Síndrome de transfusão feto-fetal: revisão de literatura / Twin-twin transfusion syndrome: a literature review

A síndrome de transfusão feto-fetal é uma complicação das gestações gemelares monocoriônicas. Além de ocorrer comumente no segundo trimestre, apresenta elevada morbimortalidade fetal e neonatal, e taxas de incidência que variam de 10 a 15% dentre todas as gravidezes monocoriônicas. O objetivo deste estudo é realizar uma revisão de literatura a partir de levantamento bibliográfico acerca dos principais aspectos epidemiológicos, clínicos e terapêuticos da STFF. A base de dados PubMed foi consultada, uma vez que os termos de pesquisa utilizados foram "síndrome de transfusão feto-fetal", "diagnóstico" e "tratamento". Obtiveram-se sessenta e oito artigos de revisão de literatura e/ou revisão sistemática, sendo que apenas vinte e nove foram selecionados após aplicação dos critérios de elegibilidade. Em relação à fisiopatologia, a síndrome é explicada pela transferência sanguínea direta entre os fetos gemelares através de anastomoses arteriovenosas placentárias, conceitualmente determinando a existência de um feto receptor e outro doador. Embora as gestantes comumente se apresentam assintomáticas, as repercussões clínicas fetais costumam ser graves. O diagnóstico é exclusivamente ultrassonográfico e deve ser feito o mais precocemente possível, ressaltando-se a importância da detecção da corionicidade da gestação gemelar, além de acompanhamento ultrassonográfico seriado para rastreio do desenvolvimento da síndrome. Apesar de ainda não haver protocolo de tratamento bem estabelecido, a ablação dos vasos placentários a laser é tida como o padrão-ouro dentre as opções terapêuticas disponíveis. Apresenta elevada taxa de sobrevida de pelo menos um dos fetos e baixos índices de sequelas neurológicas neonatais, podendo ser realizada somente até a 26ª semana de gestação.

Twin-twin transfusion syndrome is a complication of monochorionic twin pregnancies. In addition to commonly occurring in the second trimester, it has high fetal and neonatal morbidity and mortality and incidence rates ranging from 10 to 15% among all monochorionic pregnancies. This study aims to perform a literature review based on a bibliographic survey about the main epidemiological, clinical and therapeutic aspects of TTTS. The PubMed database was consulted, as the search terms used were "twin-twin transfusion syndrome", "diagnosis", and "treatment". Sixty-eight literature review and systematic review articles were obtained, and only twenty-nine were selected after applying the eligibility criteria. About the pathophysiology, the syndrome is explained by direct blood transfer between the twin fetuses through placental arteriovenous anastomoses, determining the existence of a recipient fetus and another donor. Although pregnant women are usually asymptomatic, the clinical fetal repercussions are often severe. Diagnosis is exclusively ultrasonographic and must be made as early as possible, emphasizing the importance of detecting chorionicity in twin pregnancy, in addition to serial ultrasonographic follow-up to track the development of the syndrome. Although there is still no well-established treatment protocol, endoscopic laser ablation of vascular anastomoses is considered the gold standard among the available therapeutic options. It has a high survival rate for at least one of the fetuses and low rates of neonatal neurological sequelae and can only be performed until the 26th week of pregnancy.

Atendimento de famílias com crianças pequenas / Care of families with young children / Cuidado de familias con niños pequeños

Este artigo apresenta o atendimento de uma família com gêmeos com três anos e meio de idade. Discute brevemente a importância do atendimento familiar nos casos de suspeita de autismo e no caso de gêmeos, para apresentar a complexidade dos vínculos, da configuração edípica e da própria configuração do ego de cada gêmeo. Traz o relato de uma sessão de família com o referencial da psicanálise dos vínculos que nos dá uma ideia clara das situações importantes que emergem em uma sessão e das intervenções psicanalíticas possíveis neste setting.

This article presents the care of a family with three-and-a-half-year-old twins. Briefly discuss the importance of family care in cases of suspected autism and in the case of twins, to present the complexity of the bonds, the oedipal configuration, and the ego configuration of each twin. It brings the report of a family session with the psychoanalysis of bonds framework that gives us a clear idea of the important situations that emerge in a session and the possible psychoanalytic interventions in thissetting.

Este artículo presenta el cuidado de una familia con gemelos de tres anos y medio de edad. Discute brevemente la importancia del cuidado familiar en casos de sospecha de autismo y en el caso de gemelos, para presentar la complejidad de los lazos, la configuración edípica y la configuración del ego de cada gemelo. Trae el informe de una sesión familiar con el marco de vínculos de psicoanálisis que nos da una idea clara de las situaciones importantes que surgen en una sesión y las posibles intervenciones psicoanalíticas en este entorno.

Dental anomalies in the deciduous dentition of non-syndromic oral clefts patients / Anomalias dentárias na dentição decídua de pacientes com fissuras orais não sindrômicas

Abstract Objectives: to investigate the prevalence of dental anomalies in complete deciduous dentition of children with NSCL/P. Methods: this study included 75 children with NSCL/P and 286 healthy control. In both groups the children had deciduous dentition with ages varying from 4 to 6 years. Clinical examination, panoramic and periapical radiographies were performed and dental anomalies of number and shape were considered. Results: there was a higher prevalence of dental anomalies in the case group, compared to the control group. In all, 42 dental anomalies were identified, 25.33% in the case group and 8.04% in control group (p<0.001). Therewas a higher frequency of dental anomalies in NSCL/P (47.36%), followed by non-syndromic cleft lip (31.57%) and non-syndromic cleft palate (21.05%). The occurrence of agenesis (p= 0.005) and twinning (p = 0.029) were higher in the case group. Conclusions: the occurrence of agenesis and dental twinning was more frequent in the case group and may contribute to the definition of oral cleft subphenotype.

Resumo Objetivos: investigar a prevalência de anomalias dentárias na dentição decídua completa de crianças com FL/PNS. Métodos: este estudo incluiu 75 crianças com FL/PNS e 286 controles saudáveis. Em ambos os grupos as crianças tinham dentição decídua com idade variando de 4 a 6 anos. Exame clínico, radiografias panorâmicas e periapicais foram realizadas e anomalias dentárias de número e forma foram consideradas. Resultados: houve maior prevalência de anomalias dentárias no grupo caso, comparado ao grupo controle. Ao todo 42 anomalias dentárias foram identificadas, 25,33% no grupo caso e 8,04% no grupo controle (p<0,001). Houve maior frequência de anomalias dentárias na FL/PNS (47,36%), seguida da fissura labial não sindrômica (31,57%) e da fissura palatina não sindrômica (21,05%). A ocorrência de agenesia (p= 0,005) e geminação (p=0,029) foram maiores no grupo caso. Conclusão: a ocorrência de agenesia e geminação dentária foram mais frequentes no grupo caso e pode contribuir para a definição de subfenótipos de fissuras orais.

A rare case of conjoined twins presenting as dicephalus parapagus: a case report

Conjoined twinning is a congenital abnormality resulting in various presentations of the fetuses in utero. It is a rare embryological developmental disorder occurring in one in 100,000 births. We present a case of conjoined twinning, which is characterized by the presence of two heads, single vertebral column and single symphysis pubis, with single genitor-urinary tract and single gastro intestinal tract. The present condition, referred to as dicephalus parapagus, is a rare entity among the conjoined twinning and has seldom positive outcomes. The mechanism of occurrence of conjoined twinning has been proposed either through fusion or fission of the embryos. In either case, surgical separation of the conjoined twins is often unsuccessful and results in increased morbidity and mortality. However, it is essential to screen for the presence of such congenital anomalies early during pregnancy, in order to terminate and provide parental counselling.

Secuencia de perfusion arterial reversa (TRAP) / Twin Reversed Arterial Perfusion, TRAP

Resumen:Considerada como una complicación exclusiva de gestaciones múltiples monocoriales, la secuencia de perfusión arterial reversa se caracteriza por la presencia de un feto malformado que tiene un corazón rudimentario o ausente, con una perfusión desde el gemelo estructuralmente normal hacia el feto acárdico y una mortalidad del 100% en el feto acárdico y el 50% en el feto sano. Se reporta un caso clínico de una paciente de 15 años con embarazo gemelar monocorial de 27 semanas, referida al Hospital San Juan de Dios, en donde se le dio seguimiento diario con ultrasonido y se documentó el patrón ultrasonógrafico anormal de sumación-colisión. A los 7 días de ingreso se decide la interrupción del embarazo por sospecha de coriamnioitis, naciendo un producto viable y otro polimalformado.

Abstract:Considered an exclusive complication of monochorionic gestations, the TRAP sequence is characterize by the presence of a malformed fetus with a rudimentary or absent heart, in which there is an perfusion from the structurally normal twin to the acardiac fetus and a 100% mortality in the acardiac fetus and 50% in the healthy one. We present a clinical case of a 15 years old patient with monochorionic twin pregnancy of 27 weeks, referred to Hospital San Juan de Dios, where daily monitoring with ultrasound was done and an abnormal collision-summantion pattern was documented and reported. After 7 days of admission chorioamnionitis was suspected and termination of the pregnancy was decided resulting in a viable product and another with multiple malformations.

Historical Demography of Iceland.

Knowledge of the seasonal variation in births and deaths during normal years is important for analyses of the effects of wars, famines, epidemics or similar privations on these variables. In studies of seasonality, multiple trigonometric regression models are more flexible than the simple sine curve. The seasonal variation in mortality in Iceland, 1856-1990, shows a strong secular decrease, and a connection between this and the epidemiological transition is considered. Comparisons with findings in other European countries are made. The temporal trends in Iceland of the birth components; the twinning rate, the still birth rate and the secondary sex ratio, are presented and compared with the corresponding values in neighbouring countries. No marked differences were emerged.

Clinical and cytogenetic features of a Brazilian sample of patients with phenotype of oculo-auriculo-vertebral spectrum: a cross-sectional study / Características clínicas e citogenéticas de uma amostra brasileira de pacientes com fenótipo de espectro óculo-aurículo-vertebral: um estudo transversal

CONTEXT AND OBJECTIVE: Oculo-auriculo-vertebral spectrum (OAVS) is considered to be a defect of embryogenesis involving structures originating from the first branchial arches. Our objective was to describe the clinical and cytogenetic findings from a sample of patients with the phenotype of OAVS. DESIGN AND SETTING: Cross-sectional study in a referral hospital in southern Brazil. METHODS: The sample consisted of 23 patients who presented clinical findings in at least two of these four areas: orocraniofacial, ocular, auricular and vertebral. The patients underwent a clinical protocol and cytogenetic evaluation through high-resolution karyotyping, fluorescence in situ hybridization for 5p and 22q11 microdeletions and investigation of chromosomal instability for Fanconi anemia. RESULTS: Cytogenetic abnormalities were observed in three cases (13%) and consisted of: 47,XX,+mar; mos 47,XX,+mar/46,XX; and 46,XX,t(6;10)(q13; q24). We observed cases of OAVS with histories of gestational exposition to fluoxetine, retinoic acid and crack. One of our patients was a discordant monozygotic twin who had shown asymmetrical growth restriction during pregnancy. Our patients with OAVS were characterized by a broad clinical spectrum and some presented atypical findings such as lower-limb reduction defect and a tumor in the right arm, suggestive of hemangioma/lymphangioma. CONCLUSIONS: We found a wide range of clinical characteristics among the patients with OAVS. Different chromosomal abnormalities and gestational expositions were also observed. Thus, our findings highlight the heterogeneity of the etiology of OAVS and the importance of these factors in the clinical and cytogenetic evaluation of these patients. .

CONTEXTO E OBJETIVO: O espectro oculoauriculovertebral (EOAV) é considerado um defeito de embriogênese envolvendo estruturas originadas a partir dos primeiros arcos branquiais. Nosso objetivo foi descrever os achados clínicos e citogenéticos de uma amostra de pacientes com fenótipo de EOAV. TIPO DE ESTUDO E LOCAL: Estudo transversal em um hospital de referência no sul do Brasil. MÉTODOS: A amostra foi composta de 23 pacientes que apresentaram achados clínicos em pelo menos duas das quatro áreas: orocraniofacial, oculares, auriculares e vertebrais. Os pacientes foram submetidos a um protocolo clínico e avaliação citogenética através do cariótipo de alta resolução, hibridização in situ fluorescente para as microdeleções 5p e 22q11 e pesquisa de instabilidade cromossômica para anemia de Fanconi. RESULTADOS: Alterações citogenéticas foram observadas em três casos (13%) e consistiam de: 47,XX,+mar; mos 47,XX,+mar/46,XX e 46,XX,t(6;10)(q13;q24). Observamos casos de EOAV com história de exposição gestacional à fluoxetina, ácido retinoico e crack. Um dos nossos pacientes foi um gêmeo monozigótico discordante que teve restrição de crescimento assimétrica durante a gravidez. Nossos pacientes com EOAV foram caracterizados por um amplo espectro clínico e alguns apresentaram achados clínicos atípicos como um defeito de redução de membro inferior e um tumor do braço direito, sugestivo de hemangioma/linfangioma. CONCLUSÕES: Verificamos grande variedade de características clínicas entre os pacientes com EOAV. Também foram observadas diferentes anomalias cromossômicas e exposições gestacionais. Assim, nossos achados salientam a heterogeneidade da etiologia do EOAV e a importância desses fatores na avaliação clínica e citogenética desses pacientes. .

Geographic Variation in Fertility Measures in Sweden in (1749-1870).

We analysed geographic variation in the number of males per 100 females at birth also called the secondary sex ratio (SR), the crude birth rate (CBR), the total fertility rate (TFR) and the twinning rate (TWR). Earlier studies have noted geographic variations in the TWR and racial differences in the SR. Statistical analyses have shown that comparisons between SRs demand large data sets because random fluctuations in moderate data are marked. Consequently, reliable results presuppose national birth data. In this study, we analysed historical demographic data and investigated the geographic variations between the counties in Sweden for the SR among the live born (1749-1869), the CBR in 1751-1870, the TFR in 1860 and the TWR in 1751-1860. We built spatial models and as regressors we used geographic co-ordinates for the residences of the counties in Sweden. The influence of the CBR and TFR on the SR and TWR was examined. For all variables, we obtained spatial variations, albeit of different patterns and power. Hence, no common spatial pattern for the demographic variables SR, TFR, CBR and TWR was detected, but a better fit was noted for TFR, CBR and TWR than for SR.

Os sintomas psicofuncionais e a relação mãe-bebês gêmeos aos nove meses de idade / Symptoms psychofunctional and the mother-twin babies at nine months of age / Los síntomas psicofuncionales y los bebés gemelos de madre a los nueve meses de edad

Os sintomas psicofuncionais manifestados pelo bebê se refletem no comportamento disfuncional da criança e se manifestam nas áreas relacionadas ao sono, alimentação, digestão, respiração, pele e comportamento. A literatura aponta para a existência de uma relação entre a presença de tais sintomas no bebê e a dinâmica da relação deste com a mãe. A partir de uma perspectiva psicanalítica, a presente pesquisa, de caráter exploratório e abordagem qualitativa, utilizou o delineamento de estudo de caso único para investigar a relação mãe-bebês, em situação de gemelaridade, cujos bebês apresentam indicadores de sintomas psicofuncionais aos nove meses de idade. Participaram deste estudo uma tríade formada pela mãe e seus bebês gêmeos com idade de nove meses. Os instrumentos utilizados foram o Symptom Check-List, uma ficha de dados sócio-demográficos, entrevista semi-estruturada com a mãe e sessão de observação da interação livre da mãe com os bebês. Os resultados apontam que a gemelaridade pode configurar-se como um dos fatores que pode aumentar as chances do surgimento dos sintomas psicofuncionais em fase precoce do desenvolvimento. Além disso, a conflitiva conjugal aliada à falta de apoio paterno, em especial em situação de gemelaridade, pode potencializar as chances de surgimento de falha materna e consequente risco ao desenvolvimento de sintomas psicofuncionais nos bebês. Desta forma, ampliar a compreensão acerca do funcionamento de uma tríade pode contribuir como medida preventiva e fornecer subsídios para profissionais de diversas áreas de atuação que trabalham com bebês e suas mães como escolas, hospitais, clínicas e psicoterapeutas da relação pais-bebê.

The symptoms manifested by psychofunctional baby are reflected in the child's dysfunctional behavior and manifested in the areas related to sleep, feeding, digestion, respiration, skin and behavior. The literature points to the existence of a relationship between the presence of such symptoms in the baby and the dynamics of its relationship with the mother. From a psychoanalytic perspective, this research, exploratory and qualitative approach, we used the design of a single case study to investigate the mother-infant in situation of twins, whose babies have symptoms indicators psychofunctional nine months age. The study included a triad formed by the mother and her twin babies aged nine months. The instruments used were the Symptom Check List, a form of socio-demographic data, semi-structured interview with the mother and observing session of free interaction of mothers with babies. Results show that the twins can set up as one of the factors that can increase the chances of the onset of symptoms psychofunctional in early stage of development. Moreover, the conflictive marital coupled with lack of parental support, especially in situations of multiple births, can enhance the chances of emergence of maternal failure and consequent risk to develop symptoms in babies psychofunctional. Thus, increasing the understanding of the functioning of a triad can contribute as a preventive measure and provide subsidies for professionals from various fields of expertise who work with babies and their mothers as schools, hospitals, clinics and therapists of parent-infant relationship.

Los síntomas se manifiestan por psicofuncionales bebé se reflejan en el comportamiento disfuncional del niño y que se manifiesta en los ámbitos relacionados con el sueño, la alimentación, la digestión, la respiración, la piel y el comportamiento. La literatura apunta a la existencia de una relación entre la presencia de tales síntomas en el bebé y la dinámica de su relación con la madre. Desde una perspectiva psicoanalítica, la investigación, el enfoque exploratorio y cualitativo, se utilizó el diseño de un estudio de caso único para investigar la relación madre-niño en situación de gemelos, cuyos bebés tienen indicadores de síntomas psicofuncionales nueve meses edad. El estudio incluyó una tríada formada por la madre y sus bebés gemelos de nueve meses. Los instrumentos utilizados fueron la Lista de verificación de síntomas, una forma de datos sociodemográficos, semi-estructurada entrevista con la madre y la sesión de observación de la libre interacción de las madres con bebés. Los resultados muestran que los gemelos pueden establecerse como uno de los factores que pueden aumentar las probabilidades de la aparición de los síntomas psicofuncionales en la etapa inicial de desarrollo. Por otra parte, el acoplado conflictivo matrimonio con la falta de apoyo de los padres, especialmente en situaciones de nacimientos múltiples, puede aumentar las posibilidades de aparición de insuficiencia materna y el consiguiente riesgo de desarrollar síntomas en los bebés psicofuncionales. Por lo tanto, el aumento de la comprensión del funcionamiento de una tríada puede contribuir como una medida preventiva y proporcionar subvenciones para profesionales de diversas áreas de conocimiento que trabajan con bebés y sus madres como escuelas, hospitales, clínicas y terapeutas de la relación padre-hijo.

Gemeralidade conjugada tipo onfalópagos - Avaliação radiológica / Omphalopagus conjoined twins – Radiologic evaluation

Este trabalho descreve a gemelaridade conjugada tipo onfalópagos em que os métodos de imagem foram essenciais para a definição da fusão anatômica e o diagnóstico de possíveis anormalidades associadas, com o objetivo de conferir o correto planejamento cirúrgico e sobrevida adequada aos pacientes.

This paper reports on the omphalopagus conjoined twins in which imaging methods were essential for defining anatomical connection and diagnosis of possible associated abnormalities with the objective of providing accurate surgical planning and their survival.

História natural das gestações gemelares monocoriônicas diamnióticas com e sem transfusão feto-fetal / Natural history of monochorionic diamniotic twin pregnancies with and without twin-twin transfusion syndrome

OBJETIVO: avaliar a evolução de gestações gemelares monocoriônicas diamnióticas com e sem síndrome de transfusão feto-fetal (STFF), acompanhadas de forma expectante. MÉTODOS: estudo retrospectivo no qual as gestações sem e com STFF e com as formas leve (estágio I de Quintero) e grave (estágios II, III, IV e V de Quintero) da doença foram comparadas quanto a parto pré-termo extremo, comprometimento neurológico e alta dos gêmeos do berçário. Os gêmeos pré-termo extremo que tiveram ou não STFF foram comparados quanto à ocorrência de comprometimento neurológico. Foram utilizados os testes do χ2 ou exato de Fisher. RESULTADOS: quinze entre 149 gestações gemelares monocoriônicas diamnióticas apresentaram STFF, 11 (11/15-73,3 por cento) na forma grave e 4 (4/15-26,7 por cento) no estágio I. O parto pré-termo extremo foi mais frequente (p<0,001) nos casos com (11/15 - 73,3 por cento) do que sem a doença (25/134 - 18,7 por cento) e mais comum (p=0,033) em casos graves (10/11 - 91,1 por cento) do que leves (1/4 - 25,0 por cento). O comprometimento neurológico de pelo menos um gêmeo foi mais frequente nos casos com (5/8=62,5 por cento) do que sem (9/134=6,7 por cento) a doença (p<0,001). A alta do berçário de pelo menos um gêmeo foi mais comum (p<0,001) nos casos sem a doença (132/134=98,5 por cento versus 8/15=53,0 por cento). O dano neurológico em pelo menos um gêmeo foi mais frequente (p=0,04) na forma grave (5/5=100 por cento) do que leve (1/4=25 por cento) da doença. A alta de ambos os gêmeos do berçário foi mais comum (p=0,004) no estágio I (4/4=100 por cento) do que na doença grave (1/11=9,0 por cento). Entre os 47 gêmeos pré-termo extremo, o dano neurológico foi mais frequente (p=0,001) naqueles que tiveram (6/6-100 por cento) do que entre os que não tiveram STFF (11/41-26,8 por cento). CONCLUSÕES: casos com transfusão feto-fetal acompanhados de forma expectante têm prognóstico perinatal ruim, com elevada mortalidade neonatal e altos...

PURPOSE: to evaluate the evolution of monochorionic-diamniotic twin pregnancies with and without the twin-twin transfusion syndrome (TTTS), followed up in an expectant way. METHODS: retrospective study in which the pregnancies with and without TTTS and with mild (Quintero's stage I) and severe (Quintero's stages II, III, IV and V) disease manifestations were compared according to extreme preterm delivery, neurological impairment and the twins' nursery discharge. The extreme preterm twins who had had TTTS, or not, were compared whether they had or not neurological impairment. The χ2 or Fisher's exact test were used. RESULTS: among 149 monochorionic-diamniotic twin pregnancies, 15 presented TTTS, 11 (11/15 - 73.3 percent) in the severe form and 4 (4/15 - 26.7 percent) at stage I. The extreme preterm delivery was more frequent (p<0.001) in the cases with the disease (11/15 - 73.3 percent) than in the cases without it (25/134 - 18.7 percent), and more common (p=0.033) in severe (10/11 - 91.1 percent) than in mild cases (1/4 - 25.0 percent). Neurological impairment in at least one twin was more frequent in cases with (5/8 - 62.5 percent) than in cases without (9/134 - 6.7 percent) the disease (p<0.001). Nursery discharge of at least one twin was more common (p<0.001) in cases without (132/134 - 98.5 percent) than in cases with the disease (8/15 - 53.0 percent). Neurological impairment in at least one of the twins was more frequent (p=0.04) in the severe (5/5 - 100 percent) than in the mild (1/4 - 25 percent) form of the disease. Nursery discharge of both twins was more common (p=0.004) at stage I (4/4 - 100 percent), than in the severe form of the disease (1/11 - 9.0 percent). Among the 47 extreme preterm twins, the neurological impairment was more frequent (p=0.001) among the ones who had (6/6 - 100 percent), than among those who did not have TTTS (11/41 - 26.8 percent). CONCLUSIONS: cases with twin-twin transfusion syndrome, followed...

Gêmeos monozigóticos: revelações do discurso familiar / Monozygotic twins: hidden aspects of family speech

OBJETIVO: Nas famílias de gêmeos monozigóticos, algumas práticas podem acompanhar o processo de gestação, nascimento e desenvolvimento dessas crianças. Inclui-se a escolha de roupas iguais ou com diferença apenas na cor, nomes com semelhanças fonéticas, rotinas parecidas quanto à alimentação e sono. O objetivo, aqui, foi acompanhar longitudinalmente uma família, analisando os pressupostos e práticas sociais manifestados discursivamente, a respeito da gemelaridade, a partir do diagnóstico da gestação gemelar de crianças monozigóticas, considerando-se, em especial, o desenvolvimento da linguagem e o processo de constituição da identidade de tais crianças. MÉTODOS: O trabalho pauta-se na abordagem naturalista/observacional, perspectiva histórico-cultural e no paradigma de natureza indiciária. Considerou-se os dados de oito entrevistas, vídeo-gravadas a cada três meses, a partir do diagnóstico da gestação gemelar monozigótica com uma família. Os dados foram analisados, considerando-se: a descoberta, escolha de nomes, vestuário, interação, rotina, linguagem e identidade. RESULTADOS: As categorias analisadas apareceram nos discursos coletados e revelaram a dificuldade familiar em assimilar a presença de gêmeos, que acabam sendo dois vistos como um. CONCLUSÕES: Os aspectos sociais envolvidos frente à semelhança são marcantes o suficiente para vencer a possibilidade de alteração no processo de desenvolvimento da linguagem e identidade dessas crianças. A Fonoaudiologia precisa incorporar à prática clínica, o acolhimento dessas famílias, com suas crenças e valores, para que as intervenções fonoaudiológicas, junto a essa população, sejam efetivas.

PURPOSE: Families with monozygotic twin children have some typical practices which begin in early pregnancy and persist during the childhood, including wearing the same clothes and colors, choosing phonetically similar names and offering the same food and sleeping patterns. The purpose of this study was to follow-up, prospectively, one family with identical twins, analyzing the influence of assumptions and social practices expressed in their discourse on the language development and the construction process of each child's identity, from the diagnosis of monozygotic twin pregnancy. METHODS: The study is based on the naturalist/observational approach, the historic-cultural perspective and the indiciary paradigm. Eight interviews were video recorded every three months since the diagnosis of identical twin pregnancy in one family, and information regarding the following categories were analyzed: the announcement of pregnancy, choice of names, clothes, family interaction, general routine, language and identity of each child. RESULTS: All analyzed categories were referred by the family during the interviews, and revealed their difficulty in assimilating the presence of two different children, who end up being seen as one child. CONCLUSION: The social aspects that come along with the similarities of monozygotic twins are remarkable enough to overcome and change its influence on these children's processes of language and identity development. The Speech-Language Pathology has an important role to support these families in the context of their beliefs and values, so that the intervention, when necessary, is effective.

Frequency of twinning in southwest Nigeria.

BACKGROUND: In the human species, twin is a type of multiple birth in which the mother gives birth to two offspring from the same pregnancy. The occurrence and frequency of twinning, however, varies across human populations. The maternal age, socio-environmental factors, increase in the use of contraceptives, the race of human population, increase in the spontaneous abortion rate, and seasonal variations are among the factors that could influence twinning rate. Information on twinning rates in southwest Nigeria is limited. AIMS: This study presents information on the frequency of twinning, as well as its analysis by maternal age, in four urban settings in southwest Nigeria. This is with the aim of extending current knowledge on the frequency of twinning in southwest Nigeria and contributing to the demographic studies in the country. MATERIALS AND METHODS: Data on single births and twin births from January 1995 to December 2004 were collected from the Oyo State General Hospital (OSGH), Wesley Guild Hospital (WGH), Obafemi Awolowo University Teaching Hospital (OAUTH), and Ekiti State Specialist Hospital (ESSH) in Ogbomoso, Ilesa, Ile-Ife, and Ado-Ekiti respectively. These were analyzed by year and maternal age groups of 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years according to the standard method. RESULTS: A frequency of twin births of 46.5 per 1000 deliveries and 46.2 per 1000 deliveries was recorded for Ilesa and Ile-Ife respectively. The frequency recorded for Ogbomoso and Ado-Ekiti was 38.5 and 22.1 per 1000 deliveries respectively. The overall average frequency of 40.2 per 1000 deliveries for the four hospitals ranks among the highest recorded rates of twin births in the world. The maternal age group of 25-29 years had the highest occurrence of twin births, while the lowest was recorded in the 45-49 years age group. CONCLUSION: This analysis reveals high incidence of twinning in the studied areas and supports previous assertion that the southwestern part of Nigeria has the highest twinning rate in the country and in the whole world. It is our opinion that diet, maternal history of twinning, and some socio-environmental factors may have influenced the results.

Twinning In Selected Coastal Areas Of South Kerala.

A total of 26,237 deliveries were monitored for twinning and malformations at the 4 government hospitals catering to the population of Kollam and Alapuzha-districts of South Kerala. Among these 7.8 per thousand were twin births showing an increase in the incidence with maternal age. The twin births were high among children of consanguineous marriages (11.7 per thousand) as compared to non-consanguineous marriages (7.7 per thousand). Still births and malformations were also higher in twin deliveries as against singleton deliveries. A large data base is being built to establish a twin registry.

Frequency of Twinning in India.

Twinning frequency in India has been studied on data derived from primary and secondary sources. Preliminary results on twinning rates in the state of Punjab have presented from fertility history of 101 Gujjar mothers and from delivery records of a public hospital for the year 1987. The former sample showed much higher twinning rate (30.2 per 1000 births). (19.2 per 1000 births). The above results were compared with those from other Indian studies. Further 51 regional samples drawn from different Indian states were analyzed for studying regional trends. Though no definite trend emerged from the analysis, the twinning rate was the highest in Uttar Pradesh and the lowest in Tamilnadu. The Indian data also revealed secular trends in twinning rates, as seen in many other countries.

Dicephalus bipus tetrabrachius twinning report of a case.

This is a report of conjoined twins, Dicephalus Bipus. Tetrabrachius variety which are particularly rare. The diagnosis was suspected antenatally on the basis of radiologic criteria. They were delivered by caesarean section and died 4 hours after because of respiratory insufficiency. Clinical features, embryogenesis, diagnosis modalities and management of conjoined twins are reviewed in detail.