docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2023-22-1-68-75docru-210Research ArticleОБМЕН ОПЫТОМSHARING EXPERIENCEПеринатальные исходы при дискордантности физического развития монохориальных близнецовPerinatal Outcomes in the Discordance of the Physical Development of Monochorionic Twinshttps://orcid.org/0000-0002-4941-9318ПавличенкоМ. В.PavlichenkoM. V.

Павличенко Мария Васильевна — к. м. н., старший научный сотрудник отделения физиологии и патологии новорожденных и детей раннего возраста, заведующая отделением детской реабилитации

620028, г. Екатеринбург, ул. Репина, д. 1

1 Repina Str., Yekaterinburg, 620028

pavlichenko-mariya@mail.ruhttps://orcid.org/0000-0002-4670-798XКосовцоваН. В.KosovtsovaN. V.

Косовцова Наталья Владимировна — д. м. н., заведующая отделом биофизических и лучевых методов исследований

620028, г. Екатеринбург, ул. Репина, д. 1

1 Repina Str., Yekaterinburg, 620028

kosovcovan@mail.ruhttps://orcid.org/0000-0002-9988-1199ПоспеловаЯ. Ю.PospelovaYa. Yu.

Поспелова Яна Юрьевна — врач ультразвуковой диагностики, аспирант

620028, г. Екатеринбург, ул. Репина, д. 1

1 Repina Str., Yekaterinburg, 620028

jana.pospelova@yandex.ruhttps://orcid.org/0000-0002-4882-8494МарковаТ. В.MarkovaT. V.

Маркова Татьяна Владимировна — к. м. н., ведущий научный сотрудник, врач акушер-гинеколог

620028, г. Екатеринбург, ул. Репина, д. 1

1 Repina Str., Yekaterinburg, 620028

ta.ma.vl@mail.ruФГБУ «Научно-исследовательский институт охраны материнства и младенчества» Министерства здравоохранения Российской ФедерацииРоссияUrals Scientific Research Institute for Maternal and Child CareRussian Federation202318022025221ГИНЕКОЛОГИЯ6875Copyright © Павличенко М.В., Косовцова Н.В., Поспелова Я.Ю., Маркова Т.В., 20252025Павличенко М.В., Косовцова Н.В., Поспелова Я.Ю., Маркова Т.В.Pavlichenko M.V., Kosovtsova N.V., Pospelova Y.Y., Markova T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/210Цель исследования

Цель исследования: сравнение перинатальных исходов в группе дискордантных монохориальных диамниотических близнецов в зависимости от специфических осложнений монохориального многоплодия в антенатальном периоде.

Дизайн

Дизайн: когортное ретроспективное исследование.

Материалы и методы

Материалы и методы. Обследованы 104 пары дискордантных монохориальных диамниотических близнецов: 60 пар с признаками синдрома селективной задержки роста одного из плодов (ССЗРП) и 44 пары, перенесшие синдром фето-фетальной трансфузии (СФФТ) в сочетании с ССЗРП.

Результаты

Результаты. В группе СФФТ + ССЗРП чаще встречались истмико-цервикальная недостаточность (р = 0,004), роды в сроке до 32 недель гестации (ОШ = 4,84; 95% ДИ: 1,78–13,18) и был выше риск крайне тяжелой степени дискордантности (≥ 50%) (р = 0,018): ОШ = 4,12; 95% ДИ: 1,2–14,6. Тяжелая асфиксия зафиксирована чаще у детей, перенесших СФФТ + ССЗРП, — 34 (38,6%) пациента против 26 (21,7%) новорожденных группы ССЗРП: ОШ = 2,36; 95% ДИ: 1,28–4,36, р = 0,006. Определена обратная корреляционная связь между гестационным возрастом и степенью дискордантности в группе ССЗРП.

Заключение

Заключение. Выявлены различия перинатальных исходов у монохориальных диамниотических двоен, дискордантных по массе тела при рождении, в зависимости от вида специфического осложнения внутриутробного развития.

Aim

Aim: To compare perinatal outcomes in the group of monochorionic discordant twins, depending on the complications of the antenatal period.

Design

Design: Cohort retrospective study.

Materials and methods

Materials and methods. 104 pairs of discordant monochorionic twins were examined: 44 pairs with feto-fetal transfusion syndrome (TTTS) and 60 pairs with signs of selective fetal growth retardation (SSFGR).

Results

Results. In the TFFT + CVDGR group, cervical insufficiency was more common (p = 0.004), delivery before 32 weeks of gestation (OR = 4.84; 95% CI: 1.78–13.18) and there was a higher risk of extremely severe discordance (≥ 50%) (p = 0.018): OR = 4.12; 95% CI: 1.2–14.6. Severe asphyxia was recorded more often in children who underwent TTTS — 34 (38.6%) patients versus 26 (21.7%) newborns of the SSFGR group: OR = 2.36; 95% CI: 1.28–4.36, p = 0.006. An inverse correlation was determined between gestational age and the degree of discordance in the SSFGR group.

Conclusion

Conclusion. Differences in perinatal outcomes in monochorionic diamniotic twins with discordant physical development were revealed depending on the type of specific complication of intrauterine development.

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The authors declare that there are no conflicts of interest present.