Tijek i ishod blizanačkih trudnoća u Kliničkom bolničkom centru Zagreb

OBJECTIVE: The aim of this retrospective study was to compare the perinatal and neonatal outcome of monochorionic versus dichorionic twins delivered in the year 2019 and 2020 at the University Hospital Centre (UHC) Zagreb. ----- METHODS: This was a retrospective study of 212 twin pregnancies delivered at a tertiary center between 1st of January 2019 and 31st of December 2020. According to chorionicity, pregnancies were classified into three groups: dichorionic-diamniotic (DCDA), monochorionic-diamniotic (MCDA) and monochorionic-monoamniotic (MCMA). The perinatal and neonatal outcome were determined by analyzing maternal diseases, foetal and neonatal complications between the three groups. ----- RESULTS: The study included 165 (77.9%) DCDA, 45 (21.2%) MCDA and 2 (0.9%) MCMA twins that were delivered in the UHC Zagreb in a 2-year period. The MCDA group showed a significantly higher incidence of adverse foetal and neonatal outcome in comparison with DC twins (p=0.0252, p=0.0104), however no differences in incidence of adverse outcomes were found between MCDA and DC twins and maternal diseases such as gestational diabetes, gestational hypertension and preeclampsia. Mothers of DC twins conceived more often through assisted reproductive technology compared to mothers of MC twins (58.8% vs 8.9%, p<0.0001). Preterm delivery occured in almost 61% of all twin pregnancies and the number of extremely preterm deliveries (22 – 28 weeks) was significantly higher in MC compared to DC twins (p=0.0032). Among the 3 groups, there were no difference in pPROM. Caesarean section occurred in 75.8% of DC vs. 61.7% of MC twin pregnancies. Furthermore, MCDA group was more commonly delivered by emergent CS compared to DC group (69% vs. 42.4%). Analysing foetal complications, MCDA twins had a significantly higher number of growth discordance in comparison to DC twins (24.4% vs. 7.9%, p=0.0316). Significant differences were also detected in the birth weight of the 1st (p<0.0001) and the 2nd twin (p=0.0018) and in the Apgar scores in the 1st and 5th minute (1st minute: p=0.0009, p=0.0019; 5th minute: p=0.0002, p=0.0003). According to complications specific for MC pregnancies, TTTS and TAPS occurred in 6.4% and 8.5% of MC twins respectively. MCDA twins had a significantly higher number of complications of prematurity compared to DC twins (p=0.0108). ----- CONCLUSION: The incidence of adverse perinatal and neonatal outcome in MC twins is significantly higher compared to DC twin pregnancies, while the incidence of maternal complications in the two groups was not significantly different. The results of this study support the current knowledge about twin pregnancies and further emphasize the importance of regular antenatal care for twin pregnancies with special emphasis on MC pregnancies.CILJ: Cilj ove retrospektivne studije je usporediti perinatalni i neonatalni ishod jednojajčanih u odnosu na dvojajčane blizance porođene u Kliničkom bolničkom centru Zagreb u 2019. i 2020. godini. ----- METODE: Retrospektivno istraživanje uključilo je 212 blizanačkih trudnoća porođenih u tercijarnom centru u periodu od 01. siječnja 2019. do 31. prosinca 2021. U odnosu na korionicitet blizanaca, ispitanice su podjeljene u tri skupine: bikorijati-biamnijati (BCBA), monokorijatibiamnijati (MCBA) i monokorijati-monoamnijati (MCMA). Perinatalni i neonatalni ishod određivani su analizom razvoja maternalne patologije u trudnoći, i analizom fetalnih i neonatalnih komplikacija između tri skupine. ----- REZULTATI: Istraživanjem je obuhvaćeno 165 (77,9%) BCBA, 45 (21,2%) MCBA blizanaca i 2 (0,9%) MCMA blizanaca koji su rođeni u KBC Zagreb u periodu od dvije godine. MCBA skupina je imala značajno veću učestalost fetalnih komplikacija i nepovoljnih neonatalnih ishoda u usporedbi s BC blizancima (p=0,0252, p=0,0104), međutim nije bilo statistički značajnih razlika između bolesti majki MCBA i BC blizanaca poput gestacijskog dijabetesa, gestacijske hipertenzije i preeklampsije. Majke dvojajčanih blizanaca su češće začele pomoću medicinske potpomognute oplodnje u usporedbi s majkama jednojajčanih blizanaca (58,8% nasuprot 8.9%, p <0,0001). Prijevremeni porodi dogodili su se u gotovo 61% svih blizanačkih trudnoća, a broj izrazito prijevremenih poroda (22 – 28 tjedna) bio je značajno veći kod MC u usporedbi s BC blizancima (p=0,0032). Među 3 skupine nije bilo razlike u prijevremenom prsnuću plodovih ovoja. Carskim rezom je rođeno 75.8% BC nasuprot 61.7% MC blizanačkih trudnoća. Nadalje, MCBA blizanci su češće porođeni hitnim carskim rezom u usporedbi s BC blizancima (69,0% nasuprot 42.4%). Analizirajući fetalne komplikacije, MCBA blizanci su imali značajno veći broj diskordantnog rasta u usporedbi s BC blizancima (24,4% nasuprot 7,9%, p=0,0316*). Također su pronađene značajne razlike u porođajnoj težini prvog (p