[Prematurity and placental insufficiency in twin pregnancies. Results during the care of multiple pregnancies at a center for premature births].

An analysis was made of 151 twin pregnancies, in 1975, 1978 and 1979, to study the effectiveness of obstetrico-neonatological attention to bigeminal pregnancies in a premature infant centre. -- Significant rise in early detection of bigeminal pregnancy due to much wider use of ultrasonic diagnosis and intensification of hospital treatment have drastically reduced the number of extremely immature twin births by delaying delivery to somewhere between the 34th and 36th weeks of gravidity. With the use of tocolysis nearly unchanged throughout the period of observation, change in average gestational age at birth should be interpreted primarily as the result of more long-time prepartum hospitalisation, with attention being offered for periods of more than three weeks. This conclusion was supported by unsatisfactory results regarding average gestational age and birth weight, following exclusive outpatient attention to women with bigeminal pregnancies. Improvement of foetal prognosis was found to depend primarily on proper therapeutic approach to prematurity. -- The authors' own experience differed from reports of other workers, in that the rate of hypotrophy declined in the wake of intensive prepartum care. Substantial reduction of the gap between average birth weights of first multiple foetuses and those of second multiple foetuses as well as declining differences between average birth weights of heavier twins, on the one hand, and those of less heavy twins, on the other, were recorded from all gestational age groups and attributed to improvement in intra-uterine care for all multiple foetuses due to intensified treatment. -- Significant rise in survival rates (after deduction of all foetal loss up to the 28th day of age) of all premature twins is considered an expression of increasingly improving life chances of twins, in general. It was based on growing numbers of highly immature survivors, but even more on significant rise in the number of premature survivors between the 34th and 36th weeks of gestation.