CLINICAL AND PATHOGENETIC CAUSES OF DEVELOPING THE COMPLICATIONS DURING MULTIPLE PREGNANCIES
DOI:
https://doi.org/10.11603/24116-4944.2019.2.10805Keywords:
multiple pregnancy, miscarriage, preterm labor, feto placental dysfunction, placental growth factor, pre-eclampsiaAbstract
The aim of the study – to investigate the effect of the placental growth factors on gestational process during multiple pregnancies.
Materials and Methods. A prospective study of maternity pregnancy in 320 females with multiple pregnancies was conducted, which comprised the main group of the subjects and 40 healthy women with unipolar pregnancy. The level of PlGF in serum was determined by solid phase enzyme analysis using monoclonal antibody sets in the first trimester of pregnancy. Indicators of the hemostasis system (vascular thrombocyte and coagulation link) were evaluated according to generally accepted methods. Dopplerometry of placental and fetal blood flow was performed in uterine arteries, arteries and umbilical cord veins, middle cerebral artery of the fetus.
Results and Discussion. Women with multiple pregnancies are at the risk of gestational complications – premature births in 67.8 % (p <0.01), fetoplacental dysfunction, pre-eclampsia – in 17.5 % (p <0.05) cases. The revealed violations of the vascular thrombocyte and coagulation homeostasis in the first trimester of pregnancy are the main risk factors for early premature abortion. It has been shown that the low level of placental growth factor in serum of pregnant women with multiple pregnancies in the case of premature labor, fetoplacental dysfunction and pre-eclampsia (111.23±8.4), (203.24±6.4) and (305.86±7.4) pg/ml) compared with the corresponding indicators for single-pregnancy (418.2±10.4) pg/ml) is a prognostic marker for the development of gestational complications.
Conclusions. Timely medical correction of gestational complications during multiple pregnancies with the use of micronized progesterone, low molecular weight heparins, angio protectants allowed prolonging the pregnancy with mono choric type of placentation by 3.2 weeks (up to (34.2±2.4) weeks), and in the case of dichorial twins – to full-term pregnancy.
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