Рroblem of miscarriage in multiple pregnancies
DOI:
https://doi.org/10.14739/2310-1210.2013.4.16866Keywords:
multiple pregnancy, chorionicity, abortion, termination of pregnancy, premature birth.Abstract
A multiple pregnancy (MP) remains one of the most thorny problems of modern obstetrics [1]. According to data of world statistics only 15-30% women with multiple gestations have a physiological process of pregnancy [13]. Therefore on the amount of obstetric and perinatal complications MP indisputably belongs to gestation with the high degree of risk.
For the last three decades the increase of frequency of MP [3] fixed. Only in a period from 2000 to 2010 in Ukraine frequency of MP increased on 30%, almost 95% - twins and other 5% were gestations of higher-order [3]. This problem acquires the special actuality because of annual increase of number of the MP, conditioned by wide introduction of assisted reproductive technologies in treatment of sterility [1].
It is presently well-proven that one of major factors qualificatory perinatal ends at MP is not zygocity, but chorionicity [4]. A monochorionic (MC) type of placentation at MP is most unfavorable in regard to perinatal ends, as a mortinatality at MC twins in 3-4 times exceeds such at dichorionic (DC) twins [11].
Touching the process of MB, firstly it is necessary to underline appearance of threat symptoms of pregnancy breaking (75%) [9]. It should be noted that at spontaneous MP this symptomatology is less expressed and has another mechanisms [9]. For example, the threat of pregnancy unmaturing at spontaneous twins is more often related to uterus overdistension and releasing of prostaglandins, which raise myometrium tone [9]. Thus this symptomatology appears in later gestational terms (26-28 weeks) [9]. In induced MP (IVF) it is necessary to detect presence of infection and endocrine disbalance, that determines the features of therapeutic approach [9].
The aim of this research was to study the features of pregnancy process, structure and frequency of obstetric and antenatal complications in women and newborn.
Materials and methods of research
From data of medical documentation, namely: exchange pregnancy cards (form №113/o), case histories (form №096/o), conclusions of pathohistology research (form №014/o) we have done the retrospective analysis of multigestational process and twins labor in 80 women hospitalized and afterwards delivered on the base of the Clinical maternity hospital №5 Zaporozhye for period from 2008 to 2010 years.
We analysed labor histories of women with a spontaneous MP. All patients were divided into 2 groups depending on chorionicity: Ist group – 37(46,2%) patients with monochorionic diamniotic twins; IInd group – 43(53,8%) patients with dichorionic diamniotic twins. Category of pregnancy after IVF – 5 women: 2(MC) and 3(DC) excluded from research.
Results and conclusions
- Women with a multigestation are included in a high-risk group of development of pregnancy miscarriage. Among complications of gestational process more often meet: premature labor (61,3±21,92%), threat of pregnancy breaking (32,5±38,18%), threat of premature labor (22,5±43,84%), premature rupture of amniotic membranes (20,0±45,25%).
- Clinical experience shows that monochorionic type of placentation is accompanied by greater frequency of such specific complications multiple pregnancy as discordant fetal growth (18,9±21,21%), fetofetal transfusion syndrome (2,7±5,45%), twin reversed arterial perfusion (2,7±5,45%), fetal growth retardation syndrome (2,7±5,45%). Thus, chorionicity exactly determines the process of multiple pregnancy and its ends.
- It’s extremely important to use modern uninvasive and safe methods of fetus state function analysis for early diagnostics, prevention of multiple pregnancy miscarriage.
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