Concentrations of mercury (Hg) and selenium (Se) in afterbirth and their relations with various factors.

The aim of the study was to evaluate Hg and Se concentrations and Se:Hg molar ratios in the placenta, umbilical cord and fetal membranes, and to examine the relationship between the concentrations of the elements and selected factors. The study material consisted of the placenta, umbilical cord and fetal membranes obtained from 91 healthy women from northwestern and central Poland. In our study mean Hg and Se concentrations in afterbirth were ~ 0.01 mg/kg dry weight (dw) and ≤ 0.5 mg/kg dw, respectively. Correlation analysis showed negative relationships between placenta weight and Se concentration in the placenta and umbilical cord, as well as between placenta length and Se levels in the umbilical cord. We found negative correlations between THg concentration in the placenta and birth weight and between Se concentration in the placenta and umbilical cord and the morphological parameters of the placenta. Furthermore, we noted new types of interactions in specific parts of the afterbirth. In our study, Se:THg molar ratios ranged from 5 to 626; these values indicate protection against Hg toxicity.

Oxidative Stress in Pregnancy.

Recent years have seen an increased interest in the role of oxidative stress (OS) in pregnancy. Pregnancy inherently heightens susceptibility to OS, a condition fueled by a systemic inflammatory response that culminates in an elevated presence of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the circulatory system. The amplified OS in pregnancy can trigger a series of detrimental outcomes such as underdevelopment, abnormal placental function, and a host of pregnancy complications, including pre-eclampsia, embryonic resorption, recurrent pregnancy loss, fetal developmental anomalies, intrauterine growth restriction, and, in extreme instances, fetal death. The body's response to mitigate the uncontrolled increase in RNS/ROS levels requires trace elements that take part in non-enzymatic and enzymatic defense processes, namely, copper (Cu), zinc (Zn), manganese (Mn), and selenium (Se). Determination of ROS concentrations poses a challenge due to their short half-lives, prompting the use of marker proteins, including malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), catalase (CAT), and glutathione (GSH). These markers, indicative of oxidative stress intensity, can offer indirect assessments of pregnancy complications. Given the limitations of conducting experimental studies on pregnant women, animal models serve as valuable substitutes for in-depth research. This review of such models delves into the mechanism of OS in pregnancy and underscores the pivotal role of OS markers in their evaluation.

The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth.

Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS: The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS: It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS: Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.

Fetus papyraceus in dichorionic diamniotic twin pregnancy: a case report.

INTRODUCTION: The actual rate of multiple pregnancies is significantly larger than that observed during labor due to the fact that in the course of pregnancy intrauterine death of one or more fetuses may occur. CASE PRESENTATION: A twenty-six old woman (GII, PII) reported to hospital in 26 weeks of DC/DA twin gestation complicated by intrauterine death of one fetus in the second trimester of a spontaneous pregnancy. Pregnancy ended at term with vaginal birth of a single live fetus. After birth, entanglement of the fetal umbilical cord around the leg of the dead fetus was discovered. It was the most probable cause of death. CONCLUSIONS: Conservative management is preferred in case of intrauterine demise of one of the fetuses in DC/DA twin pregnancy. One of the reasons of fetal death may be entanglement of the umbilical cord around fetal small parts. The time of fetal death can be determined on the basis of the length of the thigh bone (Femur Length - FL).

[Premature rupture of membranes one fetus from a multiple pregnancy]. / Przedwczesne pekniecie pecherza plodowego jednego z plodów w ciazy wieloplodowej.

In multiple gestation, premature rupture of fetal membranes (PROM) is an important risk factor for premature delivery and intrauterine infection. The incidence of PROM in twin gestations is threefold of that in singleton pregnancies. The incidence in triplets occurs even more frequently underlining the role of PROM as a leading cause of infant mortality and morbidity. Besides prematurity the complications of PROM include umbilical cord compression due to oligohydramnios, cord prolapse, placental abruption, and chorioamnionitis. Together with PROM, chorioamnionitis is held responsible for significant maternal and neonatal morbidity including endometritis and sepsis in the mother and early-onset sepsis, respiratory distress syndrome, inborn pneumonia, bronchopulmonary dysplasia, intraventricular hemorrhage, and periventricular white matter injury in the neonate. Furthermore, in twin gestations, PROM remains an independent risk factor for long-term neonatal care. An uncommon situation develops when in multiple gestation PROM affects only one of the fetuses. In such cases, the co-existence in the uterine cavity of the properly developing fetus(es) can be a challenge for the process of medical decision-making. In the present work, limited world literature on the topic was critically reviewed in search of the best possible recommendations for clinical management.

Selected Metal Concentration in Maternal and Cord Blood.

Essential and non-essential elements deficiencies may lead to various birth complications. The aim of this paper was to determine calcium (Ca), copper (Cu), iron (Fe), potassium (K), magnesium (Mg), sodium (Na), phosphorus (P), lead (Pb), strontium (Sr), and zinc (Zn) concentrations in maternal blood and cord blood. Whole blood and cord blood samples collected from pregnant women (n = 136) were analyzed for the concentration of the elements by spectrophotometric atomic absorption in inductively coupled argon plasma (ICP-OES). The results showed that Ca, Pb, and Sr concentrations were similar in maternal and cord blood, while Fe and K levels were higher in cord blood than in maternal blood. The cord blood Cu, Na, and Zn concentrations were lower than those in maternal blood, suggesting transplacental transfer of these elements were limited. Moreover, checking the influence of studied elements on the anthropometric parameters of the newborns, we found that the highest number of associations was between Cu in cord blood. Due to the fact that the pregnant women were healthy, and the newborns were without any disorders, we suggest that the values obtained in our study are normal values of studied elements in whole blood and cord blood in patients from Poland.

[Birth status and twin birth weight discordance]. / Stan urodzeniowy a rozbieznosc mas urodzeniowych blizniat.

OBJECTIVES: The aim of the research was to estimate the influence of birth weight discordance on birth status of twins. MATERIAL AND METHODS: Material of the research consisted of 560 foetuses derived from successful twin pregnancies. In the analysis the following factors were taken into consideration: birth status, gasometry, and birth weight discordance. RESULTS: The degree of birth weight discordance under 10% was noted in 50% of twin pregnancies (n = 140), discordance of 10%-20% was observed in 30.7% (n = 86), and > 20% - in 19.3% (n = 54). CONCLUSIONS: Birth weight discordance is an important risk factor for fetal and neonatal morbidity which is higher in smaller twins than in larger ones. Along with the degree of birth weight discordance, an increased risk of neonatal complications was observed.

[Women's opinions regarding gynaecological examination in a hospital]. / Opinie kobiet na temat badania ginekologicznego w szpitalu.

A visit to the gynaecologist is connected with considerable embarrassment and stress for most women. AIM OF THE RESEARCH: To ascertain patients' opinions about gynaecological examination, frequency of visits, and doctors' attitudes towards patients. MATERIAL AND METHODS: A hundred women from Western-Pomeranian region underwent an anonymous examination. The women were divided into three age groups: 20-40, 41-60 and 61+. The study was carried out in two hospital clinics of the Pomeranian Medical University: the Clinic of Procreation and Gynaecology and the Clinic of Obstetric and Gynaecology, between 2006-2007. RESULTS: 70% of the respondents find the gynaecological examination embarrassing and stressful. According to patients, the most unpleasant moment during their visit to the gynaecologist is time spent in the gynaecological chair (47%) and preparation for the examination (30%), whereas the least embarrassing moment is the gynaecological examination itself (21%). However, the most embarrassing moment of the examination is vaginal examination (40%), rectal examination (33%), colposcopy (27%), and breast examination (2%). All the women stated that gynaecological examination is necessary; with 40% of them having examinations once every twelve months, 32% once every six months, 9% once every twenty-four months and 19% even more seldom. Sense of safety and psychical comfort during the examination is ensured by the presence of a qualified midwife (46%), presence of another doctor (9%), privacy (only the doctor and the patient are present) (36%). 53% of the respondents stated that the doctor ensures intimacy during the examination and 47% gave negative answer. Analysis of the doctor's gender indicated that 56% women prefer to be examined by a woman, 37% by a man, and 7% find the gender to be of no importance. The respondents would prefer if the doctor were nice, good-tempered and communicative. CONCLUSIONS: (1) Gynaecological examination is embarrassing and stressful for women and that is why patients expect the gynaecologist to ensure intimacy and sense of safety during the examination, as well as a pleasant individual approach to a patient, and presence of a midwife. (2) The most embarrassing moment is climbing to the gynaecological chair and the most unpleasant moment is the vaginal examination. (3) The fact that women go to the gynaecologist so rarely is particularly worrisome.

Interactions between 14 Elements in the Human Placenta, Fetal Membrane and Umbilical Cord.

The aim of the study was to investigate relationships between the concentrations of macroelements (Ca), microelements (Cr, Cu, Fe, Mn, Mo, Ni, Sn, Sr, V, Zn) and heavy metals (Ag, Cd, Pb) in the placenta, fetal membrane and umbilical cord. ‪Furthermore, we examined relationships between the concentrations of these metals in the studied afterbirths and maternal age, gestational age, placenta parameters (breadth, length, weight) and newborn parameters (length, weight and Apgar score). This study confirms previously reported Zn-Cd, Pb-Cd and Ni-Pb interactions in the placenta. New types of interactions in the placenta, fetal membrane and umbilical cord were also noted. Analysis of the correlations between metal elements in the afterbirths (placenta, fetal membrane and umbilical cord) and biological parameters showed the following relationships: maternal age and Mn (in the fetal membrane); gestational age and Cr, Fe, Zn (in the fetal membrane), Ag and Cu (in the umbilical cord); newborn's length and Sr (in the placenta), Ag (in the umbilical cord); newborn's weight and Sr (in the placenta), Cu (in the fetal membrane), Ag (in the umbilical cord); Apgar score and Ca, Cr and Ni (in the umbilical cord); placenta's length and Cr and Sn (in the fetal membrane), Cu (in the umbilical cord); placenta's width and Mo, Pb (in the placenta) and placenta weight and Sr (in the placenta), Ag, Fe, Mn (in the fetal membrane). The results show the influence of metals on the placenta, mother and newborn parameters, and the same point indicates the essential trace elements during the course of pregnancy.

Serum and peritoneal fluid concentrations of soluble human leukocyte antigen, tumor necrosis factor alpha and interleukin 10 in patients with selected ovarian pathologies.

BACKGROUND: Although immune system plays a key role in the pathogenesis of both endometriosis and ovarian cancer, its function is different. Therefore, we hypothesized, that selected immune parameters can serve as diagnostic markers of these two conditions. The aim of this study was to compare serum and peritoneal fluid concentrations of sHLA-G, IL-10 and TNF-alpha in women with selected ovarian pathologies: benign serous cysts, endometrioma and malignant tumors. Clinical significance of using them for diagnostic purposes in women with serous ovarian cysts, endometriosis, and ovarian cancer, which in the future may improve the early diagnosis of ovarian diseases. CASE PRESENTATION: The study included women treated surgically for benign serous ovarian cysts, ovarian endometrioma and serous ovarian adenocarcinomas. Peripheral blood and peritoneal fluid samples were obtained intraoperatively. Patients with benign serous cysts, endometrioma and ovarian malignancies did not differ significantly in terms of their serum and peritoneal fluid concentrations of sHLA-G. Ovarian cancer patients presented with significantly higher median serum concentrations of IL-10 and TNF-alpha than other study subjects. Median concentrations of IL-10 and TNF-alpha in peritoneal fluid turned out to be the highest in ovarian cancer patients, followed by women with endometrioma and subjects with benign serous cysts. All these intergroup differences were statistically significant. Irrespective of the group, median concentrations of sHLA-G, IL-10 and TNF-alpha in peritoneal fluid were higher than serum levels of these markers. CONCLUSIONS: Elevated serum and peritoneal fluid concentrations of IL-10 and TNF-alpha distinguish ovarian malignancies and endometriomas from benign serous ovarian cysts. In contrast to endometriosis, ovarian malignancies are characterized by elevated peritoneal fluid concentrations of IL-10 and TNF-alpha, elevated serum concentrations of IL-10 and low serum levels of TNF-alpha. Serum and peritoneal fluid concentrations of sHLA-G have no diagnostic value in differentiating between ovarian malignancies and endometriomas.

[Superfecundation in etiology of twin pregnancy]. / Zjawisko nadplodnienia w etiologii ciaz wieloplodowych.

Superfecundation is the fertilisation of two or more ova from the same cycle by sperm from separate acts of sexual intercourse. The term is also sometimes used to refer to the instances of two different males fathering fraternal twins, though this is more accurately known as heteropaternal superfecundation. This therefore leads to the possibility of twins also being half-siblings. This way of formation of multiply pregnancy aroused and it arouses still among doctors on whole world. This problem aroused large interest also among Polish doctors. For example, we found mention of superfecundation in first Polish medical journal, in Primitiae physico-medicae..., given in Leszno in years 1750-1753. Authors introduced relate opinion of superfecundation in aetiology of multiple pregnancies in historical aspect, as early as from Old Testament to present times as well as current state of medical knowledge of such a situation.

[Monoamnotic twin pregnancy. Multicenter study]. / Ciaza blizniacza jednoowodniowa. Badanie wieloosrodkowe.

OBJECTIVE: The purpose of this study was to evaluate of perinatal mortality and morbidity of monoamniotic twins. STUDY DESIGN: This was a multicenter retrospective analysis of 26 monoamniotic twin gestations identified between 1985 and 2004 in a 3 perinatal departments. Of these 26 pregnancies, 11 women were admitted electively for inpatient fetal monitoring. Overall mortality rates, the risk of intrauterine fetal death and neonatal mortality and morbidity, pregnancy complications and fetal anomalies were calculated. RESULTS: Monoamniotic twin pregnancies were diagnosed reliably prenatally by ultrasound in 22 women and at delivery in 4 cases. Of the 26 gestations, spontaneous fetal losses before 22 weeks of gestation were 4 cases. The overall loss rate and the perinatal mortality rate were 52% and 19.4%, respectively. Twenty-two women had both twins alive at 24 weeks of gestation; 11 women were admitted electively for inpatient fetal monitoring at 26-27 week of gestation. In this group there were 2 neonatal deaths. No intrauterine fetal death occurred in any hospitalized patient. In our series there were 100% incidence of prematurity, 38,5% of umbilical cord entaglement, 23% of TTTS, 3.6% of TRAP and 9.6% fetal congenital anomalies. CONCLUSION: Monoamniotic twins are at extremly risk of pregnancy complications and fetal loss. These pregnancies can be diagnosed reliably by ultrasound in most cases. Electively admitted women for inpatient fetal monitoring could be improved neonatal survival and decreased perinatal morbidity.

[Views and expectations of women regarding gynaecological examinations].

Introduction: It has long been known that gynaecological examination causes a lot of negative emotions for most women. The aim of the study was to learn the views of women on the issue of gynaecological examination. Materials and methods: The study involved 1200 women from the West Pomeranian and Lódz provinces in Poland. Results: The majority of non-pregnant women considered gynaecological examination to be embarrassing. The most embarrassing moment of the visit for the respondents from both groups was lying down on the gynaecological chair, and the most unpleasant stage of examination was palpation through the vagina. The greatest sense of security and mental comfort during the examination was provided by the presence of only the gynaecologist. Most pregnant respondents prefer to be examined by a male gynaecologist. Respondents would most willingly have examinations with a doctor who is nice, talkative, calm, smiling and mature. Most of the pregnant surveyed women claimed that the gynaecological examination is very necessary, while only 49% would appear for it once every 6 months. Conclusions: 1. Gynaecological examination was significantly more embarrassing and stressful for women who were not pregnant. 2. In the opinion of pregnant women, breast examination is the least embarrassing stage of the examination. 3. Pregnant women significantly more often chose a man as their gynaecologist. 4. The frequency of having a gynaecological examination depended significantly on the status of pregnancy. 5. The expectations of the surveyed women to a gynaecologist focused mainly on him/her maintaining a sense of intimacy and security, on informing the women on the procedures taken, as well as on a nice and individual approach.

The case of monochorionic twin gestation complicated by intrauterine demise of one fetus in the first trimester.

The study investigated the clinical and pathomorphological characteristics of monochorionic diamniotic twin gestations complicated by the spontaneous loss of one fetus during the first trimester. Nine monochorionic diamniotic twin gestations were analyzed in which the demise of one fetus occurred during the first trimester. During the course of the study, 178 twin gestations were sonographically identified during the first trimester. Forty-three (24.2%) were complicated by the intrauterine demise of one fetus before the end of the 12th week of pregnancy. Nine cases were monochorionic diamniotic. The gestational age of the demised fetuses ranged between 5 and 11 weeks (mean 7.4 weeks). The prognoses for the surviving fetuses were rather poor with the surviving co-twin dying 1 to 3 weeks after the first twin, with abortion of both fetuses. In only one case was gestation concluded on the 40th week with delivery of a live neonate. No blood coagulation changes were observed in the affected pregnant women, and the one live newborn did not reveal any haematological or neurological abnormalities. A postnatal study provided evidence for the history of monochorionic diamniotic placentation in all of the cases. In two cases, probable causes of fetal death were established (congenital malformation, the presence of anastomoses between blood vessels). The obtained results suggest an extremely high risk of mortality for the surviving twin fetus following the co-twin's death in cases of monochorial placentation. The morphological evaluation of placentas and fetal membranes enables the establishment of the type of placenta and, in certain cases, the probable cause of the intrauterine demise of one twin fetus during the first trimester of monochorionic diamniotic twin gestation.

[Intrauterine death of one fetus during the first trimester of monochorionic diamniotic twin gestation]. / Zgon wewnatrzmaciczny jednego, z plodów w j trymestrze ciazy blizniaczej jednokosmówkowej dwuowodniowej.

OBJECTIVES: The goal of our study was the clinical and pathological characteristics of the monochorionic diamniotic twin gestations complicated by the intrauterine death of one fetus during the first trimester. MATERIAL AND METHODS: This study is a prospective review of 9 monochorionic diamniotic twin gestations involving the intrauterine death of one fetus during the first trimester. RESULTS: During the study period 178 twin gestations were identified sonographically during the first trimester. Forty three of them (24,2%) were complicated by the intrauterine death of one fetus before the end of 12th gestation week. Nine cases were monochorionic diamniotic. Gestational age of one fetus demise ranged from 5 to 11 (mean 7,4) weeks. Prognoses for surviving fetus were adverse. In 8 cases there was a death of a second fetus after the period of 1 to 3 weeks, with abortion of both fetuses. Only in one case, the gestation has finished in 40th week by delivery of liveborn infant. Maternal coagulation changes did not occur in those cases. One liveborn infant was without evidence of hematological and neurological abnormalities. The postdelivery examination allowed to establish a presence of monochorionic diamniotic placentation in all cases. In two of them, the probable causes of death were established (developmental defect, presence of anastomoses between blood vessels). CONCLUSION: These results suggest that the risk of mortality for the living twin is very high, after the death of its sibling, in case of monochorionic placentation. Morphological examination of placenta and fetal membranes lets to establish a type of placenta, and in some cases a probable cause of intrauterine death of one twin during the first trimester of monochorionic diamniotic twin gestation.

[Endoparasite twin (fetus in fetu)]. / Plod pasozytujacy wewnetrznie (plód w plodzie-fetus in fetu).

Fetus in fetu is a very rare abnormality (estimated incidences: 1 in 500,000 deliveries), and is secondary to a pathological diamniotic monochorionic pregnancy. It consists of a malformed parasitic twin that is found within the body of its sibling. Hardly 70 cases have been reported in the literature since its first description about 1800. Its discovery is usually postnatal. We present two boys: two and half years and eleven days old newborn presented a mass in the retroperitoneum in the left upper abdominal quadrant. There were removed by surgery and contained two independent fetuses. Dissection and radiological study of the fetuses showed an axial skeleton and long bones. It corresponds to the generally recognized diagnostic criteria of fetus in fetu. The embryology, operative procedure, hypothesis and pathology of this condition are discussed and the literature briefly reviewed. The difference between teratomas and fetus in fetu is point.

[Clinical significance of echogenic amniotic fluid at term pregnancy]. / Kliniczne znaczenie echogennego plynu owodniowego w ciazy donoszonej.

PURPOSE: This study is aimed to determine the clinical significance of echogenic amniotic fluid. MATERIAL AND METHODS: I surveyed 9 at term pregnancies in which the amniotic fluid was echogenic. Morphologic characteristics of amniotic fluid were assessed from samples taken at amniocentesis or upon delivery within one day after last sonographic examination. RESULTS: In pregnancies with echogenic amniotic fluid, assessment revealed clear fluid in 4 cases (44.5%), vernix caseosa in 4 (44.5%), and meconium in 1 (11.0%). CONCLUSIONS: Echogenic amniotic fluid on prenatal sonography is not predictive of fetal distress.

[Reliability of sonographic diagnosis of chorionicity and amnionicity in twin pregnancy ]. / Diagnostyka ultrasonograficzna rodzaju ciazy blizniaczej.

OBJECTIVES: The aim of the study was to compare the reliability of chorionicity determination in twin pregnancy using different ultrasonographic methods as compared with post-partum placental assessment. STUDY DESIGN: The study included 262 spontaneous twin pregnancies delivered at Kutno Hospital between 1989 and 1996. All twin gestations were diagnosed by sonography by the 28-th week's gestation. The ultrasonographic and pathologic correlation between the chorionic and amniotic type was assessed in this group. RESULTS: The ultrasonographic evaluation of the 262 spontaneous twin gestations demonstrated 181 (69.1%) dichorionic and 81 (30.9%) monochorionic twin pregnancies. Three of monochorionic twins were monoamniotic. In all 262 transvaginal and abdominal ultrasonography correctly predicted the chorionic and amniotic type as determined by the pathologic findings. CONCLUSIONS: Ultrasonography before the 28-th week can accurately determine the chorionic and amniotic type in twin pregnancies. The determination of chorionicity during the first half of pregnancy should be based on the various signs. In the second half of pregnancy, the obstetrician should rely on fetal sex in combination with the number of placentas, and characteristics of the dividing membrane.

[Triplets, quadruplets and more...]. / Troje, czworo i wi4cej...

Theoretically, a woman could bear unlimited number of fetuses. Practically, the human being on the top of his phylogenetic spread, has chosen the singleton birth as its dominant. The anatomical constitution of the woman let her feed no more than two children at the same time. This were probably the reasons for considering the multiple birth as a nature phenomenon. With the time passing, there was a growing body of legends and misunderstandings, based on exagerated histories on their births. Based on world literature, the super multiple births are analyzed.

[Umbilical cord complications in twin pregnancies]. / Rodzaje przyczepów pepowiny w ciazach blizniaczych.

OBJECTIVES: The postpartum umbilical cord examination can provide a lot of significant information concerning discordant twin growth or reasons of intrauterine death of one or all the fetuses. The aim of this study was the postpartum assessment of umbilical cords in twin pregnancies. MATERIAL AND METHODS: The examination material consisted placentas coming from 110 twin pregnancies. The analysis concerned the assessment of placenta types, the umbilical cords attachment place and also the twins birth weight. RESULTS: Basing on the studies of placentas coming from 110 twin pregnancies 76 (69.0%) dichorionic and 34 (31.0%) monochorionic placentas were found. Among dichorionic, 40 (53%) separated and 36 (47%) fused placentas were observed. Among monochorionic 31 (91%) diamniotic and 3 (9.0%) monoamniotic placentas were present. Abnormal umbilical insertion to placenta was most frequently observed in monochorionic pregnancies: in diamniotic--marginal insertion in 21.2%, velamentous insertion in 15.9%, and in monoamniotic--equally 33.3%. In dichorionic pregnancies, for fused placentas--marginal in 8.7%, velamentous in 9.1%, and for separated--5.6% and 3.1%. CONCLUSIONS: The abnormal umbilical cord insertions to the placenta was most frequently found in monochorionic pregnancies. Among pairs of twin born with body weight discordance, the abnormal umbilical cord insertion was more frequently found in the case of the smaller newborn.