An algorithm of the ultrasonic monitoring of multiple pregnancy is with the different types of choriality

Abstract

DOI: 10.52705/2788-6190-2025-3-02
УДК 618.344-06:618.255-073.48

Research purpose. To develop on to inculcate the algorithm of the ultrasonic monitoring of multiple pregnancy at the different types of choriality.
Materials and methods. Work is based on the analysis of results of pregnancy in 207 pregnant with twins, from what 137 observed with the use of the developed algorithm and 70 on a standard method, accepted for a singleton pregnanacy. The term of pregnancy was determined from the first day of the last menstruation, taking into account information of bimanual research in women’s consultation and ultrasonic research in the early terms of pregnancy. Depending on character of choriality were selected 2 basic groups: «dichorionic diamniotic twins» - 146 women and «monochorionic diamniotic twins» is a 61 woman.
Results. Active tactic of ultrasonic control in a sub-group 2.1 allowed to improve perinatal indexes due to diminishing of amount of premature births timely diagnostics of pathological conditions of intrauterine fetuses as a fetal growth retardation and violations of hemodynamics in to the fetoplacental complex. It is here necessary to specify, that by reason of preterm delivery in all 6 cases in a sub-group 2.1 there were complications of pregnancy from the side of mother or fetuses the origin of which does not depend on tactic of conduct of pregnancy the health of mother related to the features forming of fetoplacental complex, while in a sub-group 2.2 - 10 (76,9%) from 13 (100%) premature births happened on a background the preterm premature rupture of membranes. Without regard to that the ultrasonic monitoring of the state of intrauterine fetuses at a monochorionic placentation did not allow fully to prevent antenatal losses, however reduced their frequency and allowed to improve the indexes of health of twins which gave birth for the women of sub-group 2.1 against those indexes for the women of sub-group 2.2. In a sub-group 2.1 in one case took place syndrome of sudden death of 2 (2,4%) fetuses which develop normally, in 37-38 weeks, and a 1 (1,2%) fetus died through decompensation of placenta dysfunction in 27 weeks. In the sub-group of 2.2 antenatal 5 fetuses died for 4 expectant mothers: 2 fetuses died in 30 weeks on a background feto-fetal transfusion syndrome, which was not diagnosed at pregnancy, and 3 fetuses with the signs of fetal growth retardation heavy degree died in 36 weeks of gestation in connection with diagnostics of pathological conditions, which was late. In a sub-group 2.1 it is written from a maternity hospital under the supervision of district paediatrician were 54 (65,8%) children, 25 (30,4%) children were transferred for the subsequent nursing in a children’s hospital, from them 3 (3,7%) needed intensive therapy. In a sub-group 2.2 it is written from a maternity hospital under the supervision of district paediatrician there were 8 (20%) children, 27 (67,5%) children were transferred for the postnatal care in a children’s hospital, from them 14 (35%) needed intensive therapy. Reliable (р<0,05) differences have the indicated information.
Conclusion. The developed algorithm of supervision allowed to improve the perinatal results of multiple pregnancy. Timely correction of cervical insufficiency shortened the percent of premature births, that resulted in the improvement of indexes of the state at birth, adaptation and neurological health of new-born. In addition, early diagnostics of violations of the state of fetus allowed to choose the most optimum obstetric tactic and improve the result of pregnancy for fetuses with fetal growth retardation.