OPTIMIZATION OF TACTICS OF MANAGEMENT OF MULTIPLE PREGNANCY AND LABOR

Abstract

A thorough analysis of the course of labor and perinatal outcomes was conducted in pregnant twins. It is proved that multiple pregnancy is a factor of high risk of perinatal complications. The features of the process of neonatal adaptation in twins are studied depending on the tactics of delivery. Goal: to improve perinatal outcomes in women with multiple pregnancies by optimizing the management of pregnancy.Material and methods. Examined 68 pregnant women with twins after IVF, who made up the I group of subjects, 62 pregnant women with spontaneous twins - group II, and 38 women with self-singleton pregnancy who entered the control group. Pregnant Groups I and II, depending on the treatment prescribed, were divided into two subgroups: IА (36 pregnant women) and IIA (32 pregnant women) received a standard amount of treatment and prophylactic measures. Subgroups IB (32 pregnant women) and IIB (30 pregnant women) received natural micronized progesterone (200 mg 3 times a day) in addition to standard treatment and prophylactic measures. All pregnant women underwent a complete clinical and laboratory examination using ultrasound, Doppler, and cardiotocography (CTG), and a biophysical profile of the fetus. The analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups were carried out. In the neonatal period, neurosonography was performed, a part of the newborns were followed by psychomotor development in the first six months of life. The obtained results were statistically processed using standard packages of applied statistical analysis (Statistic 6.0 for Windows, Statgraphics v. 7.0).Results. The results of pregnancy analysis in patients with IVF revealed a number of serious complications during pregnancy and childbirth: the threat of premature birth (66.2%), placental dysfunction (48.5%), iron deficiency anemia (51.5%), preeclampsia (52, 9%), premature rupture of amniotic membranes (17.6%), weakness of labor (27.9%), and a high incidence of operative delivery (30.9%). Against the backdrop of hormonal support, a decrease in the frequency of very early premature births in the first group was 1.6 times, early premature births by 1.5 times and an increase in the frequency of late premature births by 1.4 times, which is a favorable prognostic factor for reducing perinatal losses. Among the main methods of delivery, mention should be made of the high rate of cesarean section in the I A subgroup (55.6%) and the IIA subgroup (46.9%), each of which was significantly higher than the control group (10.5%) ( p <0.05). Almost with the same frequency cesarean section was observed in women with independent multiplicity. Premature and deep morphofunctional immaturity were inherent in children from premature births, which significantly influenced the Apgar score, which was lower in the first group than in group II and control group (p <0.05).Conclusions. A differentiated approach to the preparation and management of labor, careful observation of patients and dynamic monitoring of the fetus state allows to reduce the frequency of postnatal complications, contributing to the reduction of perinatal morbidity and mortality.