than in newborns without PDA (0,78, 0,81).
Type 1 diabetes mellitus (IDDM) results from a chronic process of autoimmune destruction of ß cells of the Langerhans islets. The presence of autoantibodies (ICA, GADA, anti-IA2, IAA) in serum preceds the clinical onset of the disease. Genetic predisposition for IDDM is connected with HLA, CTLA-4 and insulin gene region.
The aim of the study was the genetic and immunological analysis of a triplet. One of them developed Type 1 diabetes mellitus. We analysed HLA class II, CTLA-4 and insulin gene polymorphisms in the whole family. Besides, we investigated immunological status of three brothers.
All patients present identical genotype for VNTR loci: D1S80, D17S5 and Apo B, as well as for HLA-DRB1, — DQA1, — DQB1, CTLA-4 gene and all studied insulin gene polymorphisms. That proves their monozigosity. The triplet presents strong genetic predisposition for IDDM. The two patients without overt diabetes have increased levels of ICA, GADA, IA2 and IAA.
OBJECTIVE. 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, and the relation between size and morphologic features of the yolk sac and the outcome of twin pregnancies.
RESULTS. In all 38 sets of twins two yolk sacs were identified. During the first trimester of a 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 sac was abnormally large (> 8mm) and had thin wall. Four 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.
CONCLUSION. The sonographic identification of yolk sacs in multiple pregnancies allows an early and efficient recognition of presence and chorionicity of twin pregnancy, both in intra – and extrauterine. Identification of abnormal yolk sac or yolk sacs suggests death of one or all embryos.
The objective of this study was to answer the question whether there is the relation between the uterine capacity, estimated by the total birth weight of fetuses, and the duration of twin gestation. The material for researches contains data received from the books of births and case records concerning the pregnant who gave births to twins in the Institute of Obstetrics and Gynecology of the Medical University in Lódź between 1970-1998. The final analysis concerned only gestations lasting more than 29 weeks, without any complications (excluding prematurity and the growth-discordant twins), and when gestational age was exactly known. The selected group was finally composed of 188 pairs of twins. The analyses considered relations between total birth weight of twins, the sex of newborn babies, parity, and the duration of gestation. The duration of the analyzed twin pregnancies was 35,6 weeks, including primiparous with 35,8 weeks, and multiparous – 35,1 weeks. In the group of male-male twin pairs the average duration of pregnancy was 35,7 weeks, in unlike-sexed pairs – 35,6 weeks, and in female-female pairs – 35,5. In the group of the primiparous having male-male twin pairs the average duration of pregnancy was 35,1 weeks, unlike-sexed pairs – 36,4 weeks and female female pairs – 36,6 weeks, while in the group of multiparous relatively: 36,4, 35,4, 35,0 weeks. The total birth weight of the specific pairs of twins was from 2270 g to 6900g (average 4794g), while in 92% <5500g. In the primiparous group it was 4908,1 g. and in the multiparous group – 4663,1 g. Analyzing the total twins' weight according to the fetal gender and parity it was found that in primiparous with male-male twins - 4715,3, unlike-sexed – 5271,6 and female-female – 4967,5, whereas in multiparous relatively: 4961,5, 4692,6, 4414,0. The shortening of twin pregnancies was caused by the following factors: total body mass achieved by fetuses was > 5500 g, presence of male sex in twin pregnancies (only in primiparous), and also the multiparity.
The aims of the study were as follows: 1. to evaluate the effectiveness of current program to promote breast-feeding in our population of infants from multiple pregnancy; 2. to define factors responsible for failure in early breast-feeding establishing and /or maintaining breastfeed during the hospitalization of the babies in neonatal department. 122 newborn infants (2 sets of triplets and 58 twin pairs) born in the Clinic for Pathology of Pregnancy and Labor in Szczecin, Poland, in the years 1995 (January) – 1999 (May) from multiple pregnancy were included in the study. In the examined material there were estimated neonatal conditions at birth, neonatal complications, which may disturb successful breast-feeding as well as other factors contributing to early breast-feeding, the way of feeding the babies during neonatal period and the mean time of starting breast-feeding. It was found that most of the examined babies were born with the features of prematurity: mean gestational age was 35,6 ± 2,2 weeks and mean birthweight – 2225,3 ± 193,2 grams. Only 57,4% of babies were born in good conditions according to Apgar scores. Factors which influence in a negative way early breast-feeding were as follows: respiratory disturbance (22,1%), temporary oral nutrition intolerance due to sickness of the baby or early onset of infections (27,5%), operative delivery (62,3%), medicine taken by mothers (13,9%) and failure in maternal lactation (8,2%). Factors disturbing a normal course of breast-feeding were: fototherapy due to hyperbilirubinemia (20,5%) and late onset of infections (1,6%). In most cases breast-feeding was started 3-4 days after birth and the most frequent way of feeding was formula followed or in combination with maternal milk (at discharge in 86,9% of babies).
We concluded that exclusive breast-feeding, despite program of promotion, is a rarity in population of newborn babies born from multiple pregnancy; time to start breast-feeding in this population is usually 3-4 days after delivery. Most pre-term and full-term twins are discharged from neonatal department on maternal milk – exclusively or in combination with formula in situation of scarce maternal milk for two or more infants – what should be considered as our professional success.
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.
We described a case of pregnancy, delivery and peurperium of 28 years old multipara with twins pregnancy in bicornuate, unicollis uterus. Each fetus was placed in separate horn of uterus. Biological mature pregnancy was delivered by cesarean section. During the peurperium the involution disturbances of one of the uterus horns were observed. The case was discussed in context of other similar anomalies.
The frequency of the developmental dysfunction and specific learning disabilities were assessed in the retrospective study in the group of 56 school-aged twins. The relationships between genetic, perinatal and social factors and learning disability were also determined. It was found that 12.5% of twins had learning disabilities. The most common neurodevelopmental dysfunction were language disorders, poor graphomotor fluency and poor fine motor dexterity. It was also found that educational difficulty were associated with prematurity, low Apgar scores, neonatal complications and familial predisposition.
I studied 8 pairs of male twins and 14 pairs of female twins. The aim of this paper is to demonstrate the evaluation of development age in pairs of twins examined through the electrophoretical mobility of nuclei. EMN index in pairs of male twins, the index figures do not change dramatically between the ages of 8 – 12. EMN index in pairs of female twins rises from 9 – year – old to 11 – year – old pair. In this paper I want to indicate the studies on development age, which began at The Twins Festival in Szczecin in 1998.
Multiple pregnancies pose numerous threats both for foetuses and neonates. The following disorders are encountered among the most important perinatal disturbances: EPH – gestosis, immature labour and premature rupture of foetal membranes. Also during the labour, particularly the second one and the following ones, various lesions that may cause increased incidence of diseases and mortality in this group of neonates [5, 6, 10, 18, 21, 22, 25]. Complications encountered in neonates from multiple pregnancies, resulting both from abnormal conditions of intrauterine development and from perinatal pathology, require still wider studies, particularly within the context of intensified obstetrical care of women with multiple pregnancies [7, 11, 13, 16, 24].
In the years 1996-1998, out of 3883 neonates born in the Chair of Obstetrics and Gynaecology of the Silesian Medical Academy, 152 (3,9%) came from multiple pregnancies. This period included one case of quadruplets, eight cases of triplets and 62 twin pregnancies. Pregnant women were directed to our Chair within the program of multidisciplinary care of women with complicated pregnancies and they also came from the Department of Pathology of Pregnancy in our Chair. In 18 women, treated for infertility, the pregnancy was accomplished as a result of application of various techniques of assisted procreation. In one case – 4 foetuses were indicated, in five cases – three foetuses and in 12 cases – two foetuses.
Objective. The aim of this study was to show the diagnostic possibilities of ultrasound in twin-to-twin transfusion syndrome (TTTS), to demonstrate its usefulness in cases of hemoglobin difference < 5 g/dL in neonates as well as in cases complicated by intrauterine death of one or both twins.
Study design. The study included 4 pairs of twins. In two cases 3 fetuses died in utero. In the other two the hemoglobin difference in newborn infants was < 5 g/dL. The ultrasound examination, evaluating the fetal anatomy and biometry, amniotic fluid volume, placentation, was performed. The special attention was paid to polyhydramnios/oligohydramnios, discordant fetal growth (fetal weight, abdominal circumference), the presence of fetal hydrops, ascites, pericardial effusion. Doppler blood flow velocimetry has been done in umbilical vessels, middle cerebral artery. The data was compared with normal reference values for singleton pregnancies. The waveforms from both uterine arteries were also evaluated to exclude placental insufficiency. Additionally the blood flow through the AV valves was measured to exclude or confirm its regurgitation. Postnatally the hemoglobin difference was evaluated if available and compared with sonographic findings.
Results. In all cases inter-twin difference in abdominal circumference was greater than 18 mm and inter-twin weight difference of more than 15%. We observed polyhydramnios/oligohydramnios in all twin pregnancies.
It has been found decreased PI in middle cerebral artery in larger fetus (recipient) in all our cases (comparing to single pregnancy). PI values for this vessel in smaller fetuses were within normal range (for single pregnancy). PI values in umbilical arteries of recipients were abnormal (increased PI or absent end-diastolic flow).
Comments. The sonographic criteria seem to be very useful in diagnosis of twin-to-twin transfusion syndrome, especially in cases where the measurement of hemoglobin level is impossible. Doppler blood flow velocimetry in fetal vessels helps to explain the changes in fetal hemodynamics in TTTS.
The study comprised 14 pairs of twins. All the children were prematurely born between the 27 and the 33 weeks of pregnancy with birth weight 600-1900 g. Somatic development was assessed on the basis of the body weight, length/height measurements taken in the 6th and 12th months of the corrected age and in the 24th month of the calendar age. Body mass index was also calculated as weight in kilograms divided by the square of the height in meters. The obtained results were compared with the regional norms for children from Lodz. Moreover, in each child individual measurements and body mass index were normalized as compared to the arithmetic mean and the standard deviation for the established age norm. The percentage of children with body mass deficiency and decreased body length/height was relatively high. Individual assessment of somatic development, taking into account the normalized values enable observation of the direction of changes within the range of somatic features in individual children. Retardation of somatic development of prematurely born twins should be first of all associated with their very low birth weight. Severe complications of prematurity affect physical development of the children examined by us, especially in the first two years of life.
The study comprises 889 pregnant women between 14 and 21 weeks of gestation. The control group consisted of 862 pregant 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 pregant women AFP (Microparticle Enzyme Immunoassay AxSYM Abbott), total (β-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 (β-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 adavantageous 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%.
The authors have analysed the frequency and structure of congenital anomalies in children born in the Pomeranian district in the period from 01.07.1997 to 31.12.1998. Among a total of 28.361 births in that area, 748 (2.64%) were affected by congenital anomalies. Among 28.361 births, 620 (2.18%) were from multiple pregnancies. 23 (3.71%) among births from multiple pregnancies were affected by congenital malformations. The prevalence rate of inborn anomalies in births from multiple pregnancy in our area were higher (3.71%) in comparison to births from singleton pregnancy (2.61%). It implies that children born from multiple pregnancy are at higher risk of developing congenital anomalies.