The author reports on primary diseases and on secondary reactions of adaptation in fetal hearts of twins. Cases of fibroelastosis endocardica, cases of hypertrophy of the heart, and the circulatory reactions following feto-fetal transfusion in twins, are discussed.

Using histochemical methods, several enzymes of the myocardium in deceased twins have been investigated.

Cells from blood stains in absorbent and nonabsorbent materials like stainless steel, unpolished wood, cloth, glass, and paper, can be correctly sexed using fluorescent stains even after 90 days, during which the stains had been exposed to light, unfixed.

The course of hemolytic disease is generally more severe in twin than in single-born infants, because of prematurity prevailing in twin births and resulting prolonged hospitalization.

The course of hemolytic disease in double conflict (ABO and Rh) does not appear to be milder than in single Rh incompatibility. In one case it was even found to cause more extensive damage to one fetus, as compared to the other with simple Rh conflict.

An up-to-date review of literature on the distribution of haemoglobinopathies in the Indian subcontinent has been presented. Haemoglobins S, D, E, J, K, L, M, Q, β-thalassaemia major, β-thalassaemia minor, α-thalassaemia minor, haemoglobin H, haemoglobin Lepore and persistence of foetal haemoglobin have been reported from India, β-thalassaemia in combination with haemoglobins S, E, D, J, K, Q has also been reported. Haemoglobin S is found to be prevalent among tribal populations in various regions of India, while haemoglobin D is prevalent among Sikhs, Pathans and Gujratis. Haemoglobin E is present in high frequency among populations of Assam, Bengal and Veddahs of Ceylon. β-thalassaemia major is widespread in various populations. There is paucity of data regarding distribution of β-thalassaemia minor and α-thalassaemias in this region.

This paper aims at drawing the attention of obstetricians and pediatricians to a peculiar syndrome: a neonatal emergency without any preliminary signs of fetal distress. This emergency can be predicted before birth. The uterine content film obtained, when a twin pregnancy or an abnormal presentation is suspected, shows an extreme and permanent fetal malposition as early as the 6th month of gestation: the head is forcibly overextended, embedded in the spinal abnormal concavity. Its severity and duration entail a cervical elongation and a temporary atonia of inspiratory muscles. Respiratory autonomy is impossible at birth. A prolonged artificial ventilation should be organised and used immediately at birth to prevent death or any risk of transient cerebral anoxia. The acute neonatal neurological syndrome is only due to a purely peripheral motor and transitory impairment, and it will have no consequences.

The current data on the distribution of blood genetic markers in Chinese populations outside China have been reviewed and summarised. The Chinese were found to exhibit varying degrees of heterogeneity in some of the marker systems, and attempts have been made, where appropriate, to relate this heterogeneity to the diverse backgrounds in China of the populations studied.

Pregnancy duration was examined in 389 multiple pregnancies out of 29,656 general deliveries. Mean duration of multiple pregnancy appears to be 258.5 days, i.e., 23.1 days shorter than general pregnancy, which is statistically significant (t = 32.16, P < 0.001).

There is high linear positive correlation between fetal weight and length, and between these and maternal abdominal circumference. A highly significant multiple correlation exists between fetal weight and length and maternal abdominal circumference in multiple pregnancy.

Statistical studies have shown a significant correlation between maternal pregestational weight and duration of pregnancy (i.e., a low weight may cause a shortening of pregnancy). Duration of pregnancy is further correlated to the weight gain (i.e., it is shortened by an insufficient gain). This phenomenon is observed in thin women, but not in women of heavy weight before the pregnancy.

The studies of weight losses obtained through hypocaloric or sodium-free diets or diuretics, show that a sudden weight loss may cause a shortening of pregnancy duration. This is verified in patients with normal or insufficient weight gain and starting with a normal or small weight, but not in overweight patients or with an important weight gain.

This study demonstrates the dangers of excessive measures toward prevention of toxemia. The decision of compulsive weight loss in mothers with multiple pregnancy must be well thought and carefully applied, for excessive measures could reduce the duration of pregnancy and thus increase the risks of perinatal death.

The possibilities of early diagnosis of multiple pregnancy are shown, which helps to prevent and reduce the incidence of premature deliveries.

B-scannings were performed on 86 pregnant women with clinical suspicion of twin pregnancy. In 22 out of 23 twin cases the ultrasonic diagnosis was right. The earliest diagnosis was in 17th week of pregnancy. The possible difficulties of diagnostics and faults are discussed.

The determination of oxytocinasemia is the method of choice in monitoring multiple pregnancy. An increase in the level of the enzyme indicates a normal development of the pregnancy.

Although, as a rule, the oxytocinasemia level is higher in multiple than in single pregnancy, there are cases with a level pointing to intrauterine fetal danger, if, in a gestation beyond the seventh lunar month, it is lower than 4 μmol∣l∣min.

The birth of a newborn with a body weight below 2500 g, when the oxytocinasemia level exceeds 12 I.U., indicates that a multiple pregnancy is involved.

Total estrogens (E/day), pregnanediol (P/day) in diurnal urine, and thermostable alkaline phosphatase (APt) in blood serum were investigated. Simultaneously, amnioscope examinations were carried out during pregnancy and the beginning of labour. A retrospective assessment of placental test values with respect to the state of newborns was also made. The usefulness of these tests in the diagnosis of a fetus at risk in multiple pregnancies appears to be limited.

In a series of 114 twin pregnancies followed in the course of 12 years (1961-1972) we noted the favourable effect of specialised preventive care. More exact diagnostics (ultrasound scanner) shifted the recovery of twins from the 35th to the 30th week of pregnancy. Due to the therapeutic and preventive bed rest and to the systematic use of orciprenalin, the duration of pregnancy has been prolonged from 36 to 38.5 weeks on the average. The perinatal mortality in twin deliveries decreased from 14.4 to 5%.