HEALTH OF WOMAN. 2019.4(140): 46–49; doi 10.15574/HW.2019.140.46

Tkachenko A. V.
Shupyk National Medical Academy of Postgraduate Education, Kiev

The objective: to analyze the peculiarities of pregnancy, labour and condition of newborn twins with monochorionic type of placentation.
Materials and methods. A comparative analysis of pregnancy, labour and perinatal consequences in 110 cases in monochorionic twins pregnancies (MT) was conducted. The I group consisted of 92 patients who did have obstetric complications specific for multiple pregnancy during pregnancy; in group II 18 pregnant women with specific complications during multiple pregnancy were included. Additionaly, ultrasound fetometry, placentalography, doplerometry, cardiotocography were used.
Results. Pregnancy with monochorionic twins is a risk factor for the development of pregnancy complications, and specific complications due to this type of placentation are extremely unfavorable in relation to perinatal outcomes. Even with pathogenetic treatment, there is a high risk of pregnancy loss, premature birth, and the development of pathology in newborns.
Analysis of perinatal outcomes showed that in the absence of specific complications of MC type of placentation in 49.0% cases normotrophic children were born, according exceeds the percentage of patients whose children were born with hypotrophy varying severity – 51.0% respectively.
In both subgroups pregnancies were characterized by high risk of abortion (61.4% and 67.1% respectively), preeclampsia various severity in 33.3% and 44.6%, gestational anemia in 43.4%, and 39.8%, premature birth, which occurred in 66.7% and 46.8% respectively. This explains the high incidence of operative delivery 44.4% and 52.1% respectively, while the incidence of planned abdominal delivery in subgroup 1b was 3.3 times higher than in subgroup 1a.
Perinatal loss in patients with MC twins in subgroups were 4.4% and 5.3% respectively.
Conclusion. Pregnancy and delivery of monochorionic twins with specific complications has a higher risk for fetus and newborn, which lead to higher rates of perinatal mortality and morbidity in this group of infants. So searching for effective methods of prevention and treatment of these complications is required. The results should be considered during making algorithm of diagnostic and preventive measures in multiple pregnancies.
Key words: monochorionic twins, labour, perinatal consequences.

REFERENCES

Kalashnikov SA, Sichinava LG, Savinova AA. 2008. Perinatalnyie ishodyi pri monohorialnoy dvoyne. Voprosyi ginekologii, akusherstva i perinatologii 6: 41–45.

Brackley KJ, Kilby MD. 2015. Twin-twin transfusion syndrome. Hosp Med. 60 (6):419-424. https://doi.org/10.12968/hosp.1999.60.6.1134; PMid:10492713

Management of monochorionic twin pregnancy. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 2012.

Golianovskyi V. 2017. Vedennia monokhorialnoi vahitnosti dviineiu. ZTZh  8 (83).

Leduc L, Takser L, Rinfret D. 2013, Nov. Persistence of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation. Am J Obstet Gynecol. 193(5): 1670-1675. https://doi.org/10.1016/j.ajog.2005.04.007; PMid:16260208

Zharova AA, Novikova CB, Tumanova VA, Klimova IV, Tsivtsivadze EB. 2010. Optimizatsiya taktiki vedeniya mnogoplodnoy beremennosti na ambulatornom etape. Mater. Vserossiyskogo kongressa «Ambulatorno-poliklinicheskaya praktika – novyie gorizonty». M: 105.

Krasnopolskiy VI, Novikova SV, Kapustina MV, Titchenko LI, Aksenov AN, Zharova AA. 2009. Sovremennyie problemyi mnogoplodnoy beremennosti. Rossiyskiy vestnik akushera ginekologa 9;2:79–81.

Baxi LV, Walsh CA. 2009. Monoamniotic twins in contemporary practice: a single4center study of perinatal outcomes. J. Matern. Fetal Neonatal Med. 27: 1–5. https://doi.org/10.1080/14767050903214590

Management of monochorionic twin pregnancy. Royal College of Obstetricians and Gynaecologist Green4top Guidline 51. 2008.

Novikova CB, Zharova AA, Klimova IV, Tsivtsivadze EB. 2010. Osobennosti techeniya i perinatalnyie ishodyi u beremennyih s dvoyney. Mat i ditya v Kuzbasse. Spetsvyipusk 1: 145–147.

Sichinava LG, Kalashnikov SA, Panina OB i dr. 2003. Monohorialnaya dvoynya: osobennosti techeniya beremennosti i rodov, perinatalnyie ishodyi. Akusherstvo i ginekologiya 2: 8–12.

Zhuk SI, Oshovskyi VI, Oshovska IO, Melnyk OV. 2011. Feto-fetalnyi transfuziinyi syndrom: etiopatohenez, diahnostyka, likuvannia ta rozrodzhennia. Zdorove zhenshchyny 3 (59): 193–197.

Liem SMS , van Baaren GJ, Delemarre FMC  et al. 2014. Economic analysis of use of pessary to prevent preterm birth in women with multiple pregnancy (ProTWIN trial). Ultrasound Obstet. Gynecol. 44:338–345. https://doi.org/10.1002/uog.13432; PMid:24898103

Guseva OI. 2000. Feto-fetalnyiy transfuzionnyiy sindrom: sovremennyie predstavleniya o patogeneze, diagnostike i lechenii. Ultrazvukovaya diagnostika v akush., ginekol. i pediatrii 1: 7–17.