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Copyright of Thélème is the property of Universidad Complutense de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Conjoined twins are a rare form of monozygotic and monoamniotic twins. Fetal prognosis is very poor and, if the diagnosis is made early, it most often requires therapeutic abortion. We here report a case of three-hour old thoracopagus conjoined twins who were born vaginally, at term, at 40 weeks + 3 days. They were born to non-consanguineous parents, without any significant pathological history. Their mother was young and primiparous. She received 5 antenatal visits and 3 obstetric ultrasounds were performed by an inexperienced physician. The diagnosis of thoracopages twins was suspected based on clinical examination and computerized tomography (CT) results. This test showed cardiovascular abnormalities incompatible with life. The twins died after 23 hours of age due to acute respiratory distress. Conjoined twins are a rare congenital abnormality. Early diagnosis based on ultrasound would help to determine common anatomical structures, investigate associated congenital abnormalities, schedule delivery in a suitable structure and multidisciplinary neonatal management. [ABSTRACT FROM AUTHOR]

A great deal of concepts are mistakenly classified as doubleness. There are two types of doubles, me-doubles and you-doubles. The first ones are subordinated, the second ones are equal. Me-double is a personification of an autonomous part of an ego which can (but does not have to) be concretised in a new character. They are an artistic superstructure either of a schizophrenic situation or of expressed fears, desires and fantasies. You-doubles are two physically identical characters who exchange their roles or are in some rivalry relationship. You-doubles can be twins, clones, or understudies. There are various subtypes of doubles, from diabolical to dreamed ones. At least, a double has an integrative mental function.

Objectives: To summerize the results of the JUMODA study (JUmeaux MODe d'Accouchement) on the planned mode of delivery of twin pregnancy and the management of second twin delivery., Methods: JUMODA was a national observational prospective comparative study that took place between february 2014 and march 2015 in 176 french maternity units performing more than 1500 deliveries per year. Its main objectives were the comparison of neonatal and maternal morbidity according to the planned mode of delivery and the determination of the managements of second twin delivery associated with the best neonatal outcomes. To control for potential confounding factors and indication biases, statistical analyses comprized multivariate logistic regressions and matching on propensity scores., Results: The JUMODA study recruited 8823 women with twin delivery at or beyond 22 weeks of gestation. For twin pregnancies with a cephalic first twin at 32 weeks of gestation and beyond, severe neonatal morbidity was higher in the planned cesarean (150/2908 (5.2 %) than in the planned vaginal delivery group (199/8922 (2.2 %), aOR 1.56, 95 % CI 1.19-2.04). Increased neonatal morbidity in the planned cesarean delivery group was explained by higher severe morbidity in neonates born preterm (aOR 1.64, 95 % CI 1.13-2.39, for deliveries between 32 +0  and 34 +6  weeks of gestation, aOR 2.04, 95 % CI 1.22-3.41, for deliveries between 35 +0  SA and 36 +6  weeks of gestation) but not in neonates born at term (aOR 1.19, 95 % CI 0.58-2.44). In comparison with planned cesarean delivery, planned vaginal delivery was not associated with increased severe neonatal morbidity in case of breech presenting first twin after 32 weeks of gestation or with decreased survival witout severe neonatal morbidity in case of delivery before 32 weeks of gestation whatever the first twin presentation. In comparison with planned vaginal delivery, planned cesarean delivery was associated with increased severe maternal morbidity only in women aged 35 and higher. Delivery of non cephalic second twin was associated with similar severe neonatal morbidity rate than delivery of cephalic second twin. Finally, in case of cephalic second twin, internal version followed by total breech extraction was associated with less cesarean for the second twin but with higher severe neonatal morbidity in case of preterm birth in comparison with pushing efforts, ocytocin perfusion and artificial rupture of membranes., Conclusions: Planned vaginal delivery is the planned mode of delivery to encourage for the majority of pregnant women with twins, whatever first twin presentation and gestational age at delivery. No management of cephalic second twin appears better than an other, its choice will rest on obstetrician preferences., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Romulus and Remus were twin brothers, but according to a curious statement by John Lydus, Romulus was younger than Remus. The gloss altellus Romulus dicebatur transmitted by Paul the Deacon suggests that the Byzantine scholar may have been preserving an old tradition. Although the form altellus has been interpreted in various ways, the likeliest explanation is that altellus goes back to *alter-elo-s and means 'the second of the twin brothers'. Of the twins, Remus was the first to be born. The word altellus is not related to altus 'high, tall' or alere 'nourish', despite the attempts of ancient authorities (and more recently the Christian cabalist Egidio da Viterbo) to buttress such an etymology. Moreover, a playful allusion to altellus can possibly be found in Ovid's Fasti (Romulus alter erit), which would confirm the reconstruction *alter- elo-s. As a result, the founder of Rome is not the elder brother. Scholars have emphasised that the biblical twins Esau and Jacob offer a close parallel, as Jacob, who may be regarded as the founder of Israel, was not the firstborn son. The parallel is even more striking if one pays attention to the fact that in the Book of Jubilees and the Testaments of the Twelve Patriarchs, Esau was killed by his brother. The logic of these stories is ultimately based on a high degree of diagrammaticity or constructional iconicity between the order of the twins' births and their personal tropism: Esau (a hunter) and Remus are associated with a quite primitive way of life (elder brother: past), whereas Jacob and Romulus are characterised by metis and are presented as the bearers of a more advanced way of life (younger brother: modernity). The word altellus is rich in implications because it encapsulates the fact that the elder brother must be supplanted by his younger twin. [ABSTRACT FROM AUTHOR]

Scoliosis is called the lateral angulation of the vertebra more than 10 degrees. Scoliosis is divided into two groups that is congenital and idiopathic scoliosis. Congenital scoliosis was presented in one of the two 14-year-old sisters who were identical twins; while the other developed adolescent idiopathic scoliosis. The sister with congenital scoliosis has hemivertebra in the thoracic third and seventh vertebras, block vertebra in the thoracic 10th-11th vertebras, and fusion the L3-L4 vertebras. The Cobb angle of this sister was 44.4 degrees of thoracic scoliosis. In the other sister, 13.8 degrees lumbar scoliosis was detected. Scoliosis has been shown to occur not only with the genetic background but also due to low birth weight.

Sohane and Sélenn are twins and will soon be 6 years old. They had a birth journey often described as unusual, because they were born far too early, at 31 weeks of amenorrhea. Through the pen of their father, they share their testimony with us, looking back on this complicated period of which they were able to keep memories thanks to the photographs and stories of their parents., (Copyright © 2023. Published by Elsevier Masson SAS.)

Résumé: Après avoir esquissé les grandes lignes de la biographie de AR Luria, cet article présente ses travaux en psychologie générale, essentiels pour la compréhension de sa conception de la neuropsychologie : 1) sa participation à la construction de la théorie historique et sociale de la psychologie, développée avec LS Vygotski ; 2) le rôle du langage dans le développement des activités psychiques supérieures chez l'enfant (i.e. conscientes et volontaires) et, tout particulièrement, la régulation du comportement par le langage intérieur. Starting with an overview of AR Luria's biography, we will present his works in general psychology which are key to his conception of neuropsychology (this will be developed in a forthcoming paper). We will focus on the construction of the historical and cultural theory of psychology developed with LS Vygotski, according to which, in man, the natural mental activities, related to the genetic evolution and shared by all humankind, are transformed into higher cortical functions (that is conscious and voluntary activities) through the mediation of language and the products of social activity, thus differ according to the development of societies. We review the Luria's studies devoted to support the theory in his expeditions in Central Asia, his studies in twins and intellectual disabled children, and the demonstration of the role of speech in the child development of the higher mental activities and regulation of behavior. [ABSTRACT FROM AUTHOR]

Conjoined twins are a rare malformation of monozygotic and mono-amniotic twin pregnancies. We report the case of a patient in whom dicephalic conjoined twins was diagnosed in the antenatal period at 37 week amenorrhea. Fetal prognosis is very poor and, if the diagnosis has been made early, it most often requires therapeutic abortion. The purpose of this case study was to remind clinicians of this very rare disease, of the importance of ultrasound as an essential diagnostic tool to implement a strategy to manage patients in the postpartum period and of prognosis which is most often very guarded. [ABSTRACT FROM AUTHOR]

En la comparación forense de hablantes se pueden examinar diversos parámetros. En el presente trabajo se utilizó un sistema multiparamétrico que combina parámetros acústicos de largo plazo (f0, cualidad de voz y aspectos duracionales) con los parámetros de corto plazo (MFCCs) empleados por un sistema automático estándar basado en el enfoque i-vector/PLDA (sistema base). El objetivo era determinar si el nuevo sistema de comparación de hablantes ofrece mejor rendimiento que el sistema base. Para ello se llevaron a cabo tres diseños experimentales –que permitieron evaluar el nuevo sistema multiparamétrico en condiciones extremas, a modo de prueba de estrés–: (1) uso de grabaciones con características forenses realistas (e.g. ruido de fondo, reverberación, variabilidad intra-hablante, compresión de la señal); (2) comparación de las voces de 12 parejas de gemelos monocigóticos; y (3) cotejo de voces con enmascaramiento mediante pinzamiento de nariz. Los resultados obtenidos con el nuevo sistema muestran una mejora de rendimiento con respecto al sistema base, si bien el aporte medio de los parámetros de largo plazo al nuevo sistema fue de un 6,5%, siendo el restante 93,5% responsabilidad de los parámetros de corto plazo.

Objectives: To compare the mortality of monochorionic-monoamniotic (MCMA) and monochorionic-biamniotic (MCBA) twin pregnancies, from 14weeks of gestation to 28th day of life, before and after exclusion of major congenital malformations., Methods: We conducted a retrospective cohort study in two level 3 maternity units of the Hospices civils de Lyon (France) including all patients with a monochorionic twin pregnancy between January 2013 and December 2020. We excluded TRAP sequences and conjoined twins., Results: A total of 38 MCMA and 658 MCBA pregnancies were included. We showed an increase in overall mortality in the MCMA group compared to the MCBA group (31.6% versus 16.4%, P=0.03) even after exclusion of major congenital malformations (20.3% versus 9.5%, P=0.01). The main cause of mortality found in the MCMA group was the occurrence of unexpected IUGR., Conclusions: MCMA pregnancies have a higher foetal and neonatal mortality rate than MCBA pregnancies even after exclusion of congenital malformations related to the occurrence of unexpected MFIU., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The incidence of twin births shows a regular increase since the late 1980s. The mortality and neonatal morbidities of these infants are higher than that of singletons, particularly because of their prematurity and low birth weight. This paper put the accent on possible conflicts that twins can present during their neonatal life, like sex or weight discordance, congenital malformations, or other neonatal pathologies that may have an influence on the global prognosis of one or both infants. [ABSTRACT FROM AUTHOR]

Résumé Objectif Décrire le pronostic obstétrical et néonatal des grossesses gémellaires bichoriales (BC) présentant une discordance de poids fœtal d’au moins 20 %, et évaluer l’influence du retard de croissance intra-utérin associé sur la prise en charge. Patients et méthodes Une série de 67 grossesses gémellaires BC discordantes accouchées dans notre maternité universitaire de niveau III entre juillet 2002 et juillet 2012 a été analysée. La discordance de poids était considérée comme légère entre 20–25 %, modérée entre 25–30 % et sévère quand elle était supérieure à 30 %. Résultats Dans notre maternité, 11,4 % des grossesses bichoriales présentent une discordance de poids néonatal. Quatre-vingt pour cent des discordances sévères ont été repérées en anténatal, 41 % pour les moyennes et 20 % pour les discordances légères. Nous relevons 30 % de pathologies vasculaires gravidiques dans notre population dont 44 % dans le groupe discordance sévère. L’âge gestationnel moyen du diagnostic de discordance était de 30 SA et 2 jours. Le terme moyen d’accouchement était de 35 SA et 1 jour pour les discordances légères à modérées, et 33 SA pour la discordance sévère. Le taux de césariennes était de 48 % pour la discordance sévère et de 36 % pour la discordance légère. Le taux d’accouchements par voie vaginale est de 56,7 %. Plus de la moitié des discordances sévères ont accouché voie basse. Le taux de retards de croissance intra-utérin (RCIU) inférieur au 10 e percentile était de 18,7 %. La prévalence du RCIU est de 24 % dans les discordances sévères, 23,5 % dans le groupe discordance modérée et 10 % dans le groupe discordance légère. Le taux de morbidité néonatale était de 20,8 % et concernait principalement les enfants avec un RCIU. Discussion et conclusion Le risque de morbi-mortalité néonatale est surtout augmenté dans la discordance sévère avec retard de croissance intra-utérin associé, et ces grossesses sont à haut risque de morbidité maternelle. La voie basse est une voie d’accouchement envisageable pour les discordances minimes et modérées. En cas de discordance sévère la voie d’accouchement sera fonction du degré de retard de croissance intra-utérin associé. Objective To describe neonatal and obstetrical prognosis in dichorionic (DC) twins with a birth weight discordance under 20% and evaluate the influence of intrauterine growth restriction on the management. Patients and methods We studied retrospectively 67 DC twins birth between July 2002 and July 2012 at our university labour ward. Birth weight discordance was considered slight between 20–25%, moderate between 25–30%, and severe over 30%. Results Prevalence of birth weight discordance in DC twins is estimated at 11.4% in our study. Eighty percent of severe discordance was diagnosed before delivery, 41% for moderate discordance and 20% for slight discordance. We note 30% of pre eclampsia in our population with 44% in the severe discordance group. Mean gestational age was 35.1 weeks for slight and moderate discordances, and 33 weeks for severe discordance. Caesarean section rate was 48% for severe discordance and only 36% for slight discordance. Vaginal delivery rate is 56.7%. More than half of patient with a severe discordance gave birth vaginally. Intrauterine growth restriction rate under the 10th percentile was 18.7%. Prevalence of IUGR was 24% in sever discordance group, 23.5% in the moderate discordance group and 10% in the slight group. Neonatal morbidity rate was 20.8% mainly in children with IUGR. Discussion and conclusion Neonatal mortality and morbidity rate are mainly increased in severe discordant twins. These pregnancies are at high risk of maternal morbidity. Vaginal delivery must be preferred for slight and moderate discordances. In case of severe discordance, vaginal delivery should be considered depending on the degree of intrauterine growth retardation. [ABSTRACT FROM AUTHOR]

A digital twin is the virtual double of a system. This article shows how, within a hospital, decision-makers can mobilize this technology to improve the quality of care. Specifically, digital twins of services and care processes can be performant in risk management inherent in a health crisis. However, the articulation of virtual twins with simulations in the real world seems the best option for professionals to become rational and pragmatic practitioners, able to apprehend uncertainty and prepared to face the unknown in the troubled context that we know., (© 2022 médecine/sciences – Inserm.)

Résumé: La folie à deux a toujours interrogé sur la possible transmission des troubles délirants. Les cas de folie à deux chez des jumeaux monozygotes, ayant un terrain génétique identique et une relation gémellaire unique, posent la question de l’étiologie du trouble. Cet article propose l’étude d’un cas de folie à deux chez des jumelles monozygotes, dont l’une était enceinte. Après la présentation clinique, il rappelle les définitions du trouble, décrit historiquement par Lasègue et Falret (1877). La deuxième partie présente des articles de la littérature concernant des cas de folie à deux chez des jumeaux monozygotes. Ces publications font part de plusieurs formes cliniques. La folie imposée serait l’apparition d’un délire chez une personne vulnérable et au contact d’un sujet délirant. La folie simultanée serait deux schizophrénies à début concomitant, sur un terrain génétique prédisposant. La folie communiquée reste une entité plus floue, avec une origine génétique controversée. La rareté du trouble et le manque de données épidémiologiques entraînent des biais qui limitent ces études. Une troisième partie rappelle quelques données issues des études de jumeaux dans la schizophrénie. Le taux de concordance de la maladie chez les jumeaux homozygotes varie de 41 à 65 %, contre 0 à 28 % chez les hétérozygotes. Il existe donc un terrain génétique fort associé à des composantes environnementales. Ces notions se recoupent donc avec les données sur la folie à deux et la folie simultanée. La quatrième partie précise quelques notions concernant les troubles psychotiques pendant la grossesse avant de revenir sur l’histoire clinique présentée. Ce cas de folie à deux chez des jumelles homozygotes est une belle illustration des interactions entre un terrain génétique identique, des histoires de vies communes et individuelles, et une relation interpersonnelle unique. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer la pertinence d’un test séquentiel (détection de la fibronectine fœtale dans une population sélectionnée par la mesure échographique du col utérin) pour apprécier le risque de prématurité spontanée des grossesses gémellaires en cas de menace d’accouchement prématuré à membranes intactes. Patientes et méthodes: Suivi d’une cohorte de 50 patientes enceintes de jumeaux hospitalisées pour menace d’accouchement prématuré entre 24 et 34 semaines d’aménorrhée (SA) révolues. Les paramètres de jugement étaient la probabilité d’un accouchement dans les sept ou 14jours suivant le test ou avant 34 ou 37SA. L’utilisation séquentielle de la fibronectine après mesure échographique du col a été évaluée, avec un test considéré comme positif si le col était inférieur ou égal à 15mm ou si le col était entre 16 et 30mm avec une fibronectine positive. Résultats: Une fibronectine fœtale positive prédisait le mieux un accouchement dans les sept jours avec des sensibilité/spécificité/valeurs prédictives positive et négative (VPP et VPN) respectives de 71 %, 64 %, 26 %, et 93 %. Une longueur cervicale inférieure ou égale à 20mm prédisait le mieux un accouchement dans les 14jours avec des sensibilité/spécificité/VPP et VPN respectives de 89 %, 51 %, 31 %, et 95 %. Le test séquentiel semblait plus efficace que chaque marqueur pris isolément et qu’en population de singletons en conservant notamment une excellente VPN tout en évitant 50 % de fibronectines : prédiction d’un accouchement dans les 14jours avec une sensibilité, une spécificité, et des VPP et VPN respectives de 89 %, 57 %, 35 %, et 95 %. Discussion et conclusion: Un test séquentiel avec utilisation sélective de la détection de la fibronectine fœtale dans une population de grossesses gémellaires en menace d’accouchement prématuré sélectionnée par la mesure échographique de la longueur cervicale paraît efficace pour prédire une prématurité spontanée en cas de menace d’accouchement prématuré à membranes intactes, tout en réduisant de moitié le nombre de tests de fibronectine fœtale réalisés. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate if internal version with ruptured membranes is a risk factor of cesarean section for the second twin. Patients and methods: Two hundred and fifty-nine twins vaginal deliveries after 33 weeks of gestation from 1997 to 2009 in a level 3 maternity. A retrospective case–control study comparing two groups: cases of cesarean section on second twin and five twins vaginal deliveries following the case. Active management of the second twin delivery was performed with a short intertwin delivery. Results: Eleven cesarean sections on the second twin were performed (4.2%). The main indication was failure of internal version. The risk of cesarean section was significantly greater when the internal version was performed with ruptured membranes (OR: 25.4 IC 95% [2.3–275.7] P <0.003) and when intertwin time delivery interval was increased (8.1±5.1 vs 16.7±6.3, P <0.001). Discussion and conclusion: The rupture of amniotic membranes before or during the internal podalic version is associated with a risk of failure and cesarean for the second twin. We recommend to perform the internal podalic version with unruptured membranes according to the French recommendations. [Copyright &y& Elsevier]

Abstract: Objectives: To determine ultrasonographic markers that can help to predict prognosis in twins acardiac pathology in order to manage it. Patients and methods: A retrospective multicentric study has been led between 1997 and 2006. The following data were collected: frequency of monitoring, ultrasonographic markers studied according to the outcome of each pregnancy, associated with a review of the literature. Results: Six twin pregnancies with this condition were identified. The main studied criteria are: foetal growth of the pump twin, congestive heart failure, resistance index of the umbilical arteries, ductus venosus Doppler and middle cerebral artery peak velocity. There was no consensus concerning the method of ultrasonographic monitoring. Discussion and conclusion: According to our study and the literature, our management must take into account the ratio of (or the difference in) resistance indices between the twins, the middle cerebral artery peak velocity, the tricuspid regurgitation and the ratio of abdominal circumferences of the two twins. [Copyright &y& Elsevier]

Agota Kristof’s most successful work is a trilogy of novels. Le Grand Cahier, La Preuve and Le troisième mensonge (“The Big Note”, “The Prove” and “The Third Lie”) together tell the story of twin boys, indistinguishable from each other. The novels follow the boys through the phases of their education as they progress from an animal-like being to the capacity for reflection. The twins’ story is told against the backdrop of the 20th Century Hungarian/Central European experience with its ideologically different yet equally totalitarian dictatorships. The trilogy not only presents but links the different kind of personality’s problems: is it possible to be unique in a world which can’t define the concept of individuality, neither on the biological nor on the philosophical level? Kristof’s minimalist style enforces the heroes’ problematic states. The biological duplication of the heroes makes impossible the traditional concept of the individual, while the historical experience ruins the idea of personality. The second query is focused on the possibility of History’s representation in contemporary literature: is there an adequate way to tell more than the personal experiences about History and is there a valid language which can be truth without repeating the ancient phrases of the precedent discourse of literature? [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of prematurity, growth restriction or growth discordance. The aim of this study was to evaluate the accuracy of ultrasound fetal weight prediction in twin pregnancies. Patients and methods: Two hundred and twenty-four patients with an ultrasonography within 7 days before birth were retrospectively studied. Estimated fetal weight (EFW) was calculated with the Hadlock''s formula and was compared with birth weight (BW). Growth restriction and growth discordance superior or equal to 25% between the first (T1) and the second twin (T2) were recorded. Results: Absolute differences between EFW and BW were similar for both twins (127g [56.25–210] for T1 and 110g [50–206.25] for T2). Mean absolute percentage error was 5.41% (2.32–9.65) for T1 and 5.64% (2.46–10.37) for T2 and was superior to 10% for 24% of T1 and 27% of T2. Gestational age inferior to 32 weeks, obesity and oligoamnios were associated with a better accuracy of ultrasonography. Chorionicity as well as fetal presentation did not influence fetal weight estimation. Ultrasonography in the diagnosis of growth restriction had a sensitivity of 82%, a specificity of 76%, a positive predictive value (PPV) of 22% and a negative predictive value (NPV) of 98%. For diagnosis of growth discordance, sensitivity was 72%, specificity 95%, PPV 72% and NPV 95%. Conclusion: Fetal weight can be accurately predicted in twin pregnancies. The contribution of ultrasonography in the diagnosis of growth restriction and growth discordance is mainly due to a high NPV. [Copyright &y& Elsevier]

The assessment of optimal delivery for twin gestations is complex due to the relatively high frequency of obstetrical complications and to the heterogeneity of delivery management in these conditions. The extern validity of the Anglo-Saxon studies is limited in particular because delivery management of the second twin (approach of external cephalic version) differs from the French one (approach of internal version and/or total breech extraction) in cases of non-vertex second twin. Anglo-Saxon studies suggest that a planned vaginal delivery is associated to an increased risk of neonatal morbidity for second twin compared to first twin at term, in particular in cases of combined vaginal-cesarean birth. To reduce the interval twin-to-twin delivery interval and the number of combined vaginal-cesarean births, in our opinion, one must stop to perform external cephalic version and recommend a routinely active management for the second non-vertex twin delivery. With this active management, there is no evidence to support planned cesarean section for twins. Nevertheless, active management requires training as internal version might be difficult to perform, and therefore it is essential to pursue to teach junior obstetrician these obstetric maneuvers. There is limited role for trial of labor after cesarean delivery in twin gestation with a policy of active management. [Copyright &y& Elsevier]

The aim of infertility treatment is clearly to obtain one healthy baby. If the transfer of a top quality single embryo could provide a baby to all the patients, there would be no more discussion. The problem is that, nowadays, French pregnancy rates after fresh embryo or frozen embryo transfer are not the same as in Nordic countries. All studies show that in unselected patients, single embryo transfer decreases twin pregnancy rate but decreases pregnancy rate too. Pregnancy rate is dependent on embryo quality, women’s age, rank of IVF attempt (clear data) but also on body mass index, ovarian reserve, smoking habits. All these data cannot be taken into account in a law. That is the reason why a flexible policy of transfer adapted to each couple is preferable. Each couple and each IVF team are unique and must keep the freedom to choose how many embryos must be transferred to obtain healthy babies, and to avoid twin pregnancies but without demonizing them. [Copyright &y& Elsevier]

Limiting the number of embryos transferred from three to two does not reduce the high risk of twin pregnancy (between 21 and 40%). Scandinavian centers have proposed in the 2000s the elective single embryo transfer (eSET) as the only means to reduce maternal, neonatal and psychological consequences related to multiple births. Pooled results from prospective randomized controlled trials and prospective cohort studies comparing eSET and transfer of two embryos (DET) in a selected population have confirmed the almost complete disappearance of twins when eSET was effective but the compromising effect of eSET upon live birth rates was discussed. Optimizing the eSET overall pregnancy rate need to associate a freezing policy and to define risk factors for increased chance of multiple birth (patient age, diagnosis, number of top-embryos or unsuccessful attempts). The extension of eSET practice to an unselected population irrespective of embryo quality is still controversial. The choice between offering one cycle of SET or DET in an unselected patient population depends on the society’s willingness to optimize the in vitro fertilization results according to a defined health care policy: the first one is the twins disappearance with reduced overall pregnancy rate and the second one is a reduced twin birth rate with maintain of the total pregnancy percentage. The real question is to define what percentage of twin pregnancy could be considered as acceptable. [Copyright &y& Elsevier]

The incidence of twins has dramatically increased in the last two decades. The theorical risk of aneuploidy is higher than in singletons. Screening for aneuploidies should be offered in all twin pregnancies. This review examines the current methods and evidence regarding screening for fetal aneuploidies in twin pregnancies. [Copyright &y& Elsevier]

Objectives: To assess the effect of the twin-to-twin delivery interval on the umbilical cord blood gas status and the neonatal outcome of the second twin following vaginal delivery. Patients and methods: Retrospective study of twin deliveries at or beyond 34 weeks of gestation over a period of five years. The correlation between the twin-to-twin delivery interval, and the umbilical arterial blood gas parameters of the second twin, including pH, PO2, PCO2, HCO3- and base excess, was studied. A second analysis was performed after exclusion of non-vertex presentation, need for general anesthesia, growth restriction and weight difference between the twin>30%. Results: Two hundred and thirty-nine patients were studied. The mean twin-to-twin delivery interval was 11.3±6.4 minutes (between 6 and 14 minutes in 56.1% of cases). The second twin had more Apgar score<7 at 1 minute (P <0.02) and more arterial ombilical pH<7.20 (P <0.01) than the first twin. Over 15 minutes, the mean arterial pH was lower (P <0.01) and the number of arterial pH<7.20 increased (P <0.03). In contrast, the mean Apgar score and the rate of neonatal transfer did not differ significantly. There were significant negative correlations between arterial pH, base excess and bicarbonates and the twin-to-twin delivery interval (P <0.05). Similar results were found in the homogenised population. The reduction in the second twin arterial pH was expressed as pH=7.282–0.003×time. Discussion and conclusion: Umbilical cord arterial blood gas parameters deteriorate with increasing twin-to-twin delivery interval. Our results suggest that this interval should be less than 15 minutes, but obstetrician should adapt to every clinic situation. [Copyright &y& Elsevier]

Abstract: Objective: Appreciate the prevalence of multiple births in Congo and identify the factors and the risks associated for infant. Material and method: A case–control prospective study was conducted throughout hospitals of Brazzaville (Congo). A total of 410 multiple births (group 1) were compared to 427 births resulting of monofoetal pregnancy (group 2). Results: The frequency of twins was estimated at 1.67%, while the frequency of triple births was equal to 0.02%. This frequency was higher among mothers aged 20 to 30 years and among multipared mothers. Family antecedents of the birth of twins were observed among twins (87.6%) and in all cases of triple births. The percent of premature delivery predominated (P < 0.01) among twins: 157 cases (39.1%) in group 1 versus 98 cases (23%) in group 2. All cases of triple births were premature. In the two groups, childbirth unrolled by low tract in most cases, but more (P <0.001) in monofoetal pregnancies (n =377 or 88.3%). When Apgar quotation was superior to seven, the frequency of first twins was higher (P  <0.01) among the first twins than the second twins: 295 cases (79.9%) versus 74 cases (20.1%). As far as mortality is concerned, 56 twins (6.9%) died at birth and 164 cases (21.3%) died at first six days of life. Discussion and conclusion: The frequency of multiple births in Congo was similar to frequency observed in other African countries. Improvement of foetomaternal prognosis in multiple births is linked to an appropriate follow of pregnancy and childbirth. [Copyright &y& Elsevier]

Abstract: Introduction: Compared to single motherhood, the twin pregnancy results in important aesthetic and functional sequelae of the abdominal wall. The considerable uterine growth involves a musculocutaneous diastasis of both the supraumbilical and the infraumbilical area. This study presents the modified abdominoplasty technique with an inverted T scar as the appropriate treatment of supraumbilical and infraumbilical musculocutaneous defects. Methods and materials: This series reviews a total of 30 female patients of 35 years on average. There was no cases obesity or smoking reported. Surgical treatment consisted in a skin and fat resection following an inverted T scar design and associated to a muscle plication. In 6 patients it has been necessary to repeat the procedure in 6 months time. Results: All 30 patients resolved with an aesthetic and functional improvement. No instances of abdominal diastasis recidivation occurred. Ther were no complication observed and no impact on the healing process was referred. Conclusion: on of the main differences between single and gemellary pregnancies is that the second ones are concerned by an abdominal diastasis marked on both a vertical and a transversal direction. The complete surgical treatment sometimes includes a second intervention. Clinical results and luck of complications suggest that the T-type abdominoplasty associated to a muscle retightening offers an appropriate surgical treatment of patients concerned. [Copyright &y& Elsevier]

Abstract: Objective: Prevention of twin pregnancies using elective Single Embryo Transfer (e-SET) is now considered by many Assisted Reproductive Techniques teams as a necessity. The aim of this study was to assess the efficacy of e-SET in a prospective manner in a selective population of patients using Take Home Baby Rate per couple as principal parameter. Patients and methods: This prospective study was conducted from January 2003 to December 2004. Elective Single Embryo was proposed to women above 37 years in their first IVF or ICSI attempt. It was then performed only in cases when at least one embryo with high implantation potential (score-4 embryo in our embryo scoring) was obtained for transfer and one more (score-3 or score-4 embryo) was available for freezing. Results: e-SET was proposed and accepted in 225 couples (25% of eligible couples and 7.8% of total population) and was possible in 96 of these). Two embryos were transferred in all other eligible patients (Double Embryo Transfer group =DET). Cumulative delivery rate after fresh embryo transfers and, if necessary, after frozen-thawed embryo transfers were 39.5% per couple e-SET group and 41.7% in DET group (NS). On the other hand, the percentage of twin pregnancies was significantly different between the two groups (2.6% vs 26.6% respectively; P <0.01). Discussion and conclusion: In women younger than 37 years in their first IVF/ICSI attempt, the elective transfer of only one embryo with high implantation potential strongly allowed to avoid twin pregnancies without any significant delivery rate decrease. This transfer policy is particularly efficient in laboratories displaying good results in their embryo freezing program. [Copyright &y& Elsevier]

Abstract: Objectives . – To describe obstetrical policy variations concerning the delivery management in the case of twins, at term. Patients and methods. – A mail survey was undertaken among the medical supervisors of the maternity wards belonging to the AUDIPOG Network (N =170). Results. – The participating rate was 73.35%. 124 answers were analysed. Elective caesarean was realized by 0.8% of participants for diamniotic twins and by 57% of cases for monamniotic twins An elective caesarean is planned for respectively 74% of answers if first (J1) and second twin (J2) are in a breech presentation, 81% if J1 is in breech and J2 in cephalic presentation, and 68% if J1 is in breech and J2 in transverse presentation. Delivery with J1 in breech and J2 in cephalic presentation had a higher risk than a delivery of a single breech at term. When J1 and J2 had a breech presentation 73% of participants thought that this delivery is more difficult than a delivery of a single breech at term. However, they were only 17.5% to consider that a delivery of twin with J1 in cephalic and J2 in breech presentation had a higher risk than a single breech delivery. Discussion and conclusion. – Medical policy variations are not extensive except for X-ray pelvimetry and the presence for the delivery of one paediatrician and one anaesthesiologist. An elective caesarean policy for twins is infrequent in France. [Copyright &y& Elsevier]

Abstract: The neurological outcome is an important issue regarding twin pregnancies. In fact, twin pregnancy is clearly associated with an important neurological morbidity, roughly 4 times higher than singleton pregnancy. It is possible to distinguish some high-risk situations, making it possible to calculate more accurately the individual risk. The different aetiologies are analysed: hypotrophy, prematurity, malformations, prenatal occurrence of anoxic and ischemic lesions, and particularly the link with monochorionicity. The neurological outcome is mainly depending on hypotrophy and prematurity. However, the rate of long-term neurological complications is not different between twins and singletons after adjustment for term and birth weight. An increased risk of malformation is associated with twin pregnancies, essentially a high rate of abnormal neural tube closing (RR=2). Monochorionic pregnancies have a specific morbidity, not related to these aetiologies, with characteristic anoxic and ischemic lesions. Cerebral palsy is observed in 10–20% of the monochorionic pregnancies, vs 3.7% of the bichorionic ones. These complications are linked to the constant vascular anastomoses, between the circulations of the two monochorionic twins. When the twin-to-twin transfusion syndrome is severe, a poor neurological outcome is observed in 4 to 18% of the surviving children. However, this rate depends on studies, treatments, and methods of neurological evaluation. The laser destruction of anastomoses could decrease this morbidity. The stillbirth rate, either associated or not with twin to twin transfusion syndrome, is increased by monochorionicity. The death of one of the twins is associated with a 20% higher risk of neurological sequelae for the surviving co-twin. [Copyright &y& Elsevier]

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This article has the aim to study resilience in a specific context (twins) with an original methodology to compare the productions of monozygotic twin brothers, which had to face traumatic environmental conditions. We have used interview procedure and projective methodology (Rorschach Test, Tales’ test). Results show that resiliency and vulnerability are associated with different external conditions (especially maternal libidinal investment in spite of her pathology) and intrapsychic differences (related to quality of mentalization). [Copyright &y& Elsevier]

Copyright of EMC-Psychiatrie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The examination of the official records from Artas, Ise`re (North Dauphine´, France), provides nearly continuous information from 1540 to 1900. These allowed us to study the twinning during this period, to specify its importance, its evolution, and its links with diverse other characteristics of reproduction. The number of twins per 1000 births is on a general average very close to 11. It seems to decrease during the last four centuries. However, the variability is very high from one year to another or one decade to another, including the composition of twins (identical or different sex), with the result that no statistical argument allows us to reject the null hypothesis. Numerous data have been collected that support a partially genetic determinism in twinning. The number of children in families with twins is clearly higher that in other families. Age of death of the mother of twins is higher than that of the mother of single births. With the result that ‘gemellity’, fecundity and longevity are related. On the other hand, the perinatal and infant death rate is much higher for twins than for single births, so that the percentage of ‘useful’ children is very low for twins. There is therefore, at the same time, selection and counter-selection. The momentary importance of either could explain the extent of variation of the ‘gemellity’ rate. The compensations, at short or long time, between the two processes could explain the roughly constant rate of ‘gemellity’ during the last four centuries. [Copyright &y& Elsevier]

Case reports. – We report two cases of cardiac dysfunction in twin-twin transfusion syndrome (TTTS) evaluated with serial echocardiography. Two cases of TTTS were referred at 27 and 26 weeks. At delivery at 31 weeks, the first recipient twin had evidence of severe cardiac dysfunction with decreased ventricular function and transient systemic hypertension. There was polycythaemia. Favorable outcome was observed after treatment with arterial vasodilating (nicardipine) and inotropic agents (dobutamine, enoximone), and reduction of haematocrit. At 28 weeks the other recipient twin had cardiac dilatation with hypokinetic myocardium. These alterations were cured by dobutamine.Conclusion. – These cases show that even severe cardiac dysfunction may be reversed after birth unlike in utero natural evolution. [Copyright &y& Elsevier]

Introduction&#160;: In Haiti, excess mortality among twins is an additional health burden, given that child mortality levels are already very high there. Haiti is the country in the Latin America and Caribbean region with the highest rate of twin births (about 17&#160;&#8240;). However, there, the excess mortality among twins has been little studied., Purpose of Research: To identify factors associated with excess mortality among twins., Methods: With data from the Demographic and Health Surveys, calculation of under-five mortality rates (U5MR) and using a Cox regression to analyze factors associated with excess mortality among twins., Results: Twins have U5MRs that are three times higher than those of singletons. However, these U5MRs fell sharply, but more sharply among twins than singletons. Indeed, between 1994 and 2016, the U5MR for twins decreased by about 53% (from 432&#160;&#8240; to 204&#8240;), while for singletons, it was only 36% (from 121&#8240; to 77&#8240;). The multivariate results show that all else being equal, twins have a 3.3 (2.86-3.87) times higher Hazard Ratio of death than singletons. They also show low birth weight, lack of prenatal visits, and lack of breastfeeding are independently associated with excess mortality among twins in Haiti.Conclusions&#160;: The health of twin children remains a major challenge for Haiti. To further reduce their excess mortality, the government has to develop accessible obstetric and pediatric services essential for the care of twin pregnancies.