FEATURES OF THE COURSE OF MULTIPLE PREGNANCIES, CHILDBIRTH AND THE STATE OF NEWBORNS IN WOMEN WITH THE ART AND THE USE OF OBSTETRIC UNLOADING PESSARY
DOI:
https://doi.org/10.11603/24116-4944.2021.2.12604Keywords:
multiple pregnancy, unloading obstetric pessary, assisted reproductive technologies, premature childbirth, miscarriageAbstract
The purpose of the study – to explore the anamnestic features, the frequency of obstetric and perinatal complications in women with multiple pregnancy (MP) after the use of assisted reproductive technologies (ART), and evaluate the results after applying the obstetric unloading pessary in order to prevent miscarriage of pregnancy and premature birth.
Materials and Methods. An analysis of 35 women with MP with the use of ART was carried out. Studied anamnestic data, the course of pregnancy and the results of ultrasound of the state of fetuses and cervix. Patients were installed obstetric unloading pessary on the period of pregnancy 16-20 weeks with a prophylactic goal.
Results and Discussion. Through the study of anamnestic data in women with MP after ART, a number of somatic and gynecological pathologies have been established, which could affect the course of pregnancy and the intrauterine state of babies. 13 (37,1 %) of pregnant women were revealed diseases of the urine-separation system, 7 (20 %) – of eyes (myopia), 5 (14,2 %) – of cardiovascular system, 3 (8,5 %) – gastrointestinal disorders, 2 (2,7 %) – diseases of respiratory organs with signs of pulmonary failure. Pathologies that could affect the course of pregnancy: 28 (80 %) patients had placental dysfunction, 18 (51,4 %) – anemia, 12 (34,2 %) – polyhydramnios, 8 (22,8 %) – preeclampsia. According to the cervicometry, ICI (shortening the cervix to <25 mm) is diagnosed of 2 (5,7 %) women. 15 (42,8 %) of patients for the period of gestation were diagnosed by the threat of interrupting pregnancy, 20 (57,1 %) – the threat of premature births. In order to prevent abortion in these patients, an obstetric unloading pessary was installed at the optimal time of 16-20 weeks of pregnancy. All 35 (100 %) surveyed women gave birth during full-term pregnancy (37-39 weeks): in 2 (2,7 %) deliveries were vaginal, in 33 (94,2 %) – planned cesarean section according to indications. In 3 (8,5 %) patients babies with low body weight were born: in one – one newborn due to a violation of the placental complex of the fetus, in the second – one fetus of twins with discordant development, in the third – both newborns with intrauterine growth retardation due to mother’s COVID -19 at 28–29 weeks gestation.
Conclusions. The course of MP after the use of ART constitutes a high risk of developing a number of maternal and perinatal complications. The use of an obstetric unloading pessary allows to prolong pregnancy until the optimal time for delivery and fetal maturity.
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