Objective. To determine the correlation between quantitative measurements of antepartum uterine activity and cervical change twin gestations.

Methods. Forty women from our Twin Clinic constituted the study group. Participants had a cervical examination each week between 20 and 37 weeks gestation and a cervical score (CS) was calculated as follows: CS = cervical length (cms)-cervical dilation (cms) at the internal os. The women also performed blinded home uterine activity monitoring (HUAM) for a mean of 7.0+3.0 hrs/wk (+SD). Uterine activity was expressed as mean number of contractions/hour/week gestation based on the average of three independent reviewers. CS was determined by a single clinician unaware of the HUAM recordings. A significant change in the CS was defined as a reduction of at least 0.5 from the preceding week. Correlation coefficients were used to determine the association between uterine activity and change in the cervical score.

Results. Twin pregnancy was characterized by a rise from 0.2 + .03 contractions/hr at 20 weeks to 3.2 + 2.4 contractions/hr at 37 weeks gestation. CS fell from a mean of 2.6 + 0.2 at 20 weeks to −2.1 + 0.9 at 37 weeks gestation. There was a significant negative correlation (−0.317, p<.0001) between increasing uterine activity and decreasing CS. There were significantly more (p <.002) contractions during the 7 days preceding a significant reduction in CS (3.3 + 3.5 contractions/hr) than when the CS was unchanged (1.6±1.5 contractions/hr).

Conclusions. In twin gestations, an increasing frequency of uterine contractions is strongly correlated with quantifiable cervical change between 20-37 weeks gestation. Persistent daytime contraction frequencies of >3/hr represent a risk factor for cervical dilation and/or effacement.

The monozygotic (MZ) twinning rate in Japan had remained nearly constant from 1975 (3.74 per 1,000 births) to 1994 (4.23), whereas the dizygotic (DZ) twinning rate had remained nearly constant from 1975 (1.86) to 1986 (2.27), and had gradually increased up to 1994 (3.89). The higher DZ twinning rate since 1987 has been attributed to the higher proportion of mothers treated with ovulation-inducing hormones and partially attributed to in-vitro fertilisation in Japan. As for maternal age, MZ twinning rates have remained nearly constant for maternal age groups except the youngest and the oldest age groups. On the other hand, DZ twinning rates increased up to the 35-39 years of age group and decrease thereafter. In 1994, the twinning rate was higher in DZ twins than in MZ twins for maternal age groups of 30-34 years and of 35-39 years. As for geographical variations in twinning rates, DZ rates statistically significantly increased with the year during the period from 1986 to 1994 in 31 out of 47 prefectures. In 1994, twinning rates in 21 out of 47 prefectures were higher in the DZ than the MZ rate, and the DZ rate is equal to the MZ rate in two prefectures. Geographical variations in twinning rates by zygosity in 1994 drastically changed from those during the period from 1955-1959 and in 1974.

The sexual index included in the Szondi test makes it possible to define the domains of an individuals “internal sex” or gender – especially the degree of the subject's bisexuality. This index was employed in a comparison between partners reared together in 62 monozygotic and 23 dizygotic pairs of twins. The observed incongruence in 1/3 MZ pairs would not appear to derive totally from errors of measurement. In most of these pairs it is competition which underlies the incongruence seen on the sexual index. It was further observed that the congruence here as in general in female pairs is clearly more marked than in males. A hypothesis was proposed, whereby competition for dominance is a distinctively major-tonality (masculinity) characteristic. The incongruence is more conspicuous among males because males are in general more markedly major-toned than females. This hypothesis was borne out. It is thus necessary here as in general to adopt two sex variables in parallel: external (i.e. matricular) sex and internal sex (gender). It is due to the presence of these competitive pairs that the means and especially deviations of twins' test results will consistently diverge from those in the population at large.

Finnish mothers with Järvi-Hakola-Nasu disease, progressive dementia with lipomembranous polycystic osteodysplasia (McKusick 221770) have a high rate of twin maternities, 128.2/1000. The exact 99% confidence intervals are 28.7 – 322.2/1000, thus above the average twinning rate in Finland, i.e. 15/1000. This eightfold increase in twinning may be an indication of a disturbed cortico-hypothalmic-hypophyseal axis or an other premorbid hormonal imbalance. It is concluded that even if dizygotic twinning is as a rule an event in itself, not only iatrogenic factors, as ovulation inducers, etc., but also some genetic disorders may be associated with twinning. More studies are needed to elucidate the incidence of twinning in families with these disorders.

Birth statistics over a period of 5 years were analyzed to study epidemiological characteristics of twinning in Southeast Uttar Pradesh, India. The data revealed higher incidence of breech twins (11.84% of all cotwins) as compared to breech single births (2.18%). But the perinatal mortality and caesarean section rates were similar in both twin and singleton pregnancies. The cumulative twinning rate over the studied period was 11.70 per 1000 live births. The MZ and DZ twinning rates were estimated respectively as 3.67 and 8.03 per mill. The mean maternal age of sampled mothers was 26.42 years with one standard deviation of 5.30 years. The twinning rate for mothers over 35 years of age was about four times higher than that in mothers younger than 20 years. Incidently, the twinning rate was the highest at parity four and a non-linear curve could more appropriately be fitted to the series of data. Seasonal variations were observed for both twin and singleton births. The highest frequency of births was observed from August through October. But seasonal index for twinning rate showed a clear bimodal distribution with peaks in April (223) and September (167).

The computerized version of the Wisconsin Card Sorting Test (WCST) was administered to a sample of 96 subjects (Ss), constituted in equal parts by monozygotic twins (MZ), dizygotic twins (DZ), unique children and couples of “almost contemporary” brothers. The statistic tests (Analysis of principal components, ANOVA) underline, as far as the rapidity to define a category is concerned, a statistically significant difference between DZ and singletons, independently from the fact that the latter may be unique children. A significant difference emerged neither between MZ and singletons, nor between MZ and DZ.

Twin gestation is associated with higher rate of neonatal hypoglycemia than do singletons. We examined the role of specific risk factors associated with neonatal hypoglycemia of 216 premature twins and 1284 premature singletons, consecutively born in the years 1994-1996 in the Department of Pediatrics of Padua University, Italy. Significantly higher risk of hypoglycemia (Dextrostix <40 and <20 mg%) was found in twins vs singletons (54% vs 32%, OR 2.49, CI 1.77-3.56; 19% vs 8%, OR 2.65, CI 1.59-4.19, respectively). Gestational age of 34-37 weeks increased hypoglycemia risk for the premature twins (77% vs 51%, OR 3.20 CI 1.49-6.88). Twin deliveries statistically differed from those of singletons in several perinatal characteristics. More twins were born by cesarean section (85% vs 55%, OR 4.15, CI 2.48-6.95), and the birth weight of twins was much lower related to prematures with BW < 1.0 kg (12% vs 6%, OR 2.06, CI 1.11-3.82) and SGA (20% vs 10%, OR 2.41, CI 1.46-3.98). The risk of twin deliveries was increased at 30-33 weeks gestational age (25% vs 15%, OR 1.84; CI 1.17-2.90). Twins were found to have higher rates of hospitalization (50% vs 40%, OR 1.52, CI 1.04-2.23) and showed an increased risk of cardiorespiratory resuscitation (51% vs 31%, OR 2.36, CI 1.61-3.47), hypothermia (11% vs 4%, OR 3.02, CI 2.333.91), BPD (25% vs 19%, OR 2.55, CI 1.10-5.91), and PVL (4% vs 1%, OR 4.08, CI 1.23-13.5). Mortality was found more often (not significant) in premature twins. The risk for intrapartum and early neonatal morbidity was however, mostly reduced in hypoglycemic twins, while it was comparable between smaller or smaller weight discordant twins and larger twins. Similarly, SGA twins, and smaller or smaller weight-discordant twins did not show increased hypoglycemia risk. In conclusion, our findings suggest that the multiple gestation per se is the single most important relative risk factor of hypoglycemia in premature twins.