docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2022-21-5-43-46docru-278Research ArticleАКУШЕРСТВО И ПЕРИНАТОЛОГИЯOBSTETRICS AND PERINATOLOGYОпыт применения лазерной коагуляции плацентарных анастомозов при синдроме селективной задержки роста плодаExperience in Laser Coagulation of Placentary Anastomoses in Selective Foetal Growth Retardationhttps://orcid.org/0000-0002-4670-798XКосовцоваН. В.KosovtsovaN. V.

Косовцова Наталья Владимировна — д. м. н., руководитель отдела биофизических методов исследования, врач высшей категории

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

1 Repin St., Yekaterinburg, 620028

kosovcovan@mail.ruhttps://orcid.org/0000-0002-4882-8494МарковаТ. В.MarkovaT. V.

Маркова Татьяна Владимировна — к. м. н., старший научный сотрудник

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

1 Repin St., Yekaterinburg, 620028

ta.ma.vl@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 Repin St., Yekaterinburg, 620028

jana.pospelova@yandex.ruhttps://orcid.org/0000-0002-6496-5675ЮминоваА. В.YuminovaA. V.

Юминова Алиса Владимировна — врач-ординатор по специальности «акушерство и гинекология»

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

1 Repin St., Yekaterinburg, 620028

alisa_yuminova@mail.ruАйтовА. Э.AytovA. E.

Айтов Айтбек Эсенбекович — к. м. н., научный сотрудник

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

1 Repin St., Yekaterinburg, 620028

tlsbadb@mail.ruФГБУ «Уральский научно-исследовательский институт охраны материнства и младенчества» Министерства здравоохранения Российской ФедерацииРоссияUral Research Institute for Mother and Infant Welfare (a Federal Government-funded Institution), Russian Federation Ministry of HealthRussian Federation202219022025215ГИНЕКОЛОГИЯ4346Copyright © Косовцова Н.В., Маркова Т.В., Поспелова Я.Ю., Юминова А.В., Айтов А.Э., 20252025Косовцова Н.В., Маркова Т.В., Поспелова Я.Ю., Юминова А.В., Айтов А.Э.Kosovtsova N.V., Markova T.V., Pospelova Y.Y., Yuminova A.V., Aytov A.E.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/278

Цель статьи: описать течение и исход беременности монохориальной диамниотической двойней с выраженной селективной задержкой роста плода (ССЗРП) после проведения лазерной коагуляции плацентарных анастомозов.Основные положения. Лазерная коагуляция плацентарных анастомозов под контролем фетоскопии, проведенная в сроке гестации 21–22 недели, позволила пролонгировать беременность до доношенного срока, минуя риск внутриутробной гибели обоих плодов, преждевременных родов, неврологических осложнений у бо́льшего плода.Заключение. При ССЗРП с типом кровотока в артерии пуповины II или III (E. Grtacо́s) возможно применение коагуляции плацентарных анастомозов или коагуляции сосудов пуповины меньшего плода. Необходимы дальнейшие исследования с едиными критериями диагностики, анализом исходов, разработка тактики ведения беременности.

Objective of the Paper: To describe the course and outcome of a pregnancy with monochorionic-diamniotic twins with marked selective foetal growth retardation (sFGR) after laser coagulation of placentary anastomoses.Key points. Fetoscopy-guided laser coagulation of placentary anastomoses at week 21–22 of gestation made it possible to prolong the pregnancy to the term and eliminate the risks of intrauterine foetal death, preterm delivery, and neurological complications in a larger foetus.Conclusion. In sFGR with umbilical artery blood flow type II or III (E. Grtacós), it is possible to use placentary anastomosis or umbilical vessels coagulation in a smaller foetus. Further studies are needed with unified diagnostic criteria and outcome analysis; and pregnancy management approach needs to be developed.

синдром фето-фетальной трансфузиилазерная коагуляция плацентарных анастомозовсиндром селективной задержки роста плодаtwin-to-twin transfusion syndromelaser coagulation of placentary anastomosesselective foetal growth retardationReferencesMonaghan C., Kalafat E., Binder J., Thilaganathan B. et al. Prediction of adverse pregnancy outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction. Ultrasound Obstet. Gynecol. 2019; 53(2): 200–7. DOI: 10.1002/uog.19078Monaghan C., Kalafat E., Binder J., Thilaganathan B. et al. Prediction of adverse pregnancy outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction. Ultrasound Obstet. Gynecol. 2019; 53(2): 200–7. DOI: 10.1002/uog.19078Van Winden K.R., Quintero R.A., Kontopoulos E.V., Korst L.M. et al. Decreased total placental mass found in twin-twin transfusion syndrome gestations with selective growth restriction. Fetal Diagn. Ther. 2016; 40(2): 116–22. DOI: 10.1159/000442153Van Winden K.R., Quintero R.A., Kontopoulos E.V., Korst L.M. et al. Decreased total placental mass found in twin-twin transfusion syndrome gestations with selective growth restriction. Fetal Diagn. Ther. 2016; 40(2): 116–22. DOI: 10.1159/000442153Kalafat E., Thilaganathan B., Papageorghiou A., Bhide A. et al. Significance of placental cord insertion site in twin pregnancy. Ultrasound Obstet. Gynecol. 2018; 52(3): 378–84. DOI: 10.1002/uog.18914Kalafat E., Thilaganathan B., Papageorghiou A., Bhide A. et al. Significance of placental cord insertion site in twin pregnancy. Ultrasound Obstet. Gynecol. 2018; 52(3): 378–84. DOI: 10.1002/uog.18914Khalil A., Beune I., Hecher K., Wynia K. et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure. Ultrasound Obstet. Gynecol. 2019; 53(1): 47–54. DOI: 10.1002/uog.19013Khalil A., Beune I., Hecher K., Wynia K. et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure. Ultrasound Obstet. Gynecol. 2019; 53(1): 47–54. DOI: 10.1002/uog.19013Gratacós E., Lewi L., Muñoz B., Acosta-Rojas R. et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet. Gynecol. 2007; 30(1): 28–34. DOI: 10.1002/uog.4046Gratacós E., Lewi L., Muñoz B., Acosta-Rojas R. et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet. Gynecol. 2007; 30(1): 28–34. DOI: 10.1002/uog.4046Buca D., Pagani G., Rizzo G., Familiari A. et al. Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2017; 50(5): 559–68. DOI: 10.1002/uog.17362Buca D., Pagani G., Rizzo G., Familiari A. et al. Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2017; 50(5): 559–68. DOI: 10.1002/uog.17362Mackie F.L., Rigby A., Morris R.K., Kilby M.D. Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta-analysis. BJOG. 2019; 126(5): 569–78. DOI: 10.1111/1471-0528.15530Mackie F.L., Rigby A., Morris R.K., Kilby M.D. Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta-analysis. BJOG. 2019; 126(5): 569–78. DOI: 10.1111/1471-0528.15530Ishii K., Nakata M., Wada S., Murakoshi T. et al. Feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios. J. Obstet. Gynaecol. Res. 2015; 41(11): 1732–7. DOI: 10.1111/jog.12827Ishii K., Nakata M., Wada S., Murakoshi T. et al. Feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios. J. Obstet. Gynaecol. Res. 2015; 41(11): 1732–7. DOI: 10.1111/jog.12827Quintero R.A., Bornick P.W., Morales W.J., Allen M.H. Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation. Am. J. Obstet. Gynecol. 2001; 185(3): 689–96. DOI: 10.1067/mob.2001.116724Quintero R.A., Bornick P.W., Morales W.J., Allen M.H. Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation. Am. J. Obstet. Gynecol. 2001; 185(3): 689–96. DOI: 10.1067/mob.2001.116724Peeva G., Bower S., Orosz L., Chaveeva P. et al. Endoscopic placental laser coagulation in monochorionic diamniotic twins with type II selective fetal growth restriction. Fetal Diagn. Ther. 2015; 38(2): 86–93. DOI: 10.1159/000374109Peeva G., Bower S., Orosz L., Chaveeva P. et al. Endoscopic placental laser coagulation in monochorionic diamniotic twins with type II selective fetal growth restriction. Fetal Diagn. Ther. 2015; 38(2): 86–93. DOI: 10.1159/000374109Ishii K., Wada S., Takano M., Nakata M. et al. Survival rate without brain abnormalities on postnatal ultrasonography among monochorionic twins after fetoscopic laser photocoagulation for selective intrauterine growth restriction with concomitant oligohydramnios. Fetal Diagn. Ther. 2019; 45(1): 21–7. DOI: 10.1159/000486130Ishii K., Wada S., Takano M., Nakata M. et al. Survival rate without brain abnormalities on postnatal ultrasonography among monochorionic twins after fetoscopic laser photocoagulation for selective intrauterine growth restriction with concomitant oligohydramnios. Fetal Diagn. Ther. 2019; 45(1): 21–7. DOI: 10.1159/000486130Miyadahira M.Y., Brizot M.L., Carvalho M.H.B., Biancolin S.E. et al. Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels. Clinics (Sao Paulo). 2018; 73: e210. DOI: 10.6061/clinics/2018/e210Miyadahira M.Y., Brizot M.L., Carvalho M.H.B., Biancolin S.E. et al. Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels. Clinics (Sao Paulo). 2018; 73: e210. DOI: 10.6061/clinics/2018/e210Косовцова Н.В., Башмакова Н.В., Маркова Т.В., Потапов Н.Н. Селективный фетоцид при осложненном течении беременности монохориальной двойней или дихориальной тройней с использованием лазерной коагуляции сосудов пуповины. Российский вестник акушера-гинеколога. 2016; 1: 45–50. DOI: 10.17116/rosakush201616145-50Kosovtsova N.V., Bashmakova N.V., Markova T.V., Potapov N.N. Selective feticide in complicated monochorionic twin or dichorionic triplet pregnancies applying laser coagulation of umbilical cord vessels. Russian Bulletin of Obstetrician-Gynecologist. 2016; 1: 45–50. (in Russian) DOI: 10.17116/rosakush201616145-50Townsend R., D'Antonio F., Sileo F.G., Kumbay H. et al. Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2019; 53(1): 36–46. DOI: 10.1002/uog.20114Townsend R., D'Antonio F., Sileo F.G., Kumbay H. et al. Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2019; 53(1): 36–46. DOI: 10.1002/uog.20114

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