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The management of multiple pregnancies requires a correct diagnosis of chorionicity. This assessment is easy and reliable before 15 weeks of gestation by ultrasonography, but becomes much more difficult during the second and third trimester for same sex foetuses. From 5 to 8 weeks of gestation, the visualization of two gestational sacs assesses bichorionicity. From 8 to 14 weeks, the diagnosis of chorionicity is based on the presence of the lambda sign, completed by the evaluation of the thickness of the inter-twin membrane and the placenta localisation. From 15 weeks onward, the twin peak (or lambda) sign remains the best predictor of dichorionicity but is valuable only if it is present. The measurement of the thickness of the inter-twin membrane and the count of its layers are not available in all cases. From March 1999 to March 2000, we studied 31 multiple pregnancies with same sex foetuses, referred to our centre during the second trimester. The patients were asked for their former ultrasound reports. Chorionicity was mentioned only in 77% of the cases and when mentioned the information was correct in 85% of the cases. Thus, improving on that point is necessary. Prospective studies focusing on ultrasound determination of chorionicity show accuracy close to 100% when the ultrasonography is correctly realized before 15 weeks of gestation.

The management of multiple pregnancies requires a correct diagnosis of chorionicity. This assessment is easy and reliable before 15 weeks of gestation by ultrasonography, but becomes much more difficult during the second and third trimester for same sex foetuses. From 5 to 8 weeks of gestation, the visualization of two gestational sacs assesses bichorionicity. From 8 to 14 weeks, the diagnosis of chorionicity is based on the presence of the lambda sign, completed by the evaluation of the thickness of the inter-twin membrane and the placenta localisation. From 15 weeks onward, the twin peak (or lambda) sign remains the best predictor of dichorionicity but is valuable only if it is present. The measurement of the thickness of the inter-twin membrane and the count of its layers are not available in all cases. From March 1999 to March 2000, we studied 31 multiple pregnancies with same sex foetuses, referred to our centre during the second trimester. The patients were asked for their former ultrasound reports. Chorionicity was mentioned only in 77% of the cases and when mentioned the information was correct in 85% of the cases. Thus, improving on that point is necessary. Prospective studies focusing on ultrasound determination of chorionicity show accuracy close to 100% when the ultrasonography is correctly realized before 15 weeks of gestation.

Risk factors for peripartum cardiomyopathy (PPCM) are controversial. PPCM seems to be more prevalent in women of African descent, the highest observed incidence is in Haiti (1 per 300 live births). Our retrospective study conducted in Martinique showed an incidence of 1 per 5500 live births. This incidence is significantly lower than in Haiti. Women from Martinique and Haiti do not differ for most classical risk factors: African descent, age, pregnancy-associated hypertension, multiple pregnancy and pre-eclampsia. However, the parity rate and the socioeconomic level are different. Thus, African descent could be confounded by high parity rate and socioeconomic status.

Survival in patients with cystic fibrosis has considerably improved over the last years. Young adults are particularly concerned. Fertility in these patients is greatly decreased, especially in men due to obstructive azoospermia. In women, intra-uterine insemination with her spouse's sperm can overcome anomalies in the cervical glair. Several pregnancies in patients with cystic fibrosis have been reported, especially in women with a mild form of the disease. Prematurity is frequent, about 35% as is perinatal mortality related to the mother's status. When lung involvement is severe leading to major obstruction and hypoxia, cor pulmonae and denutrition, pregnancy remains a contraindication. Care for pregnant women (when pregnancy is possible) should rely on a multidisciplinary team and include a rigorous nutritional and anti-infection support.

There have been few studies of the way women walk in pregnancy, though some of the causes of low back ache of which they complain have only been partially worked out. This is why this study has been carried out on ten women between the third and eighth month of pregnancy. The speed at which they walk and the parameters of the gait as well as the localization of the centre of gravity when keeping upright have been measured in these pregnant women as well as in twenty control women of the same age. The results show that the speed at which they walk whether with or without carrying a weight usually is identical at the beginning and the end of pregnancy. When walking normally the size of the steps taken are no larger in pregnant women than in the control patients (p less than 0.05). Though the results are not statistically significant the rhythm of the steps is faster as well as their being a reduction in the length of the steps between the third and eighth month of pregnancy. When carrying a weight the length of the steps does not change greatly with pregnancy (p less than 0.05) and it would seem therefore to be a good way of assessing the changes that locomotion undergoes in pregnancy. The fact that women do not walk faster or slower can give evidence that they adapt to the change in posture that happens in pregnancy and they make the best possible biomechanical use of the parameters of walking in order to economise total energy output of the organism.(ABSTRACT TRUNCATED AT 250 WORDS)

The cycle ergometer (an exercise cycle) Monark was used to study the repercussions on the fetus of physical exercises carried out by the mother at the end of pregnancy (after 37-39 weeks of amenorrhoea). The maternal and fetal heart rates were measured at the same time while the mother was pedalling against increasing resistance. This was a form of sub-maximal aerobics. Fourteen women took part in the study but only six traces could be analysed. The mean duration of the exercises was 15 (+/- 2.5) minutes. The mothers' heart rate rose from 84 (+/- 7) beats a minute (bpm) before exercise to 153 (+/- 14) bpm at the last level reached. It took 15.6 (+/- 4) minutes for the maternal heart rate to return to what it was before exercise. The basal fetal heart rate was around 144 (+/- 5) bpm before exercise and rose to 170 (+/- 12) during exercise with no change in the oscillations in the fetal heart rate. After exercise the fetal rate slowed down very slowly and there was a marked diminution in the amplitude of the oscillations (Hammacher's Type 1). They never disappeared. Those few women who were in "false labour" during the test went out of false labour. We have hypothesised that the fetal heart rate rises significantly during the mother's exercise and this action is a mechanical one rather than a humoral or hormonal one. When exercise stops the diminution in oscillations, which is rapid, could be a sign of the fetus becoming drowsy, or it could be due to the intervention of maternal factors.