The dissertation is devoted to increasing the effectiveness of diagnosis,
prediction and prevention of preeclampsia, reducing the frequency and severity of
preeclampsia, perinatal and obstetric complications in women with multiple
pregnancies resulting from assisted reproductive technologies, based on the
improvement and implementation of the algorithm of diagnostic and preventive
measures.
The research was conducted on the basis of the “Leleka” Medical Center and
the clinical base of the Department of Obstetrics and Gynecology No 1 of the
Shupyk National University of Health Care of Ukraine at municipal noncommercial enterprise of Kyiv Regional Council "Kyiv Regional Perinatal Center"
during 2019-2022 and included three stages of implementation.
At the first stage of the study, a retrospective analysis of medical records of
150 histories of pregnancy and childbirth was carried out. All pregnant women
were divided into two groups: Group I – 75 pregnant women with a singleton
pregnancy after AGT; Group II – 75 pregnant women with multiple pregnancies
after assisted reproductive technologies. At the II and III stages of the prospective
study, pregnant women with dichorionic diamniotic twins were involved, in whom
pregnancy occurred by the method of in vitro fertilization using five-day
cryoembryos, and in some cases by the method of ICSI (intracytoplasmic injection
of a single sperm) in the classic version: 35 pregnant women with twins, which
proposed a developed algorithm for monitoring and prevention of PE (III main
group) and 27 pregnant women who were monitored and prevented from
preeclampsia in accordance with the Order of the Ministry of Health of Ukraine
dated 04.08.2015 No. 205 "Procedure for providing medical care to women
with multiple pregnancies (IV – comparison group).
The following tasks were defined to solve the set goal: to conduct
a comparative retrospective analysis of the course of pregnancy and childbirth in
patients with singleton and multiple pregnancies after assisted reproductive
technologies, to identify the most significant risk factors for the development
of preeclampsia; to analyze the peculiarities of the course of pregnancy, childbirth,
the postpartum period and perinatal consequences, to determine the peculiarities
of placentation and the morphological structure of the placenta in pregnant women
with dichorionic diamniotic twins; determine the role of angiogenesis markers
in the prognosis, diagnosis of the occurrence and development of preeclampsia
in women with multiple pregnancies; to develop, implement and evaluate the
effectiveness of a complex of diagnostic and preventive measures aimed at
reducing the frequency and severity of preeclampsia in women with multiple
pregnancies after the use of assisted reproductive technologies.
The results of a retrospective analysis of the course of pregnancy and
childbirth in patients with multiple pregnancies after assisted reproductive
technologies, compared with singleton pregnancies, showed that multiple
pregnancies are a high risk factor for the development of: gestational anemia (76.4
vs 32.4%, p<0.01), preeclampsia (52.7 vs 20.6%, p<0.01), placental dysfunction
(47.3 vs 22.1%, p<0.05), early fetal growth retardation (20,0 vs 8.1%, p<0.01). The
most significant risk factors for the development of preeclampsia in multiple
pregnancies after assisted reproductive technologies are: the presence of primary
infertility, significantly higher frequency of diabetes, hypertension, anemia, thyroid
pathology (p<0.05).
The main complications during childbirth in women with multiple
pregnancies were: premature rupture of the membranes (30.9 vs. 10.3%, p<0.05),
anomalies of labor (16.4 vs. 5.9% p>0.05), fetal distress (29.1 vs. 14.7%, p<.05),
premature placental abruption (3.6% versus the absence of this indicator), which
leads to a high frequency of abdominal delivery (32.7%) and the frequency of
asphyxia in newborns (35,0 vs. 5.9%, p<0.05), fetal growth retardation (27.3 vs.
7.4%, p<0.01), which significantly affected the frequency of early neonatal
morbidity with a predominance in the II group of posthypoxic encephalopathy
(23.6%); implementation of intrauterine infection (12.7%); hemorrhagic syndrome
(9.1%) and hyperbilirubinemia (12.7%).
When determining the role of angiogenesis markers in the prognosis,
diagnosis of the occurrence and development of preeclampsia in women with
multiple pregnancies, and group analysis of observation, the following was noted:
increase of the pro-angiogenic biomarker PlGF up to 28 weeks (III group 604.9
(83.4 – 814.5) vs. 568.6 (68.1 – 765.3) pg/ml); in the period of 26-28 weeks, in the
main group, we noted a decrease in the level of PlGF below 100 pg/ml in
4 (11.4%) women; in 32-34 weeks, the results of PlGF below the level of 100
pg/ml were obtained in 6 (17.1%) women of III group against 7 (25.9%) women
of IV group.
