Perinatology and pediatric.Ukraine. 2017.4(72):41-48; doi 10.15574/PP.2017.72.41
Skrypchenko N. Y., Shamаeva O. V., Grebinichenko A. O., Podolsky Vol. V., Mogilevska S. I., Mazur T. M.
SI «Institute of Paediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv, Ukraine

Objective — to compare the features of the course of twin pregnancies and deliveries of spontaneous origin and after using the assisted reproductive technologies, taking into account the type of chorionicity and amnionicity.
Material and methods. In total 73 pregnant women with twin gestations were under observation: 56.2% (n=41) spontaneous ones and 43.8% (n=32) — after using the assisted reproductive technologies. The monochorionic twins were in 61.0% of spontaneous twin gestations (including: monochorionic-diamniotic — 53.7%, monochorionic-monoamniotic — 7.3%) and the dichorionic ones were in 39.0% cases (all — diamniotic). All of the twins from the assisted reproductive technologies were dichorionic-diamniotic.
Results. All pregnant women with spontaneous twin gestations and twin gestations after the assisted reproductive technologies are a high-risk group of a number of maternal and perinatal complications. Some of them are nonspecific and independent of the chorionicity type, and the others are specific complications, generally characteristic or more characteristic of the monochorionic type and associated with changes in the distribution of vasculature in a common placenta: intrauterine growth restriction syndrome (36.4%), polyhydramnios and intrauterine fetal death (13.6%), placental dysfunction and fetal distress (50.0%), premature termination of pregnancy (63.7%). Therefore, among the different types of twin gestations, the monochorionic ones are the highest risk group of these pregnancy complications. The most favorable pregnancy course with the fewest complications, including threatened miscarriage (37.5%), was noted in women with spontaneous dichorionic twins, which delivered after 34 weeks of gestation in all cases. The women with twin pregnancies resulting from extracorporal fertilization also form a high-risk group for premature termination of pregnancy (84.4%) and preeclampsia (21.9%).
Conclusions. The problem requires further more in-depth study to develop recommendations for early diagnosis and treatment of complications in pregnant women with twins to prevent perinatal losses and to amend existing regulations for their management.
Key words: twins, spontaneous twins, twins after the assisted reproductive technologies, chorionicity, amnionicity.

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