Gestational complications and characteristics of the morphofunctional structure of the placental complex in women with multiple pregnancies

Currently, the incidence of multiple pregnancies is 0.7–1.5%, and there is an increasing trend. This tendency is associated with assisted reproductive technologies. Aim. To study the frequency of gestational complications and the morphostructural characteristics of the placental complex in monozygotic and dizygotic twins. Materials and methods. The pregnancy and delivery outcomes were analyzed in 283 mothers with multiple pregnancies (at a gestation period of 34 weeks or more). In this study, 151 women were diagnosed with monozygotic twin pregnancies and 132 women were diagnosed with dizygotic twin pregnancies. The comparison group consisted of 214 mothers who had delivered a single child. The study’s results were analyzed using descriptive and analytical statistics. Results. Specific complications of the gestational period and delivery, which prevailed in cases of multiple pregnancies compared to singleton pregnancies, were oligohydramnios (p<0.001), uterine scar (pp<0.001), twin-to-twin transfusion syndrome (p<0.05), hypotonic bleeding (p<0.001), manual removal of placenta (p<0.001), and manual examination of the uterine cavity (p<0.001). The frequency of cesarean sections was higher in cases of multiple pregnancies, regardless of whether they were monozygotic (p<0.001) or dizygotic (p<0.001). The study of the morphological characteristics of the placental complex revealed that a higher incidence of abnormal umbilical cord attachment was associated with monozygotic twins (p<0.001), compared to dizygotic twins, while the central variant of umbilical cord attachment prevailed in singleton pregnancies (p<0.001). In addition, compared to dizygotic twins and singleton pregnancies, monozygotic twin pregnancies showed a statistically significant presence of fetal membrane edema (p<0.01), placentitis (p<0.01, p<0.01), focal placental necrosis (p<0.001), fibrin deposition (p<0.001; p<0.001), and placental abruption (p<0.05; p<0.01). Сonclusion. The morphological characteristics of the placental complex can act as a kind of "calling card" providing valuable information about the conditions in which a fetus developed and helping to predict the risk of potential complications in the neonatal period.