Tkachenko A. Prevention of perinatal losses and obstetric complications during twin pregnancy.

The dissertation is devoted to reducing the frequency of obstetric and perinatal complications in twin pregnancy by developing and implementing a scientifically sound medical and organizational algorithm for pregnancy and childbirth management and a differentiated set of prognostic, treatment-and-prophylactic measures based on the study of clinical features of gestation and adaptive mechanisms of the mother and fetus. The analysis of clinical and statistical aspects of multiple births showed that in Ukraine over the past 20 years there has been an increase in the proportion of multiple pregnancies and births by more than 1.4%. The rate of multiple births since 2000 has grown exponentially, amounting to 28% for the period 2000-2010, and almost 40% from 2010 to 2018, which occurred against the background of negative trends in the female population of reproductive age by 6% and reduction in the birth rate by almost a quarter over the past 5 years. Over the last 20 years in the Kyiv Regional Center for Maternal and Child Health Care there has been an increase in the frequency of multiple births by 7 times (from 1.2% in 2001 to 8.66% in 2017), and in the Kyiv City Center for Reproductive and Perinatal Medicine the frequency of multiple births over 10 years - from 0.48% to 1.89%.The evaluation of the diagnostic significance of ultrasound indicators has shown that complications of multiple pregnancy develop on the basis of hemodynamic disorders in the fetoplacental system, the severity of which can be assessed by a dynamic analysis of fetometric parameters and changes in blood flow in the uterine arteries, umbilical and main vessels of the fetus.