MODELS AND METHODS IN MODERN SCIENCE
International scientific-online conference
87
RISK FACTORS FOR COMPLICATIONS IN WOMEN WITH MULTIPLE
PREGNANCIES
Shodieva Khurshida Tuxtasinovna
PhD in medical science, senior teacher of obstetrics and gynecology in family
medicine department of Tashkent medical academy, Uzbekistan
https://doi.org/10.5281/zenodo.14499091
Abstract:
The problem of multiple pregnancies, despite numerous studies,
is of particular importance due to the increase in the birth rate of twins
worldwide. The aim of our study was to assess the course, pregnancy and
outcome of childbirth in women with multiple pregnancies, depending on the
type of placentation. MX pregnancy is a high risk factor for perinatal
complications. This dictates the need for careful monitoring in the antenatal
period, ultrasound monitoring from early pregnancy, which allows for a
personalized approach to the management of pregnancy and childbirth,
contributing to a decrease in perinatal morbidity and mortality.
Keywords:
multiple pregnancy, twins, monochorial and dichorial type of
placentation
Multiple pregnancies (MP) are associated with a high risk of complications
both on the mother's side and on the fetal side [1,2]. Most authors associate the
prognosis of complications of gestation and the outcome of childbirth not only
with the number of fetuses, but also with the type of placentation. According to a
study (1964-2000), with spontaneous conception, the frequency of occurrence
of dichoric twins is 54%, monochorionic - 44% of the number of all twins, and in
2% of cases it is not possible to establish the type of placentation. Monochorial
multiple pregnancy is accompanied by complications such as selective fetal
growth retardation, feto-fetal transfusion syndrome, reverse arterial perfusion
syndrome, anemia and polycetemia syndrome, which is the reason for the high
frequency of perinatal losses compared with dichorial pregnancy [3,4,5].
The aim
of our study was to assess the course, pregnancy and outcome of
childbirth in women with multiple pregnancies, depending on the type of
placentation. We conducted a retrospective analysis of 147 birth histories from
2018 to 2019. Depending on the type of placentation, a division was made into 3
groups: 1 group (19) with monochorionic monoamniotic (MXMA) twins, 2 group
(66) with monochorionic diamniotic (MXDA), 3 group (62) with dichorionic
diamniotic (DXDA) twins.
Results.
When analyzing the course of pregnancy, there were no
statistically significant differences in the incidence of toxicosis of the 1st half of
MODELS AND METHODS IN MODERN SCIENCE
International scientific-online conference
88
pregnancy. The threat of termination of pregnancy in the first half was found
with the same frequency in all groups (47.9%, 48.5% and 43.5%), but in the
second half of pregnancy in women of the 1st (63.1%) and 2nd (65.1%) groups
with MX type of placentation, the frequency of threat of termination was 2 times
higher than with DX (31.8%) twins. Every second pregnant woman had anemia
of varying severity, pathology of the kidneys and urinary system (36,4%, 36,8%,
30,6%), pathologies of the cardiovascular system (3,0%, 15,8%, 19,4%),
varicose veins (27,3%, 15,8%, 21%), obesity (15.8%, 18.2%, 17.7%), the
association of the development of somatic pathology with the type of
placentation was not revealed. But the incidence of hypertensive disorders was
1.5 times higher in women with DXDA twins.
The outcome of childbirth, depending on the gestation period in group 1,
ranged from 22 to 36 weeks, the average gestational delivery time was 30.2± 1.6
weeks. Whereas in group 2, the delivery period was 35.7±0.3 weeks, and in
group 3, 36.5± 0.3 weeks of gestation. Patients of the 1st and 2nd groups were
delivered through the natural birth canal 31.6% and 34.8%, by cesarean section
68.4% and 65.2% of women. Whereas in group 3, 29% had spontaneous labor,
71% underwent cesarean section.
The analysis of perinatal outcomes depending on the type of placentation
showed that in women of the 1st group, the weight of the first newborn was on
average 2230±36.5, the second - 1939±59.5 gr, in patients of the 2nd group –
2306±154 and 2218±139 gr, respectively, the 3rd – 2842±465 and 2563±90 gr.
There were more low-weight newborns in the group with MX type of
placentation. 2,5 times more children were born in satisfactory condition in
women with MXDA and DXDA twins than in the group with MXMA type of
placentation. Patients with MXMA twins had 3 times more children in a
moderate condition.
Conclusion.
An analysis of the medical history of pregnant women with multiple
pregnancies showed a relationship between the outcome of pregnancy and the
type of placentation. MX pregnancy is a high risk factor for perinatal
complications. This dictates the need for careful monitoring in the antenatal
period, ultrasound monitoring from early pregnancy, which allows for a
personalized approach to the management of pregnancy and childbirth,
contributing to a decrease in perinatal morbidity and mortality.
References:
1.
Esteves-Pereira A.P., da Cunha A.J.L.A., Nakamura-Pereira M., Moreira M.E.,
Domingues R.M.S.M., Viellas E.F., Leal M.D.C., Granado Nogueira da Gama S. Twin
MODELS AND METHODS IN MODERN SCIENCE
International scientific-online conference
89
pregnancy and perinatal outcomes: Data from 'Birth in Brazil Study // PLoS One.
– 2021 – Vol. 11 (Issue 16). – P. 1-13. doi: 10.1371/journal.pone.0245152.
2.
Aviram A., Berger H., Abdulaziz K.E. et al. Outcomes Associated with
Hypertensive Disorders of Pregnancy in Twin Compared with Singleton
Gestations // Obstet. Gynecol. – 2021. – Vol. 138 (Issue 3). – P. 449-458. DOI:
10.1097/AOG. 0000000000004506
3.
D'Antonio F., Prasad S., Masciullo L., Eltaweel N., Khalil A. Selective fetal
growth restriction in dichorionic diamniotic twin pregnancies: systematic
review and meta-analysis of maternal and perinatal outcomes // Ultrasound
Obstet. Gynecol. – 2024. – Vol. 63, №2. – Р. 164-172. DOI: 10.1002/uog.26302.
PMID: 37519089.
4.
Chen Y., Zhou Y., Yang J. et al. Serum hsCRP in early pregnancy and
preterm delivery in twin gestations: a prospective cohort study // BMC Pregn.
Childbirth. – 2013. – Vol. 23, №1. – Р.1-8. https://doi.org/10.1186/s12884-023-
05445-4
5.
Bellizzi S., Sobel H., Betran A.P., Temmerman M. Early neonatal mortality
in twin pregnancy: Findings from 60 low- and middle-income countries // J.
Glob. Health. – 2018. – Vol. 8, №1. – Р.1-14. https://doi.org/10.7189/jogh.08.
010404. PMID: 29423189
