Course and outcome of twin pregnancies at the Department of obstetrics and gynecology in Clinical hospital "Sv. Duh"

Tijek i ishod blizanačkih trudnoća razlikuje se od jednoplodnih trudnoća po prosječnom trajanju trudnoće i učestalosti nekih komplikacija trudnoće, načinu i komplikacijama porođaja te učestalosti lošijih neonatalnih ishoda. Osim toga, blizanačke trudnoće izložene su i određenim specifičnim rizicima, poput razvoja međublizanačkog transfuzijskog sindroma. Ovo retrospektivno istraživanje provedeno je u KB „Sveti Duh“ u razdoblju od 1. siječnja 2014. do 31. prosinca 2016. godine. Istraživanjem su obuhvaćene 172 rodilje koje su rodile blizance te 360 rodilja koje su nasumično odabrane za kontrolnu skupinu. Provedena je analiza dobi i pariteta trudnice, učestalosti bolesti i stanja vezanih za aktualnu trudnoću, zahvata u trudnoći te metoda izvantjelesne oplodnje (IVF). Evidentirani su i korionicitet, trajanje trudnoće, poremećaji rasta i razvoja plodova, perinatalna smrt, način porođaja te učestalost intrapartalnih i postpartalnih komplikacija. Osim navedenog, zabilježeni su i neonatalni ishodi te učestalost loših neonatalnih ishoda. Usporedbom trudnoća istraživane i kontrolne skupine, ustanovljeno je da rodilje u blizanačkim trudnoćama češće razvijaju anemiju i preeklampsiju, trudnoće su višestruko češće začete IVF-om, značajno je kraće trajanje trudnoće te imaju veću učestalost fetalnog zastoja rasta i perinatalne smrti. Blizanci se uglavnom rađaju elektivnim carskim rezom, a ukoliko se rađaju vaginalnim putem, imaju manju učestalost epiziotomija. Nadalje, u porođaju imaju veću učestalost anomalija stava i položaja, a češće su i postpartalne komplikacije. Neonatalni su ishodi blizanaca lošiji, odnosno rađaju se manjih porođajnih težina i duljina te češće imaju Apgar skor manji ili jednaki 7. Usporedbom monokorionskih i bikorionskih trudnoća, ustanovljena je veća učestalost fetalnog zastoja rasta, diskordantnog rasta te vrlo ranih prijevremenih porođaja i fetalne hipoksije kod monokorionskih trudnoća i porođaja. Osim toga, monokorijati se češće rađaju manjih porođajnih težina i duljina te Apgar skorova ≤7.The course and outcome of twin pregnancies differ from that of singleton pregnancies by the average duration of the pregnancy and the prevalence of some complications during pregnancies, the route of delivery and associated complications, as well as by prevalence of poor neonatal outcomes. Besides, twin pregnancies are subject to certain specific risks, such as twin to twin transfusion syndrome. This retrospective study was conducted at the Clinical Hospital “Sveti Duh” from January 1, 2014 to December 31, 2016. The study involved 172 women who gave birth to twins and 360 women who gave birth to singletons, and were randomly selected into the control group. An analysis was performed of age and parity, incidence of diseases and specific conditions regarding the current pregnancy, procedures during pregnancy and in vitro fertilisation (IVF). Chorionicity, duration of gestation, abnormalities in fetal growth and development, perinatal death, and route of delivery were evaluated, as well as the prevalence of labour-related and postpartal complications. Neonatal outcomes and prevalence of poor neonatal outcomes were analysed as well. The comparison of twin and singleton pregnancies revealed a higher prevalence of anaemia and preeclampsia in twin pregnancies. Besides, they were more often conceived using IVF and had a significantly shorter duration of gestation, as well as a higher incidence of fetal growth retardation and perinatal death. Twins were mostly delivered by elective C-section; in case they were delivered vaginally, the incidence of episiotomy was lower. Furthermore, twins had a higher incidence of anomalous fetal presentation and lie, as well as of postpartum complications. Neonatal outcomes of twins were poorer, i.e. they had lower birth weight and birth length, and more often had an Apgar score of ≤7. The comparison of monochorionic and dichorionic pregnancies showed a greater incidence of foetal growth restriction, discordant growth, very preterm birth, and foetal hypoxia in monochorionic twins. Besides, they had lower birth weight and birth lenght, and a greater incidence of Apgar scores lower than or equal to 7