Senatorova A. Diagnosis and prognosis of cerebral circulation disorders in multiple-birth infants

The work is deals with solutions concerning the improvement in diagnosis of cerebral circulation disorders in multiple-birth newborn dichorial biamniotic twins studying peculiarities of uterine, fetal and cerebral circulation during perinatal period. Features of placental morphology in dichorial biamniotic twins were determined by the assessment of relative volume of vascular bed; condition of placental vascular endothelium; IV type collagen, CD34. Eighty one pregnant women and one hundred and twelve infants were examined. Dynamic assessment of hemodynamics in the cerebral vessels during the early neonatal period installed the difference between the maximum, minimum blood flow, index, resistance, systolo-diastolic ratio of children of single and multiple pregnancy, and depending on the presence or the lack of intrauterine development in the first and on the third day of life, which requires its monitoring in this group of children. Morphological characteristics of placentae with delayed intrauterine fetal development in multiple pregnancies bichorionic limniotisa twins symptoms violated maturation vorsichtige chorion expressed in the face of sclerotic and involutive processes in the bloodstream placenta, stromal-epithelial component, whereas odeplan pregnancy symptoms pronounced sclerosis and fbrinogen necrosis in all functional areas of the placenta, increased accumulation of type IV collagen in the basal membrane vessels, sharply reduced ability to the expression of endothelial cells receptors to CD34 that is indicative of violation of adherent cells. Prognostic predictors of cerebral hemodynamics disorders in multiple-birth infants in early neonatal period are as follows: medial cerebral artery resistance index, minimal blood flow rate in medial cerebral artery, anterior cerebral artery resistance index, maximal blood flow rate in basal cerebral artery, intrauterine growth retardation, increased amniotic index (R=0.90; R2=0.82; Wald =8.865, р=0.003). Medial cerebral artery resistance index value < 0.6, minimal blood flow rate in medial cerebral artery < 6 cm/s, maximal blood flow rate in medial cerebral artery <12 cm/s, anterior cerebral artery resistance index <0.55, maximal blood flow rate in basal cerebral artery <27 cm/s and intrauterine growth retardation can be considered prognostic criteria for cerebral hemodynamics disorders in multiple-birth dichorial biamniotic twins in early neonatal period.