Objective: This study examined the basal metabolic rate in patients with twin pregnancies and compared the results with those of singleton pregnancies and non-pregnant women. Methods: In 15 non-pregnant women, 14 patients with twin and 25 patients with singleton pregnancies, the resting energy expenditure was measured using an open-circuit ventilatory system during the third trimester of pregnancy. Results: The averaged resting energy expenditure in patients with twin pregnancy was 1,636 ± 174 kcal/day, significantly higher than that in patients with singleton pregnancy (1,456 ± 158 kcal/day; p < 0.05). Both of these levels are significantly higher than those in non-pregnant women (1,228 ± 132 kcal/day; p < 0.05). Conclusion: Our results indicate that the estimated increased metabolic demands in patients during the third trimester of twin pregnancy are about 10% higher than those in women with singleton pregnancy. A prospective clinical study concerning nutrition counseling is needed.

At 16 weeks' gestation, ultrasonography demonstrated a band-like structure in the amniotic cavity of a 27-year-old woman. Color Doppler imaging revealed blood flow in this band-like structure and a diagnosis of a placenta with succenturiate lobe rather than an amniotic band was made.

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This study was undertaken to measure the effects of mild hypothermia on cerebral blood flow and metabolism and cardiovascular responses to hypoxia in the fetal sheep. Near-term fetal sheep were chronically instrumented with laser Doppler flowmetry in the parietal cortex for measurement of relative changes in cerebral blood flow, as well as with arterial and sagittal sinus catheters for measurement of oxygen extraction by the brain and a cooling coil around the fetal thorax. Fetuses were studied during cooling alone, cooling with superimposed maternal hypoxia to achieve a fetal arterial PO 2 of 1.33 to 1.60 kPa, or hypoxia alone. In response to cooling alone [1.6°Ϯ 0.1°C (mean Ϯ SEM) decrease in brain temperature], fetal blood pressure and heart rate both increased significantly whereas cerebral blood flow decreased 14 Ϯ 4%, commensurate with a 24 Ϯ 8% decline in cerebral metabolic rate. Administration of moderate hypoxia during cooling resulted in a significant increase in cerebral blood flow, decreased heart rate, and no further increase in blood pressure. In response to hypoxia alone, fetal blood pressure was significantly increased, heart rate was decreased, and cerebral blood flow increased by 24 Ϯ 8%, whereas cerebral metabolic rate decreased by 38 Ϯ 13%. Arteriovenous oxygen extraction was unchanged by cooling alone but increased significantly in response to hypoxia administered during cooling. We therefore conclude that oxygen delivery to the fetal sheep brain remains coupled to metabolic rate during hypothermia and that hypothermia does not impair the compensatory cardiovascular responses of the fetus to acute moderate hypoxia. Under normal physiologic conditions, the rate at which the brain is consuming oxygen is the primary determinant of cerebral oxygen delivery. In the newborn and adult, this relationship has been demonstrated by observing that hypothermia or barbiturate-induced decreases in cerebral oxygen consumption result in comparable decreases in cerebral oxygen delivery (1-6). Although the relationship between cerebral oxygen delivery and consumption has been studied extensively in the fetus by inducing changes in arterial oxygen content (7), the approach of altering cerebral oxygen consumption and observing changes in oxygen delivery has not been fully explored. Because of the large difference in oxygen tensions between the fetus and adult (approximately 3.33 kPa versus approximately 12.67 kPa), the finding that decreases in cerebral oxygen consumption result in decreased cerebral oxygen delivery in the newborn and adult cannot be assumed for the fetus.Cerebral hypothermia has significant neuroprotective properties when administered to fetal sheep in conjunction with or after hypoxic-ischemic insult (8, 9) and is being evaluated for its clinical therapeutic benefit (10). Under normoxic conditions, cerebral hypothermia results in decreases in cerebral oxygen consumption and parallel reductions of cerebral blood flow and oxygen delivery (4). These responses are associated with increased cerebro...