[INCIDENCE OF SIMULTANEOUS INTRA- AND EXTRA-UTERINE PREGNANCIES AT THE CONCEPCI'ON PALACIOS MATERNITY HOSPITAL].
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A newly discovered case of heteropaternal superfecundation (HS) is reported. Three HS cases were found in a parentage test database of 39,000 records. The frequency of HS among dizygotic twins whose parents were involved in paternity suits is 2.4%. Although the study population appears similar to the general population with respect to twinning data, inferences about the frequency of HS in other populations should be drawn with caution.
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Parentage analysis has revealed a high probability that a man accused of paternity is the biological father of a male child. The child in this study, however, was the twin of a female child who could not have been fathered by the accused man. The mother of the children subsequently accused a second, unrelated man, who was excluded from paternity of the boy, but was very probably the biological father of the girl.
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Dubowitz et al. have offered a scoring system for estimating the gestational age of newborn babies. If the system is applied to twin pairs, the heavier twin is generally estimated to have a greater gestational age than the lighter one. Previously this has been interpreted as a flaw in the scoring system. However, it may well be that in some twin pairs the gestational ages are slightly different and that therefore, the heavier twin would be expected to have a greater gestational age. Such cases would arise through superfecundation (the formation of two zygotes from different coitions). Superfecundation can be proved only in rare case (those with two fathers). It can be argued that the rarity of such cases is accounted for by the rarity with which women expose themselves to the risk of bearing such twins (and by the improbability of detection), rather than by the rarity of superfecundation. It is inferred that superfecundation by the same man is relatively common and that therefore dizygotic twins quite often have different gestational ages. The scoring system of Dubowitz can be tested for bias by submitting monozygotic pairs to it: the association between weight and estimated gestational age should be absent in such pairs. If the system proves free of such bias, then a finding first reported here will assume some interest: it is that in opposite-sexed twin pairs, the male is significantly more often assessed as having the greater gestational age. It is suggested that this finding should be provisionally accepted as evidence for the hyopthesis that male zygotes are formed earlier than females.
Alpha-Fetoprotein has been determined in cord blood fron mono- and dizygotic twins and in a case of quadruplets. The possibility of superfetatio has been evaluated by the clinically calculated gestational ages and by the alpha-fetoprotein levels in cord blood, especially in a case of quadruplets.
Discordant twins are of obstetrical concern because of high morbidity and mortality of either the smaller or the larger twin, or both. The discordance becomes apparent usually in the second trimester. We report a case of discordant twins diagnosed in the 10th week of gestation, which was concluded to be a case of superfecundation. The discordancy was persistent up to the 35th week of gestation, when 2 baby boys were born by cesarean section because of preeclampsia. The postnatal courses of the babies were uneventful.