Abstract
Over the past few decades, the rate of multiple pregnancy has risen. This is due to the widespread use of assisted reproductive technologies (ART), as well as the increasing maternal age at pregnancy planning and the extensive use of oral contraceptives, after the withdrawal of which spontaneous maturation of two or more follicles can occur. Multiple pregnancy is associated with a higher risk of perinatal and maternal mortality and morbidity compared to singleton pregnancy, which may also have psychosocial and socioeconomic consequences for women and their families. Unlike dichorionic twin pregnancy, monochorionic twin pregnancy has specific complications due to shared maternal and fetal vascular connections. Based on this, updated strategies for the management of pregnancy and labor in women with multiple pregnancy are being developed to improve perinatal outcomes and correct specific complications of multiple pregnancy. Objective. To conduct a literature review on current approaches to the management of multiple pregnancy to optimize medical care for pregnant women with multiple pregnancy. Materials and methods. Literature data published between 2018 and 2023 in Medline, Scopus, Web of Science, PubMed, Willey, and Cochrane Library databases were analyzed. The search was performed using the following key words: multiple pregnancy, in vitro fertilization, twins, monochorionic twin pregnancy, selective reduction. Results. Multiple pregnancy is associated with a higher risk of maternal complications, preterm birth and disability. The risks of multiple pregnancy for both mother and fetus should be discussed based on the individualized and balanced medical approach, including the options of conservative treatment or reduction of one or more fetuses, and the risks and benefits of both choices. The techniques used to correct specific complications of multiple pregnancy depend on chorionicity, skill level, and equipment availability in the clinical setting. Conclusion. Different strategies and recommendations for the management of multiple pregnancy can optimize pregnancy outcomes. Further research may help to determine optimal recommendations for the management of multiple pregnancy, as well as identify additional factors that may influence pregnancy outcomes. Key words: multiple pregnancy, in vitro fertilization (IVF), twins, monochorionic twin pregnancy, selective reduction
Published Version
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