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[Twin pregnancy and twin birth, a retrospective (1970-1976) and prospective (1977-1978) study (author's transl)]
Twin pregnancy entails an enhanced hazard especially for the newborn, with regard to both perinatal mortality and neonatal morbidity. The authors deal with the following points in the first part of the article: 1. The classical concepts concerning the distribution of twin pregnancy with regard to enzygotism and dizygotism, and the importance of the modus of placentation. 2. Pathophysiology of twin pregnancy, making three factors responsible for prematurity and hypotrophy of the twins: Lack of sufficient space in the uterus, insufficient uteroplacental exchange and inability of the cardiovascular system to become adapted to the situation. In the second part of the article, conclusions are drawn with regard to the course of pregnancy as well as the twin birth. The main problems listed here emphasise the importance of the following points: -systematic, early ultrasound examination and more frequent controls for keeping a better check on the course of pregnancy and birth, -complete and strict rest in bed around the 31st week of pregnancy to combat prematurity and hypotrophy, -induction of labour before the due date and more liberal application of the indications leading to Caesarian section to combat perinatal mortality and morbidity. Subsequent to the practical application of these conclusions within a prospective study conducted from 1977 to 1978, the authors achieved a mortality decrease from 5.6% to 3.2% (WHO definition).
Twin pregnancy entails an enhanced hazard especially for the newborn, with regard to both perinatal mortality and neonatal morbidity. The authors deal with the following points in the first part of the article: 1. The classical concepts concerning the distribution of twin pregnancy with regard to enzygotism and dizygotism, and the importance of the modus of placentation. 2. Pathophysiology of twin pregnancy, making three factors responsible for prematurity and hypotrophy of the twins: Lack of sufficient space in the uterus, insufficient uteroplacental exchange and inability of the cardiovascular system to become adapted to the situation. In the second part of the article, conclusions are drawn with regard to the course of pregnancy as well as the twin birth. The main problems listed here emphasise the importance of the following points: -systematic, early ultrasound examination and more frequent controls for keeping a better check on the course of pregnancy and birth, -complete and strict rest in bed around the 31st week of pregnancy to combat prematurity and hypotrophy, -induction of labour before the due date and more liberal application of the indications leading to Caesarian section to combat perinatal mortality and morbidity. Subsequent to the practical application of these conclusions within a prospective study conducted from 1977 to 1978, the authors achieved a mortality decrease from 5.6% to 3.2% (WHO definition).