Segment 1 A diagnosis of twins is shown, as well as some of the risks associated with a twin pregnancy. We see a shot of a mother pushing her twin babies in a pram. The difference between dizygotic, monozygotic and identical twins is explained. There is a diagram of monozygotic fetuses which have separate amniotic sacs. Newborn dizygotic twins of different sexes are shown in their mother's arms, one being rhesus incompatible. William Smellie's treatise on the theory and practise of midwifery from 1752 is shown. Alan Guttmacher of New York noted that dizygotic multiple births were influenced by hereditary, age and race. A patient is shown having an ante-natal examination, lying on her back while an obstetric doctor reads her notes. The patient is examined by the doctor and the fetal heartbeat detected. At the time of the film a diagnosis of twins was difficult to make - x-rays were used for diagnosis and we see an x-ray photograph of twins. The most common abnormality in twins is anencephaly. The most important risk, when carrying twins, is that of premature birth. We see a pregnant woman confined in hospital, sitting in bed knitting; she has been there from the 30th week of her pregnancy onwards. Shots of the hospital meals provided are shown. The second risk is liability to toxemia, there are shots of blood pressure being taken and the mother is weighed. We also see the testing of urea to monitor toxemia. Time start: 00:00:00:00 Time end: 00:04:59:22 Length: 00:04:59:22
Segment 2 Some of the complications of a twin birth are looked at, and an uncomplicated twin birth is shown in detail. A diagram of a twin preganancy shows the large placenta and the subsequently more common incidence of placenta praevia. When the presentation is as two vertices then the delivery will be less complicated. Some twin pregnancies will have the first child vertex and the second child breech - more unusually the first child will be breech with the second child also breech. A diagram shows an example of one child lying transverse over the other with a danger of cord prolapse. There is a shot of a patient in labour being examined in order to discern the presentation of the twins. A pethidine injection is administered into the thigh. The labour is managed by the obstetrician, the house surgeon and the anaesthetist. A shot of local anaesthetic infiltrates the perineum and a mediolateral episiotomy is performed to lessen intracranial injuries. The first twin is delivered and some minutes later the second twin; an ergometrine injection is given to lessen post-partum haemorrhage. We see the delivery of the placenta which is examined. Time start: 00:04:59:22 Time end: 00:11:42:14 Length: 00:06:42:21
Segment 3 Some of the abnormalitites that can occur in a twin pregnancy are addressed, and the delivery of twins using forceps under a general anaesthetic is shown, the second child being breech presentation. Blighted twin syndrome is a condition in which one zygotic twin has failed to develop - we see a shot of this. Twin-to-twin syndrome is where the heart of one fetus supplies blood to the other and the first fetus fails to develop. Time start: 00:11:42:14 Time end: 00:14:56:12 Length: 00:03:13:27
Segment 4 We see the presentation and birth of a second twin posterior. If uterine inertia occurs, the patient receives an oxytocin infusion as is shown here. In these circumstances the delivery is effected with forceps under general anaesthetic after episiotomy is performed. We see a first child delivered and the umbilical cord cut. The obstetrician then ruptures the membranes of the second fetus and delivers the second child breech and then the placenta. Babies are shown sleeping peacefully. The narrator reiterates the four main points for the management of twin pregnancies: 1. Diagnosis of the condition; 2. Early hospitalisation; 3. Delivery in hospital; 4. Routine use of ergometrine. Time start: 00:14:56:12 Time end: 00:19:09:24 Length: 00:04:13:11