Twin to twin transfusion syndrome (TTTTS) accounts for approximately 10% of monochorionic twin pregnancies and, if left untreated, is associated with high morbidity and mortality rate. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been supposed as the major etiology of TTTTS. The donor twin becomes hypovolemic and oliguria, oligohydramnios, and a variable degree of growth restriction develop, whereas the recipient twin manifests polyuria, polyhydramnios, and hydrops in response to hypervolemia. TTTTS can be treated by either serial amniocentesis or selective fetoscopic laser coagulation of the communicating vessels. The rationale for removal of large volumes of amniotic fluid is to prevent preterm delivery secondary to polyhydramnios and to improve fetal circulation by reducing pressure on the chorionic plate. On the other hand, the goal of laser therapy is to occlude vascular anastomoses, thereby interrupting intertwin blood exchange. Although laser treatment is associated with increased survival rate and reduced neurologic complications, compared with amnioreduction, it requires highly specialized centers, whereas serial amniocentesis has the advantage of being performed worldwide. Therefore, the optimal treatment for pregnancies complicated with TTTTS is still controversial.

Human preterm labor is a syndrome that may arise from different causes. Before 30 weeks of gestation, infection appears to predominate amongst these. In later gestation, premature activation of the fetal HPA axis in response to an adverse intrauterine environment, e.g. hypoxemia, undernutrition (UN) or even infection, may underlie the stimulus to prematurity. A third pathway clearly involves vascular thrombotic processes. Tests on sheep have been shown to there is a premature birth which is a significant change was associated with precocious increases in adrenocorticotrophic hormone (ACTH) and cortisol in the fetal circulation, and increased levels of mRNA encoding proopiomelanocortin (POMC) and prohormone convertase-1 (PC-1) in the pars intermedia of the fetal pituitary. It would seem that these different pathways may occur separately, or be activated to different degrees in the same patient.

Myocarditis is defined, clinically and pathologically, as inflammation of the heart muscle. The autoimmune phase is belived to play a major role and the use immunosuppressive agents may be useful in containing myocyte destruction. Aims was to systematically review the impact of Immunomodulative therapy on the outcame of severe and acute myocarditis in children. We retrospectively studied all the children admitted to University Children s Hospital with an acute viral myocarditis (AVM) from 2003-2008y. Patients were included if they had 1.severe and acute heart failure, 2 left ventricular dysfunction assessed by echocardiography, 3. a recent history of viralillness and 4. absens of personal or familial history of cardiomyopthy. Fourteen patient (37%) had severe and acute myocaditys. Seven patients were treated with immunomodulative therapy and anticongestive therapy (group I). Other seven patients were treated with anticongestive therapi only (group II). We comparred the use of antikongestiv therapy alone, with a combination of immunomodulative. Such studies have documented succeful outcome of AVM with immunomodulative trearment.

The aim of the work is to study the development of twin pregnancy after one of twins died in early pregnancy and
possible negative influence on clotting system of pregnant women. Observation is done on patient DM, 30 years old, and
housewife. She was observed from her first appearance at the department. Personal and family anamnesis was regular. She
had one delivery tree years ago with Cesarean section. In the first ultrasonographic examination we found twin pregnancy
with obvious heartbeats of both twins. After two weeks on control examination we find only one fetus, regularly developed,
and in a separate amniotic cavity a fetus without heart beat with small quantity of amniotic fluid in bizarre position. Patient
was immediately admitted in the hospital. Ultrasonographic examination, as well as a routine laboratory analyses were
repeated every ten days. After 28-th week of gestation we included a cardiotocographic (CTG) control every five days. In
38-th week the birth was finished by cesarean section (indication for operation - previous cesarean section). Afemale child
was born. After delivery, placenta was extracted with membranes, which contained a dead fetus, 12-cm length. After
recovery which lasted seven days patient was dismissed in good condition with healthy baby. An ultrasound examination
proved to be of great help in putting a diagnosis. It is very important to put diagnosis in time, because if we don't do it, we
will probably have a great and heavy complication.