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The growth of total intrauterine, intra-amniotic and placental volume during the latter half of pregnancy was studied longitudinally with ultrasound in 115 healthy women with normal singleton pregnancies. A parallel planimetric area method was used. The range and distribution of normal values between 20 and 40 weeks was determined for a main study group of 103 primiparous women with which values from 12 parous women were compared. Total intrauterine volume increased from a median of 1006 ml to 4420 ml, intra-amniotic volume from 716 ml to 3406 ml and placental volume, calculated as the difference between total intrauterine and intra-amniotic volume, increased from 259 ml to 801 ml. Variation between individuals was wide at all stages of pregnancy. No significant difference was found between primiparous and parous women. Between successive 5-week periods from 20 to 40 weeks there was evidence that women tended to maintain their initial volume ranking. During the 30-35 week period, rate of growth of total intrauterine and intra-amniotic volume was somewhat faster than the near constant mean rate at other times, while the rate of growth of placental volume decreased after 30 weeks towards term.

Fetal movements (FM) may be spontaneous, originating in the fetus itself, or evoked by external stimuli. The relative rate of spontaneous and evoked FM has not yet been documented. As it is impossible to differentiate in a singleton pregnancy between these types of movements - the natural model of twin pregnancy was used. The FM of 10 normal twin pregnancies between 33 and 39 weeks of gestation were studied by two realtime ultrasounds, and were operated by two ultrasonographers over a period of 10 min. The mean number of independent FM of each fetus which occurred while the other fetus was resting was 7.9 FM and 7.7 FM, respectively (average 7.8 FM). A mean of 2.5 FM occurred simultaneously. The rate of independent FM was 75.7% and that of simultaneous FM was 24.3%. Vibroacoustic stimulation applied to the maternal abdomen evoked simultaneous movements of both fetuses in all cases. It is suggested that the independent FM may represent spontaneous FM and that the simultaneous FM may indicate the presence of an external stimuli and are therefore evoked responses.

SUMMARY: The removal of one of twin embryos was attempted by infusion of 24% (w/v) saline into the gestation sac in 2 mares by laparotomy. The treatment was successful in one mare (Case 1) and the untreated embryo remained viable. However, neither foetus survived in the second mare (Case 2). Plasma oestrone sulphate (E, S) concentrations fell immediately after treatment in both mares but recovered to approximately 50% of pre-treatment levels in Case 1. In Case 2 plasma E, S concentrations declined steadily and were < 1 ng/ml within 6 days of treatment. These preliminary results suggest that the method may be useful for selective removal of one of twin embryos in mares. Furthermore, plasma E, S concentrations may be a useful indicator of embryonic viability.

Summary. There were 357 twin pairs, six sets of triplets and one pair of conjoined twins born in the group of 15020 booked women compared with 392 twin pairs, 10 sets of triplets, two sets of quadruplets and two sets of conjoined twins in the 7654 emergency admissions (unbooked women). Rising maternal age, parity and height were all associated with rising twinning rate. Maternal death rates were 0.8% for singleton pregnancies, 2.0% for twin pregnancies, 6.3% for triplet pregnancies and none for the two women who had quadruplets. The mean fetal birthweights were 3.08 kg for singletons, 2.28 kg for twins, 1.71 kg for triplets and 1.36 kg for quadruplet babies. Fetal loss was 10% for singletons, 24% for twins, 42% for triplets and 75% for quadruplet babies. The poorer maternal and fetal outcomes in multiple pregnancy compared with those in singleton pregnancy were due to the combined effects of certain pregnancy complications, including the retention of the second twin, of inadequacies in our health care facilities and of unfavourable socioeconomic circumstances especially lack of antenatal care.

Few data are available about desirable weight gain during twin gestation. The present study addresses this issue through retrospective evaluation of 217 women pregnant with twins who delivered at Swedish Hospital Medical Center, Seattle, between 1982 and 1986. The purpose of the study was to identify an optimum total weight gain and an optimum weight gain pattern for normal twin gestation. A mean prenatal weight gain of 20 kg (44 lb) was associated with "optimum" outcome; optimum outcome was defined as a pregnancy lasting at least 37 weeks with the delivery of two living infants weighing greater than or equal to 2,500 gm each with 5-minute Apgar scores greater than or equal to 7. A weight gain curve for twin gestation was generated and compared with the standard curve for singleton pregnancy. While the weight gain curve during twin gestation was similar to the standard curve during the first half of pregnancy, increased weight gain began in the second trimester and continued to term. The weight gain pattern of twin gestations with less-than-optimum outcome paralleled that of the optimum outcome group until about 30 weeks' gestation, at which time weight gain slowed in women in the former group, whose mean total weight gain was 16.8 kg (37 lb).

Analysis is made of fetal growth in 563 twin pregnancies. The birth-weight of a twin is affected by the duration of pregnancy and zygosity. Intrauterine growth and weight is the same as a singleton pregnancy up to a gestational age of 32 weeks. After this stage fetal growth slows markedly. The growth curves of both twins are similar with an increasing tendency towards growth retardation in twin 2 after 39 weeks' gestation. Intrauterine growth retardation, as represented by the 10th percentile line, for twin 1 joins 1,094g at 31 weeks, 1,836g at 36 weeks and 2,428g at 40 weeks' gestation. The corresponding figures for twin 2 are 1,131g, 1,875g and 2,337g respectively.

The ovarian hyperstimulation syndrome is the combination of increased ovarian volume, due to the presence of multiple cysts and vascular hyperpermeability, with subsequent hypovolemia and hemoconcentration. We report a case of spontaneous syndrome in a singleton pregnancy. This was a spontaneous pregnancy with 12 weeks of gestational age. The pregnancy was uneventful until 11 weeks of gestational age. After that, the pregnant woman complained of progressive abdominal distention associated with abdominal discomfort. She did not report other symptoms. In the first trimester, a routine ultrasonography showed enlarged ovaries, multiples cysts and ascites. Upon admission, the patient was hemodynamically stable, her serum β-hCG was 24,487mIU/mL, thyroid-stimulating hormone was 2.2µUI/mL and free T4 was 1.8ng/dL. All results were within normal parameters. However, levels of estradiol were high (10,562pg/mL). During hospitalization, she received albumin, furosemide and prophylactic dose of enoxaparin. The patient was discharged on the sixth hospital day. RESUMO A sindrome de hiperestimulacao ovariana e a combinacao do aumento dos ovarios, devido a presenca de multiplos cistos e de hiperpermeabilidade vascular, com subsequente hipovolemia e hemoconcentracao. Relata-se um caso de sindrome espontânea em uma gestacao unica. Trata-se de gravidez espontânea com 12 semanas de idade gestacional. A gravidez ocorreu sem intercorrencias ate 11 semanas de idade gestacional. Apos, a gestante passou a se queixar de distensao abdominal progressiva, associada com desconforto abdominal. A paciente nao relatava outros sintomas. A ultrassonografia de rotina no primeiro trimestre mostrou ovarios aumentados com multiplos cistos e ascite. No momento da internacao, a paciente apresentava-se hemodinamicamente estavel, com β-hCG serico de 24.487mUI/mL, hormonio estimulante da tireoide de 2,2µUI/m e T4 livre de 1,8ng/dL, ou seja, valores dentro dos parâmetros normais. Porem, os niveis de estradiol estavam elevados (10.562pg/mL). Durante a internacao, a paciente recebeu albumina, furosemida e enoxaparina profilatica. A alta hospitalar ocorreu no sexto dia de internacao.

Thirty-five multiple and 168 singleton fetal weight estimations were made in an Australian population using the tables of Warsof et al., which have been computed from a North American population. The estimated fetal weights were compared to the actual birth weights within 96 h of estimation. Correlation coefficients of the actual birth weight with the estimated fetal weight for the total group, singleton and multiple pregnancies respectively, were 0.967, 0.969 and 0.933. The percentages of estimated fetal weights falling within 10% of the actual birth weight were for the three groups, 79.3%, 77.9% and 85.7% respectively. Individual weight sub-groups, less than 1500 g, 1500-2500 g, 2500-4000 g and greater than 4000 g, showed correlation coefficients of 0.84, 0.838, 0.839 and 0.759 respectively, which compare favourably to published studies of North American populations using this method. It is concluded that ultrasonic fetal weight estimation using the North American computerized tables of Warsof et al. is appropriate for an Australian population and is valid for both singleton and multiple pregnancies.

Physiological adaptation including expansion in plasma volume is exaggerated in women with twin pregnancies. In singleton pregnancy and multiparous twin pregnancies there is an association between plasma volume expansion and birth weight, but this is not so in primigravid twin pregnancies. Women with twin pregnancies have a similar dietary intake to singleton pregnancies, but it is not known whether there are differences with parity or zygosity. Absorption and utilisation of nutrients may be increased to meet demands for extra fetal growth. Nutrient supply and plasma volume expansion will be further discussed and their association with birth weight presented.

This study was designed to investigate the relationships between the perception of pain during active labor and nine predictor variables: age, parity, childbirth preparation, state anxiety, confidence in ability to handle labor, concern regarding the outcome of labor, fear of pain, cervical dilatation and frequency of uterine contractions. The sample included 134 low-risk women at term with a normal singleton pregnancy. Standard and stepwise regression was used to examine the ability of the selected variables to explain the variance in the sensory, affective, and evaluative components of pain as measured by the subscales of the Pain Rating Index of the McGill Pain Questionnaire. Although significant proportions of variance were explained for each component of pain, the study variables were most powerful in their ability to explain the variance in the affective component of active labor pain. The stepwise analysis suggested that of the nine variables, confidence in ability to handle labor was the most significant predictor of all components of pain during active labor.

A total of 123 twin pregnancies were studied, 68 by records analysis only, and 55 by serial haematological assessment in detail. The incidence of low haemoglobin levels is found to be greater than in singleton pregnancy; evidence of iron and folic acid deficiency is common in sternal marrow aspirates but not in peripheral blood films. Routine haematinic prophylaxis in twin pregnancy is not advocated.

Total intrauterine volume (TIUV) was determined serially in 27 twin pregnancies from which a nomogram was constructed. At the beginning of the second trimester, TIUV was similar to that in singleton pregnancy; by the 18th week it had become twice as large, and remained so until late in pregnancy. Labor was preceded more frequently by a slowing than by an acceleration of uterine growth.

A case of massive bilateral multiloculated theca-lutein cysts occurring in association with a nonmolar singleton pregnancy is described. Surgical removal of the cysts became necessary and was followed some weeks later by the spontaneous rupture of the membranes at a nonviable stage of gestation.

Summary. Myoelectrical and mechanical activities of the uterine cervix and horns of ewes fitted with electrodes and strain gauges were measured from the 30th day before until the 3rd day after parturition. During pregnancy, cervical electromyograms presented regular episodes of strong activity of a mean duration of 7 min, termed regular spiking activity, occurring at about 50-min intervals. Between two episodes, isolated or low frequency spikes occurred randomly and constituted the irregular spiking activity. The alternation of irregular and regular spiking activities was called the myoelectrical complex of the cervix. Clear relationships were noticed between electrical and mechanical events. On the pregnant uterine horn (singleton pregnancy) or on both horns (twin pregnancy), a myoelectrical complex pattern similar to that of the cervix was recorded. Regular spiking activity on the cervix and pregnant horn(s) occurred mainly simultaneously. No significant evolution of the myoelectrical complex pattern was noted throughout the last month of pregnancy until 2\p=n-\3days before parturition. The activity pattern was then modified according to three characteristic phases: (1) a phase of relative inhibition of the cervix and pregnant horn(s) 48 h before lambing and lasting about 17 h; (2) a phase of increasing activity occurring thereafter over the whole genital tract with an average duration of 31 h; and (3) a phase of continuous activity of the cervix and uterus for 0\m=.\4\p=n-\3\m=.\8h which accomplished the expulsion of the lamb. It is concluded that during the last month of pregnancy the cervix is active and that its activity arises from a basic ultradian rhythm involving the entire genital tract. Furthermore, although our results do not offer an explanation for the preparturient increase of cervical compliance described by others, they definitely excluded cervical muscular inhibition during the last 24 h of pregnancy and at the time of cervical dilatation.

Three infants, born of two mothers with inflammatory bowel disease who received treatment with sulphasalazine throughout pregnancy, were found to have major congenital anomalies. In the singleton pregnancy, the mother had ulcerative colitis, and the infant, a male, had coarctation of the aorta and a ventricular septal defect. In the twin pregnancy, the mother had Crohn's disease. The first twin, a female, had a left Potter-type IIa polycystic kidney and a rudimentary left uterine cornu. The second twin, a male, had some features of Potter's facies, hypoplastic lungs, absent kidneys and ureters, and talipes equinovarus. Despite reports to the contrary, it is suggested that sulphasalazine may be teratogenic.

Brood-farm veterinarians were surveyed and theriogenology records were examined to obtain information on the natural outcome of rectally-diagnosed twin pregnancies. Four of the veterinarians estimated that 50% of mares with twin embryos had single foals. In the analyses of palpation records, 31 53 (58%) of the diagnosed twin pregnancies terminated in birth of one foal. However, the loss of one embryo without the loss of the other occurred significantly more often before day 40-42 (30 53 ; 57%) than after day 40-42 (1 16 ; 6%). Of the remaining 15 mares with diagnosed twins at day 40-42, 5 had two foals and 10 had no foals. The methods used for intervention when twins were diagnosed were unsatisfactory. Complete termination of pregnancy with a prostaglandin or an intrauterine flushing resulted in failure to reestablish a singleton pregnancy during the operational breeding season in 10 11 mares. Attempts to eliminate one embryo resulted in loss of both in 6 7 mares. The results indicated that, at the present time, nonintervention should be given more consideration as a method of handling twin pregnancies.

Blood was collected from 344 subjects with singleton pregnancy between 28 and 40 wk gestation, together with 70 samples from 24 subjects with twin pregnancy of comparable gestation. Circulating placental protein 5 (PP5) in singleton pregnancy rose from a median of 26 microgram/l at 28 wk to reach a plateau with a median of 38 microgram/l at 36 wk. The median PP5 levels in twin pregnancy were 50 microgram/l at 28 wk rising to 65 microgram/l at 38 wk. The ratio of the medians of PP5 levels in twin and singleton pregnancies fell from 1.94 at 28 wk to 1.62 at 38 wk. An "action line' for low levels of PP5 in twin pregnancy was defined by applying a multiple of the median for twin pregnancy.

Circulating levels of placental protein 10 (PP10) were measured by radioimmunoassay in 140 women with normal singleton pregnancy (140 samples), in 6 women with normal twin pregnancy (15 samples) and in 35 pregnant women with pre-eclampsia (51 samples from singleton pregnancies and 7 samples from twin pregnancies) between 24 and 40 weeks. In singleton pregnancies with pre-eclampsia, the levels were lower than normal (P less than 0.01). In twin pregnancy the circulating PP10 levels were not significantly affected. These results suggest that changes in placental function are reflected in the circulating PP10 levels.

Summary: To assess the maternal haematological effects of betamethasone administered in late pregnancy, an automated full blood count was performed before and daily for 5 days after betamethasone in 25 women with a singleton pregnancy between 23 and 33 weeks' gestation. From a mean (±SD) baseline level of 11.0 ± 2.2 ± 109/L, the total white cell count increased significantly to 13.2 ± 2.9 ± 109/L and 13.5 ± 3.1 ± 109/L on the first and second day after treatment respectively, returning to baseline on day 3 (p < 0.0001, ANOVA). These changes represented a mean increase in the neutrophil count of 35% and a mean decrease in the lymphocyte count of 23%. While there was considerable intersubject variation in the extent of the changes, this study has quantified the leucocytosis induced by betamethasone in late pregnancy, information that may assist with the clinical evaluation of a woman at risk of preterm delivery.

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.

The measurement of serum fibronectin levels in women carrying a singleton pregnancy at between 25-30 weeks' gestation has allowed the separation of those women who will remain normotensive from those who develop preeclampsia in this pilot study. The fibronectin assays were performed using nephelometry. It is recognized that some severe cases of preeclampsia will have already declared themselves clinically by 28 weeks' gestation, but if a screening test is to be limited by cost to a single test event, then this pilot study suggests the 28-week gestation rime to be the most suitable. Further studies are being undertaken to test this hypothesis and to adequately assess the test's reliability, predictability and its cost-effectiveness.

A study was made of 94 sets of twins born during 1975-8. Nine of these sets had not been diagnosed before labour started. Of the others, 75 were diagnosed as a result of clinical suspicion and 10 were diagnosed unexpectedly during the antenatal period, nine by ultrasonic examination. Thus, while ultrasonic examination has substantially reduced the incidence of undiagnosed twins, a fifth of all patients who had ultrasonography performed in the presence of a twin pregnancy were reported on at least one occasion to have a singleton pregnancy. Ultrasonography must be performed at least twice, therefore, before a multiple pregnancy can be confidently excluded.

Bilateral ovarian enlargement with massive ascites and pregnancy occurred in a patient after two courses of clomiphene citrate (Clomid) therapy. It is likely that the patient received the second course of clomiphene during early stages of pregnancy. Early pregnancy must be ruled out prior to the administration of this type of therapy.